Newly diagnosed – excision questions

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Newly diagnosed – excision questions

This topic has 3 replies, 3 voices, and was last updated 7 years, 8 months ago by Nashvillian.

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- September 27, 2017 at 5:48 pm
- Quote
barry_g
Participant
I'm newly diagnosed with melanoma in situ on my face and want to be able to make informed treatment decisions. My dermatologist wanted me to make an appointment for excision by him. In his description of the procedure, there was no indication that pathology at the margins would be checked microscopically during the surgical procedure. He also mentioned there could be a significant scar. I would appreciate information on two questions:

1. Don't some surgeons perform a stepped excision procedure and go slowly and check microscopically as they go along so it's a minimal but thorough excision? Perhaps I need to find such a surgeon in my area?

2. Do some patients opt to have a combined excision + plastic surgery procedure to take care of much of the scarring in advance?

Thanks very much.

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- - September 28, 2017 at 1:45 am
  - Quote
  Janner
  Participant
  Mohs is the staged procedure you describe. It's not used as much for melanoma as it is for other skin cancers because Mohs uses "frozen section" technique to look for the cancer cells. Melanocytes don't show up well on frozen sections, they show up better when you process the lesion in paraffin and stain the sample. Mohs is perfect for basal cell and squamous cell. So it's not really surprising to hear your derm describe an excision. In addition, melanoma usually calls for WIDE margins, not just clean margins. In situ requires at least 5mm margins. I know my cutaneous oncologist and Mohs surgeon might do Mohs only if the lesion is lentigo maligna. Not saying you couldn't find a Mohs surgeon to do your excision, but now you understand better why that might not be the first suggestion. As for having a plastic surgeon do your procedure, I'd say yes. You could just see a plastic surgeon to have him do the excision from the start.
  - September 28, 2017 at 10:41 am
    
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    barry_g
    Participant
    
    Thanks very much for a thorough explanation. I will proceed with a plastic surgeon.
  - September 28, 2017 at 5:06 pm
    
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    Nashvillian
    Participant
    
    Thats what i did . I just got mine finsihed and mine is on my left temple. I had to have wide margins because of the level of my disease but the plastic surgeon is the corrrect jumping off point.

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