› Forums › General Melanoma Community › newly diagnosed, why general anesthesia for (second) wide excision?
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Surf Rower.
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- October 13, 2016 at 8:31 pm
Hello all, glad to have found this forum. Please forgive me for not yet knowing the right terms… I promise to study, but my second surgery is coming up soon and maybe someone has feedback for me on my questions. Two weeks ago I had very shallow 0.2mm melanoma removed from outside upper arm, in a wide excision, by a plastic surgeon I was referred to by my dermatologist. Good job 30 mins local anesthesia, not much pain, minimal scar visible on upper arm. Unfortunately the pathology on the excision indicated one lateral edge still has melanoma, so now there has to be a second, larger excision. I switched to a renowned cancer center in my region. The surgical oncologist there says the first surgeon didn't orient the sample so they don't know what side the residual cells are on (!!!!). It could even be a separate melanoma, so tiny it wasn't seen. In any case, he says he has to remove the entire scar area from the surgery two weeks ago, so it doesn't really matter and it will be pretty big. "Puckered" "divot" and "shark bite" were the not-reassuring words. Of course I am super happy this is only a Stage 1A; being high risk for this at age 62 with a life of sun, when I heard they had not gotten it all I had been very worried and working on my bucket list (more train travel). Here is my actual question, though any feedback on this situation is welcome. – Does it sound like they need to use general anesthesia for this? He drew on my arm and the excision will be football shaped and about 2.5" long. He said they would have to pull on the skin a lot so they were going to use a "light" general. I don't mind the anesthesia, but it suggests that the surgery is kind of a big deal. The first one was so easy and the stitches were internal; these will be external. Thoughts? Have any of you chosen a plastic surgeon over a surgical oncologist for this size excision? I like both of the doctors. It seems better to be treated at a cancer center, regardless of the cosmetics afterwards, right? Maybe they make it sound worse than it usually is so we are happy with the scar later. At least it is in a good spot for a tattoo.
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- October 13, 2016 at 10:26 pm
Sounds like you are in the right direction. I have a number of melenoma procedures. It's very important to dig out any possible Mel's. They come back in a bad way if you don't get them now. Go for the full procedure and it will be very tight when they close it up. I had lymph nodes removed by the onc surgeon and the reconstruction done by the plastic surgeon. They worked as a team and the results have been good. Get the bad guys out should be your first concern. Then jump on the next train. Chris.
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- October 13, 2016 at 10:26 pm
Sounds like you are in the right direction. I have a number of melenoma procedures. It's very important to dig out any possible Mel's. They come back in a bad way if you don't get them now. Go for the full procedure and it will be very tight when they close it up. I had lymph nodes removed by the onc surgeon and the reconstruction done by the plastic surgeon. They worked as a team and the results have been good. Get the bad guys out should be your first concern. Then jump on the next train. Chris.
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- October 14, 2016 at 4:10 pm
Thanks Chris, does it seem like there should be a plastic surgeon on the team for a 2.5" excision on the upper outer arm? Overkill? I'm preparing questions to ask the onc surgeon. He has the smallest most delicate hands I've ever seen on a man, probably good for a surgeon.
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- October 14, 2016 at 4:10 pm
Thanks Chris, does it seem like there should be a plastic surgeon on the team for a 2.5" excision on the upper outer arm? Overkill? I'm preparing questions to ask the onc surgeon. He has the smallest most delicate hands I've ever seen on a man, probably good for a surgeon.
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- October 14, 2016 at 4:10 pm
Thanks Chris, does it seem like there should be a plastic surgeon on the team for a 2.5" excision on the upper outer arm? Overkill? I'm preparing questions to ask the onc surgeon. He has the smallest most delicate hands I've ever seen on a man, probably good for a surgeon.
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- October 13, 2016 at 10:26 pm
Sounds like you are in the right direction. I have a number of melenoma procedures. It's very important to dig out any possible Mel's. They come back in a bad way if you don't get them now. Go for the full procedure and it will be very tight when they close it up. I had lymph nodes removed by the onc surgeon and the reconstruction done by the plastic surgeon. They worked as a team and the results have been good. Get the bad guys out should be your first concern. Then jump on the next train. Chris.
