› Forums › Cutaneous Melanoma Community › Second site, second slow Moh procedure.
- This topic has 24 replies, 5 voices, and was last updated 13 years, 1 month ago by
jfergusfl.
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- July 19, 2012 at 12:08 am
I've read a few other posts here, and learned that some here have had a second melanoma site, as I have. My question is does it matter that mine was found a month later, while others are found years later?
I've read a few other posts here, and learned that some here have had a second melanoma site, as I have. My question is does it matter that mine was found a month later, while others are found years later?
I had my second 'slow Moh' surgery today. The surgeon noted that this site, as the first, is an atypical site with undefined borders. It took three surgeries over seven days for the first site, and then the wound was declared malignant-free with clear borders. That site required over fifty stitches to close, and is now healing with stitches removed. The second site is one I'd questioned and so it was biopsied on a follow up visit a month after the first. Both sites have been visible for about two years, waiting for me to finally have the courage to see a doctor who could biopsy them and recommend surgery based on the malignant melanoma finding.
Have others here had multiple "primary" sites discovered at the relatively same time? Does this have any meaning as to metastasis? I'm guessing that more sites will be identified when I return for another skin check. I have half a dozen 'pre-cancer' sites presently healing from cryosurgery, and not yet healing well (it's been 8 days) and think some of them may be cancer, too.
Please let me know if you've had multiple melanoma sites identified at the same or nearly same time? Mine are on separate body parts (back and arm.)
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- July 19, 2012 at 12:22 am
As multiple primary sites are unrelated to each other, the timeline of finding them really has no correlation on anything. I had one in 1992, one in 2000 and another in 2001. The last one was present when the second one was removed. It just looked fine to everyone besides me. I know some who have found several after their initial one, then never any more. Others have found theirs over time. It really doesn't make much difference in the outcomes.
One question, however. You said you had slow Mohs. Mohs isn't typically done for the WLE (wide local excision) but I'm sure slow Mohs utilizes the staining techniques for identifying melanoma as opposed to the standard Mohs which uses frozen sections (not typically good at identifying melanoma). That's why it is SLOW! 🙂 However, you indicated "clear margins". Did you have extra margins? In general, clean margins aren't considered good enough because even one cell outside those margins can cause future problems. So a stage I lesion typically has 1cm of clear margins removed. That may very well have happened in your case, but I would want to know for certain if it were me.
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- July 19, 2012 at 12:22 am
As multiple primary sites are unrelated to each other, the timeline of finding them really has no correlation on anything. I had one in 1992, one in 2000 and another in 2001. The last one was present when the second one was removed. It just looked fine to everyone besides me. I know some who have found several after their initial one, then never any more. Others have found theirs over time. It really doesn't make much difference in the outcomes.
One question, however. You said you had slow Mohs. Mohs isn't typically done for the WLE (wide local excision) but I'm sure slow Mohs utilizes the staining techniques for identifying melanoma as opposed to the standard Mohs which uses frozen sections (not typically good at identifying melanoma). That's why it is SLOW! 🙂 However, you indicated "clear margins". Did you have extra margins? In general, clean margins aren't considered good enough because even one cell outside those margins can cause future problems. So a stage I lesion typically has 1cm of clear margins removed. That may very well have happened in your case, but I would want to know for certain if it were me.
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- July 19, 2012 at 12:22 am
As multiple primary sites are unrelated to each other, the timeline of finding them really has no correlation on anything. I had one in 1992, one in 2000 and another in 2001. The last one was present when the second one was removed. It just looked fine to everyone besides me. I know some who have found several after their initial one, then never any more. Others have found theirs over time. It really doesn't make much difference in the outcomes.
