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Do I need more surgery?
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Do I need more surgery?

› Forums › General Melanoma Community › Do I need more surgery?

  • Post
    • September 1, 2017 at 5:55 pm
    Kate_b
    Participant

      Hello all,

       

      I appreciate this forum and the wisdom collected through your individual experiences. Thank you in advance!

       

      I had a very fortunate diagnosis of stage 1 superficial spreading melanoma with a depth of 0.77, no ulceration, no lymphovasculer involvement, no neurotropism, no satellite lesions and all margins were cleared from the excision. I am thankful for what came back from pathology and so was the medical staff that broke it all down for me. However, they now want me to do a wider excision now. Why would this be necessary?  I err on the conservative side when it comes to medical interventions and don't want to be cut if I don't have to be. Does this sound like they want to cover their legal behinds so they're being overly aggressive? I'm open to all opinions.

       

      I do hope this doesn't read as whining when so many of you are bravely enduring serious long term treatments. Thank you for being on this forum.

       

      kate

       

       

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        • September 1, 2017 at 7:25 pm
        Janner
        Participant

          What they are suggesting is called a WLE – wide local excision.  With melanoma, clean margins aren't good enough, you want wide margins.  Melanoma cells like to travel so having wider margins gives you a safety net in case one or more cells escaped past the biopsy sample.  It is the standard if care to have 1cm margins (length x width x depth) around the entire lesion.  This will mean the scar will be decent size depending on where this is located.  In order to close a 2cm hole, they excise the lesion in an elliptical shape.  The long end will have to be at least 6cm to close the hole, but may be longer depending on how tight the skin is and how much stress the area receives.

          This really isn't a cya for the doctors, it's a cya for YOU to prevent any future dealing with melanoma.  Remember, to date, surgery is still THE most effective way to get rid of melanoma.  At your stage, it will most likely be the last bought you have with melanoma.  Everyone here has had a WLE as part of their melanoma treatment with few exceptions and those exceptions are typically if a primary tumor isn't found.

          • September 1, 2017 at 9:02 pm
          SABKLYN
          Participant

            Strikes me as a little odd.  Jammer or Bubbles are certainly more informed, but if there are clear margins, not sure why they'd do a WLE.

              • September 2, 2017 at 5:57 pm
              Janner
              Participant

                Clear margins are not a guarantee that the lesion is removed entirely – that's why.  All my 3 melanomas had clear margins.  All later had WLEs.  You cannot look at every cell on a biopsy and you cannot GUARANTEE that every cell from the primary tumor is removed – especially since melanoma cells are prone to travel.  It used to be that the margins were MUCH larger trying to get rid of every cell.  Over years and clinical trials, they have narrowed the margins to what statistically has shown gives the patients the best chances with the least tissue removed.  For a lesion under 1mm, 1cm margins is the standards.  WIDE MARGINS, not clean margins, are the standard of care.

              • September 2, 2017 at 5:20 am
              ldub
              Participant

                Janner is correct.  I had a Stage 0 with clean margins and the standard of care is still a 1 cm WLE in all directions.  It is not about the doctor, it is insurance so that you (hopefully) never have to worry about melanoma again.

                • September 2, 2017 at 5:15 pm
                ed williams
                Participant

                  Hi Kate, Brian posted an interesting article this week that looks at patients 8772 melanoma patients with tumour depths of .50mm to 1.0 mm in depth that were advised to have SNB for different reason based on risk factors like ulceration, mitosis rate and age for TB1 stage patients. Safe margins, cutting out any chance of the beast coming back is always the best approach. Not knowing all of your information, makes it is hard to give advice. Read up, do some research and ask questions until you feel comfortable with a decision. Best Wishes!!!Ed  https://www.melanoma.org/find-support/patient-community/mpip-melanoma-patients-information-page/study-slnb-data 

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