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- October 13, 2016 at 11:24 pm
I’ve had at least 8 WLEs for melanoma and atypical lesions and my deepest melanoma was a significant surgery on my shoulder blade. Shaped like >—< to get edges to fit together. I've never had twilight or general for any of them and would question that. I see no reason to pay for an operating room theater when outpatient will also work. I don't like anesthesia and would question this but it had never been offered to me for just a ALE. If your lesion was lentigo maligna, continue watching the scar area for any pigment regrowth. That type is often found in Sun exposed areas but has a higher tendency to recur locally. -
- October 13, 2016 at 11:24 pm
I’ve had at least 8 WLEs for melanoma and atypical lesions and my deepest melanoma was a significant surgery on my shoulder blade. Shaped like >—< to get edges to fit together. I've never had twilight or general for any of them and would question that. I see no reason to pay for an operating room theater when outpatient will also work. I don't like anesthesia and would question this but it had never been offered to me for just a ALE. If your lesion was lentigo maligna, continue watching the scar area for any pigment regrowth. That type is often found in Sun exposed areas but has a higher tendency to recur locally. -
- October 13, 2016 at 11:24 pm
I’ve had at least 8 WLEs for melanoma and atypical lesions and my deepest melanoma was a significant surgery on my shoulder blade. Shaped like >—< to get edges to fit together. I've never had twilight or general for any of them and would question that. I see no reason to pay for an operating room theater when outpatient will also work. I don't like anesthesia and would question this but it had never been offered to me for just a ALE. If your lesion was lentigo maligna, continue watching the scar area for any pigment regrowth. That type is often found in Sun exposed areas but has a higher tendency to recur locally. -
- October 14, 2016 at 9:37 am
So did you first have a biopsy of some kind (excision, punch, shave), then got the diagnosis, then had a wide-level excision, and now have to have an 'even wider' wide level excision? If so, I think the issue is that whoever did your first WLE was just not conservative enough. He should have taken 1cm from all around the lesion, which would have left you with a 2.5" scar right from the get go. I don't think there is any way that a surgeon could take the recommended 1cm margin in every direction, and leave you only with a minimal scar. A standard stage 1a excision would be about 10 stitches and 7cm long. Not orienting the specimen is also pretty amateur, I would have thought this was surgery 101… I am glad to hear you have changed doctors because I think this guy hasn't been particularly competent. Anyway, I don't think 'light general' anaesthetic would be required. I have a 2.5" football-shaped scar on my upper arm and this was done under local anaesthetic, I can't see why yours is any different.
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- October 14, 2016 at 9:37 am
So did you first have a biopsy of some kind (excision, punch, shave), then got the diagnosis, then had a wide-level excision, and now have to have an 'even wider' wide level excision? If so, I think the issue is that whoever did your first WLE was just not conservative enough. He should have taken 1cm from all around the lesion, which would have left you with a 2.5" scar right from the get go. I don't think there is any way that a surgeon could take the recommended 1cm margin in every direction, and leave you only with a minimal scar. A standard stage 1a excision would be about 10 stitches and 7cm long. Not orienting the specimen is also pretty amateur, I would have thought this was surgery 101… I am glad to hear you have changed doctors because I think this guy hasn't been particularly competent. Anyway, I don't think 'light general' anaesthetic would be required. I have a 2.5" football-shaped scar on my upper arm and this was done under local anaesthetic, I can't see why yours is any different.
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- October 14, 2016 at 9:37 am
So did you first have a biopsy of some kind (excision, punch, shave), then got the diagnosis, then had a wide-level excision, and now have to have an 'even wider' wide level excision? If so, I think the issue is that whoever did your first WLE was just not conservative enough. He should have taken 1cm from all around the lesion, which would have left you with a 2.5" scar right from the get go. I don't think there is any way that a surgeon could take the recommended 1cm margin in every direction, and leave you only with a minimal scar. A standard stage 1a excision would be about 10 stitches and 7cm long. Not orienting the specimen is also pretty amateur, I would have thought this was surgery 101… I am glad to hear you have changed doctors because I think this guy hasn't been particularly competent. Anyway, I don't think 'light general' anaesthetic would be required. I have a 2.5" football-shaped scar on my upper arm and this was done under local anaesthetic, I can't see why yours is any different.