One question, however. You said you had slow Mohs. Mohs isn't typically done for the WLE (wide local excision) but I'm sure slow Mohs utilizes the staining techniques for identifying melanoma as opposed to the standard Mohs which uses frozen sections (not typically good at identifying melanoma). That's why it is SLOW! 🙂 However, you indicated "clear margins". Did you have extra margins? In general, clean margins aren't considered good enough because even one cell outside those margins can cause future problems. So a stage I lesion typically has 1cm of clear margins removed. That may very well have happened in your case, but I would want to know for certain if it were me.
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- July 19, 2012 at 12:54 am
Many years ago, margins were much larger. But studies indicated that smaller margins could be taken without. In those people that recur, you can never know if extra margins would have made any difference or if that "cell" had already gone to the lymph vessels. Surgery is still the best cure for melanoma and I suppose that if you ever have another primary, you could ask for those extra 4cm margins. The scar may be disfiguring, but maybe that would give you extra peace of mind. Think about stage IA with say a 97% survival rate. Should 97% have 4cm margins to avoid the 3%? 4cm margins would mean a 24cm scar without creative cutting. (4cm margins mean 8cm width is removed. In general, the length of the excision takes 3 times the width of a lesion to close the skin). That's the reason there are guidelines. There will never be any guarantee that removing more will prevent all recurrences.
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- July 19, 2012 at 12:54 am
Many years ago, margins were much larger. But studies indicated that smaller margins could be taken without. In those people that recur, you can never know if extra margins would have made any difference or if that "cell" had already gone to the lymph vessels. Surgery is still the best cure for melanoma and I suppose that if you ever have another primary, you could ask for those extra 4cm margins. The scar may be disfiguring, but maybe that would give you extra peace of mind. Think about stage IA with say a 97% survival rate. Should 97% have 4cm margins to avoid the 3%? 4cm margins would mean a 24cm scar without creative cutting. (4cm margins mean 8cm width is removed. In general, the length of the excision takes 3 times the width of a lesion to close the skin). That's the reason there are guidelines. There will never be any guarantee that removing more will prevent all recurrences.
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- July 19, 2012 at 12:54 am
Many years ago, margins were much larger. But studies indicated that smaller margins could be taken without. In those people that recur, you can never know if extra margins would have made any difference or if that "cell" had already gone to the lymph vessels. Surgery is still the best cure for melanoma and I suppose that if you ever have another primary, you could ask for those extra 4cm margins. The scar may be disfiguring, but maybe that would give you extra peace of mind. Think about stage IA with say a 97% survival rate. Should 97% have 4cm margins to avoid the 3%? 4cm margins would mean a 24cm scar without creative cutting. (4cm margins mean 8cm width is removed. In general, the length of the excision takes 3 times the width of a lesion to close the skin). That's the reason there are guidelines. There will never be any guarantee that removing more will prevent all recurrences.
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- July 19, 2012 at 2:23 am
Thank you all for your replies. I understand the intent in cutting conservatively. It took three cuttings, each one going wider; the final size of the open wound was about four inches in diameter after the third cutting. This was a site with no center, no mole, just a flat red discoloration of the skin on my back, about the size of the palm of my hand. Each pathology lab broke the site down into 'clock' measurements: between 12 and 3, 3 and 6, 6 and 9, and 9 and 12. The first pathology after the biopsy report named it malignant melanoma and the first cutting said malignant in all four quadrants; the second was still in three of the four, the third was clear in all four. I can guess that he was widening each cut by one centimeter all the way around the original biopsy sample.
The second site is smaller than the first – about the size of a quarter. The first cut is about a centimeter beyond that outside diameter, rather than just beyond the biopsy site itself.
With atypical sites like these, the surgeon said, he would typically expand the search a centimeter at a time (he didn't say centimeter, but used his fingers to indicate that size. )
Maybe this one will appear 'clear' sooner than the first did. I didn't realize that 'slow Moh' meant days in between cuttings, waiting for the pathology. That's what makes it slow. Thanks for explaining the methodology that makes this slower (the staining) than a 'regular' Moh surgery.