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- October 14, 2016 at 3:51 pm
Yes, you described the process exactly. The onc surgeon looked at the scar from the plastic surgeon and said it was too small and that plastic surgeons sometimes work more for the cosmetic outcome. I will ask my new surgeon whether we can do a local for this.
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- October 14, 2016 at 9:38 pm
In all seriousness, that plastic surgeon should be informed that his work is dangerous – not taking the required amount of margin around a melanoma could cost someone their life (eg by leaving melanoma cells behind instead of fully excising). Also, it's going to cos you – alone – more time/money/pain because you basically have to get his work redone. Sorry you have go through it all again… and it is a bit concerning that there is residual melanoma in the original 'wide' level excision, I hope the next one is all clear.
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- October 14, 2016 at 9:38 pm
In all seriousness, that plastic surgeon should be informed that his work is dangerous – not taking the required amount of margin around a melanoma could cost someone their life (eg by leaving melanoma cells behind instead of fully excising). Also, it's going to cos you – alone – more time/money/pain because you basically have to get his work redone. Sorry you have go through it all again… and it is a bit concerning that there is residual melanoma in the original 'wide' level excision, I hope the next one is all clear.
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- October 15, 2016 at 1:31 am
Yes, I will inform him, thanks. I will also inform my dermatologist that waiting two months for an appointment to get a suspicious mole is also dangerous. I had to holler at the receptionist to get it down to a month! The oncological surgeon didn't seem too judgmental about the too-small excision – he said "It happens." The lesion (pink bump type) was small, less than a pencil eraser, and the scar is longer than a cm on either side of that, so I"m not sure how it actually gets measured. The dermatologist had told me the divot would be about the size of a quarter.
Tomorrow we will photograph the current scar with a ruler next to it, in case we need it for a lawsuit maybe. I don't want to do that, but yeah, this is not only costing me time and recuperation, and the insurance company money, it will be a worse scar in a very visible place.
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- October 15, 2016 at 1:31 am
Yes, I will inform him, thanks. I will also inform my dermatologist that waiting two months for an appointment to get a suspicious mole is also dangerous. I had to holler at the receptionist to get it down to a month! The oncological surgeon didn't seem too judgmental about the too-small excision – he said "It happens." The lesion (pink bump type) was small, less than a pencil eraser, and the scar is longer than a cm on either side of that, so I"m not sure how it actually gets measured. The dermatologist had told me the divot would be about the size of a quarter.
Tomorrow we will photograph the current scar with a ruler next to it, in case we need it for a lawsuit maybe. I don't want to do that, but yeah, this is not only costing me time and recuperation, and the insurance company money, it will be a worse scar in a very visible place.
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- October 15, 2016 at 1:31 am
Yes, I will inform him, thanks. I will also inform my dermatologist that waiting two months for an appointment to get a suspicious mole is also dangerous. I had to holler at the receptionist to get it down to a month! The oncological surgeon didn't seem too judgmental about the too-small excision – he said "It happens." The lesion (pink bump type) was small, less than a pencil eraser, and the scar is longer than a cm on either side of that, so I"m not sure how it actually gets measured. The dermatologist had told me the divot would be about the size of a quarter.
Tomorrow we will photograph the current scar with a ruler next to it, in case we need it for a lawsuit maybe. I don't want to do that, but yeah, this is not only costing me time and recuperation, and the insurance company money, it will be a worse scar in a very visible place.
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- October 14, 2016 at 9:38 pm
In all seriousness, that plastic surgeon should be informed that his work is dangerous – not taking the required amount of margin around a melanoma could cost someone their life (eg by leaving melanoma cells behind instead of fully excising). Also, it's going to cos you – alone – more time/money/pain because you basically have to get his work redone. Sorry you have go through it all again… and it is a bit concerning that there is residual melanoma in the original 'wide' level excision, I hope the next one is all clear.
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- October 14, 2016 at 3:51 pm
Yes, you described the process exactly. The onc surgeon looked at the scar from the plastic surgeon and said it was too small and that plastic surgeons sometimes work more for the cosmetic outcome. I will ask my new surgeon whether we can do a local for this.
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- October 14, 2016 at 3:51 pm
Yes, you described the process exactly. The onc surgeon looked at the scar from the plastic surgeon and said it was too small and that plastic surgeons sometimes work more for the cosmetic outcome. I will ask my new surgeon whether we can do a local for this.
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- October 20, 2016 at 9:23 pm
Returning to my thread here because now I"m more confused than ever, due to the way the cancer center is treating this (overkill). My original excision scar is 2.5 inches, same as yours, so I'm not sure why the second doctor looked at and said it wasn't long enough. Today I had EKG, blood work, and chest x-ray and several lengthy interviews in prep for the re-excision. They tell me to do all kinds of crazy cleansing for two days before, and I will not be able to work the day after the surgery and should prepare to be at the hospital 5 hours and have someone stay with me 24 hours. This seems like way too big a deal for this tiny 0.2 mm thing. So just now I called the plastic surgeon who did the first excision to ask his opinion. He thinks they are doing overkill and he would be happy to take me sooner and do it with local anesthetic as before. He thinks there was no issue with the tissue being oriented one way or the other because the speck of mel remaining would have been where the incision line was, in the middle. Now (he says) the speck is in the center where it is stitched. Does that mean he didn't go _deep_ enough? I'm having trouble picture this exactly. It was the football shape. I am seeing the original dermatologist on Tuesday, the guy who referred me to the plastic surgeon, so I can also ask him. Sorry guys, I feel like 1a problems are like "first world problems" when so many of you have much more serious challenges, but it is confusing being new to cancer. Thank you all for any additional thoughts. – Surf
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- October 20, 2016 at 9:23 pm
Returning to my thread here because now I"m more confused than ever, due to the way the cancer center is treating this (overkill). My original excision scar is 2.5 inches, same as yours, so I'm not sure why the second doctor looked at and said it wasn't long enough. Today I had EKG, blood work, and chest x-ray and several lengthy interviews in prep for the re-excision. They tell me to do all kinds of crazy cleansing for two days before, and I will not be able to work the day after the surgery and should prepare to be at the hospital 5 hours and have someone stay with me 24 hours. This seems like way too big a deal for this tiny 0.2 mm thing. So just now I called the plastic surgeon who did the first excision to ask his opinion. He thinks they are doing overkill and he would be happy to take me sooner and do it with local anesthetic as before. He thinks there was no issue with the tissue being oriented one way or the other because the speck of mel remaining would have been where the incision line was, in the middle. Now (he says) the speck is in the center where it is stitched. Does that mean he didn't go _deep_ enough? I'm having trouble picture this exactly. It was the football shape. I am seeing the original dermatologist on Tuesday, the guy who referred me to the plastic surgeon, so I can also ask him. Sorry guys, I feel like 1a problems are like "first world problems" when so many of you have much more serious challenges, but it is confusing being new to cancer. Thank you all for any additional thoughts. – Surf
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- October 20, 2016 at 9:28 pm
SORRY- I made a mistake in that last post – the first excision scar is only an inch long. It was the _second_ one, drawn on my arm with a marker, that will be 2.5". Nevertheless, all this general anesthesia business is making me think they are doing a major surgery.
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- October 20, 2016 at 9:28 pm
SORRY- I made a mistake in that last post – the first excision scar is only an inch long. It was the _second_ one, drawn on my arm with a marker, that will be 2.5". Nevertheless, all this general anesthesia business is making me think they are doing a major surgery.
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- October 20, 2016 at 9:28 pm
SORRY- I made a mistake in that last post – the first excision scar is only an inch long. It was the _second_ one, drawn on my arm with a marker, that will be 2.5". Nevertheless, all this general anesthesia business is making me think they are doing a major surgery.