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- July 19, 2012 at 2:23 am
Thank you all for your replies. I understand the intent in cutting conservatively. It took three cuttings, each one going wider; the final size of the open wound was about four inches in diameter after the third cutting. This was a site with no center, no mole, just a flat red discoloration of the skin on my back, about the size of the palm of my hand. Each pathology lab broke the site down into 'clock' measurements: between 12 and 3, 3 and 6, 6 and 9, and 9 and 12. The first pathology after the biopsy report named it malignant melanoma and the first cutting said malignant in all four quadrants; the second was still in three of the four, the third was clear in all four. I can guess that he was widening each cut by one centimeter all the way around the original biopsy sample.
The second site is smaller than the first – about the size of a quarter. The first cut is about a centimeter beyond that outside diameter, rather than just beyond the biopsy site itself.
With atypical sites like these, the surgeon said, he would typically expand the search a centimeter at a time (he didn't say centimeter, but used his fingers to indicate that size. )
Maybe this one will appear 'clear' sooner than the first did. I didn't realize that 'slow Moh' meant days in between cuttings, waiting for the pathology. That's what makes it slow. Thanks for explaining the methodology that makes this slower (the staining) than a 'regular' Moh surgery.
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- July 19, 2012 at 2:23 am
Thank you all for your replies. I understand the intent in cutting conservatively. It took three cuttings, each one going wider; the final size of the open wound was about four inches in diameter after the third cutting. This was a site with no center, no mole, just a flat red discoloration of the skin on my back, about the size of the palm of my hand. Each pathology lab broke the site down into 'clock' measurements: between 12 and 3, 3 and 6, 6 and 9, and 9 and 12. The first pathology after the biopsy report named it malignant melanoma and the first cutting said malignant in all four quadrants; the second was still in three of the four, the third was clear in all four. I can guess that he was widening each cut by one centimeter all the way around the original biopsy sample.
The second site is smaller than the first – about the size of a quarter. The first cut is about a centimeter beyond that outside diameter, rather than just beyond the biopsy site itself.
With atypical sites like these, the surgeon said, he would typically expand the search a centimeter at a time (he didn't say centimeter, but used his fingers to indicate that size. )
Maybe this one will appear 'clear' sooner than the first did. I didn't realize that 'slow Moh' meant days in between cuttings, waiting for the pathology. That's what makes it slow. Thanks for explaining the methodology that makes this slower (the staining) than a 'regular' Moh surgery.
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- July 19, 2012 at 5:02 pm
Just got the call that the biopsy of yesterday's Slow Moh surgery shows continuing malignant melanoma, so I will go back to the city today for more cutting and another biopsy. I will keep you posted here.
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- July 19, 2012 at 5:02 pm
Just got the call that the biopsy of yesterday's Slow Moh surgery shows continuing malignant melanoma, so I will go back to the city today for more cutting and another biopsy. I will keep you posted here.
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- July 19, 2012 at 5:02 pm
Just got the call that the biopsy of yesterday's Slow Moh surgery shows continuing malignant melanoma, so I will go back to the city today for more cutting and another biopsy. I will keep you posted here.
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- August 3, 2012 at 12:46 am
My initial site was on my right side near the waist, 3 weeks later a new site was found between the shoulder blades on upper back.
I have had the lower one excised and the familiar line of stitches and the upper one was removed with the biopsy, waiting to hear what they want to do next.
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- August 3, 2012 at 12:46 am
My initial site was on my right side near the waist, 3 weeks later a new site was found between the shoulder blades on upper back.
I have had the lower one excised and the familiar line of stitches and the upper one was removed with the biopsy, waiting to hear what they want to do next.
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- August 3, 2012 at 12:46 am
My initial site was on my right side near the waist, 3 weeks later a new site was found between the shoulder blades on upper back.
I have had the lower one excised and the familiar line of stitches and the upper one was removed with the biopsy, waiting to hear what they want to do next.
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Tagged: cutaneous melanoma
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