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- October 20, 2016 at 9:23 pm
Returning to my thread here because now I"m more confused than ever, due to the way the cancer center is treating this (overkill). My original excision scar is 2.5 inches, same as yours, so I'm not sure why the second doctor looked at and said it wasn't long enough. Today I had EKG, blood work, and chest x-ray and several lengthy interviews in prep for the re-excision. They tell me to do all kinds of crazy cleansing for two days before, and I will not be able to work the day after the surgery and should prepare to be at the hospital 5 hours and have someone stay with me 24 hours. This seems like way too big a deal for this tiny 0.2 mm thing. So just now I called the plastic surgeon who did the first excision to ask his opinion. He thinks they are doing overkill and he would be happy to take me sooner and do it with local anesthetic as before. He thinks there was no issue with the tissue being oriented one way or the other because the speck of mel remaining would have been where the incision line was, in the middle. Now (he says) the speck is in the center where it is stitched. Does that mean he didn't go _deep_ enough? I'm having trouble picture this exactly. It was the football shape. I am seeing the original dermatologist on Tuesday, the guy who referred me to the plastic surgeon, so I can also ask him. Sorry guys, I feel like 1a problems are like "first world problems" when so many of you have much more serious challenges, but it is confusing being new to cancer. Thank you all for any additional thoughts. – Surf
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- October 14, 2016 at 12:36 pm
Hi SR, Regarding the general anesthesia for your procedure. Ask how long the procedure will take. That may be a determining factor why your surgeon suggests it. I eould imagine they could perform this as an out patient under local anesthesia with IV sedation. It kind of knocks you out but not like general anesthesia does and it gives the surgeon the edge of having you mostly sedated. Maybe this is his term of “light general” but what I’m describing is not general at all. I used to work for a plastic surgeon. We did all our cosmetic procedures in this manner. Facelifts, etc.Also, ask about lymphedema after surgery since this is the upper arm.
Just some additional thoughts to consider but with the surgical margins not clear, which can happen sometimes, you should go for it and get that clear margin.
This is a great forum for you to find more info and keep learning. Ask lots of questions and good luck with your procedure.
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- October 14, 2016 at 3:54 pm
Thank you and everyone else very much! So helpful. Yes it will be outpatient but I have to go in for a pre-cert visit and have a bunch of tests done. Seems like overkill but I have sleep apnea so maybe the echocardiogram is needed for that reason.
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- October 20, 2016 at 9:30 pm
correction, they did an EKG, not an echocardiogram. Also chest X-ray and blood work.
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- October 20, 2016 at 9:30 pm
correction, they did an EKG, not an echocardiogram. Also chest X-ray and blood work.
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- October 20, 2016 at 9:30 pm
correction, they did an EKG, not an echocardiogram. Also chest X-ray and blood work.
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- October 14, 2016 at 3:54 pm
Thank you and everyone else very much! So helpful. Yes it will be outpatient but I have to go in for a pre-cert visit and have a bunch of tests done. Seems like overkill but I have sleep apnea so maybe the echocardiogram is needed for that reason.
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- October 14, 2016 at 3:54 pm
Thank you and everyone else very much! So helpful. Yes it will be outpatient but I have to go in for a pre-cert visit and have a bunch of tests done. Seems like overkill but I have sleep apnea so maybe the echocardiogram is needed for that reason.
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- October 14, 2016 at 12:36 pm
Hi SR, Regarding the general anesthesia for your procedure. Ask how long the procedure will take. That may be a determining factor why your surgeon suggests it. I eould imagine they could perform this as an out patient under local anesthesia with IV sedation. It kind of knocks you out but not like general anesthesia does and it gives the surgeon the edge of having you mostly sedated. Maybe this is his term of “light general” but what I’m describing is not general at all. I used to work for a plastic surgeon. We did all our cosmetic procedures in this manner. Facelifts, etc.Also, ask about lymphedema after surgery since this is the upper arm.
Just some additional thoughts to consider but with the surgical margins not clear, which can happen sometimes, you should go for it and get that clear margin.
This is a great forum for you to find more info and keep learning. Ask lots of questions and good luck with your procedure.
-
- October 14, 2016 at 12:36 pm
Hi SR, Regarding the general anesthesia for your procedure. Ask how long the procedure will take. That may be a determining factor why your surgeon suggests it. I eould imagine they could perform this as an out patient under local anesthesia with IV sedation. It kind of knocks you out but not like general anesthesia does and it gives the surgeon the edge of having you mostly sedated. Maybe this is his term of “light general” but what I’m describing is not general at all. I used to work for a plastic surgeon. We did all our cosmetic procedures in this manner. Facelifts, etc.Also, ask about lymphedema after surgery since this is the upper arm.
Just some additional thoughts to consider but with the surgical margins not clear, which can happen sometimes, you should go for it and get that clear margin.
This is a great forum for you to find more info and keep learning. Ask lots of questions and good luck with your procedure.
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Tagged: cutaneous melanoma
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