› Forums › General Melanoma Community › Curative Excision on Neck
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cloudbrows.
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- August 12, 2012 at 10:01 pm
Hi!
I just got news from my dermatologist on Friday that the mole he removed from my scalp behind my left ear was a melanoma. Considering what I'd been fearing for the last couple weeks, the news that it was about 0.5mm thick was incredibly relieving. Obviously many of you or your friends and family have been hit with much worse news. My doctor says that his initial excision was technically an evaluative excision and that I need to get a follow-up excision with margins of 10mm.
Hi!
I just got news from my dermatologist on Friday that the mole he removed from my scalp behind my left ear was a melanoma. Considering what I'd been fearing for the last couple weeks, the news that it was about 0.5mm thick was incredibly relieving. Obviously many of you or your friends and family have been hit with much worse news. My doctor says that his initial excision was technically an evaluative excision and that I need to get a follow-up excision with margins of 10mm.
Has anybody had experience with larger excisions? From reading online, it looks like they're doing much narrower margins than they used to, which is wonderful. I'm wondering whether it'll be likely to require a skin graft and also whether anyone's dealt with surgery on the neck. The initial excision wasn't too bad – the stitches are itching at this point and I can't really turn my head to the right very well, but otherwise it's been fine. But a larger one worries me.
Obviously, though, it's hard to complain when the alternatives were so much worse.
Just curious to hear from other people since I get to wait until September 10th to consult with the neck surgeon.
Best,
Nate
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- August 12, 2012 at 11:15 pm
Hi!
I had 1 cm marging ( abit more ,I think ,11mm at least) on my breast under ariola.
I did not need skin graft .I have 5 cm scar now .
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- August 13, 2012 at 1:14 pm
Natasha – thanks for your response. If I may ask, why did the scar for a 1cm-margin excision grow to be 5cm?
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- August 13, 2012 at 2:26 pm
I'll answer for Natasha here. When they do a WLE (wide local excision), they remove an elliptical piece of skin. If they only removed a circular piece (1 cm margins all around), they'd have to try to pinch together skin and stitches would never hold it. (Try it with a piece of cloth or paper and you'll see what I mean). So they remove the tissue in an elliptical shape so they can close the wound with stitches. In general, an excision length is 3 times the width. So 1cm margins on both sides means a wound is 2cm high and 6cm long. Sometimes longer, sometimes shorter depending on the anatomy. Obviously, the height part is stitched together so the wound is only that large before stitches.
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- August 13, 2012 at 2:51 pm
That explanation makes a lot of sense; I'm familiar with the elliptical principle from my first evaluative excision, so I ought to have been able to figure that out myself.
Ugh. It's really ridiculous that I can't hold on to the proper perspective, here, which is that I'm incredibly lucky to have it be stage I. Already I'm feeling sorry for myself about the followup WLE.
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- August 13, 2012 at 4:37 pm
Lucky it was early, yes. But, don't get fooled into thinking this absolutely 100% cannot come back/recur/metastasize. Chances are it won't, but when all the doctors say, "don't worry, you're cured, you won't have to worry about this", etc…. you will find people who had Stage I early thin lesions that did end up causing trouble later. It's a very tricky unpredictable and misbehaving cancer, don't let your guard down and stay vigilant.
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- August 13, 2012 at 5:16 pm
That's a fair warning. My dermatologist has definitely emphasized how serious this is and mentioned the risks of recurrance and metastization that do still exist. Struggling to find the right emotional balance right now between "holy #$@% something very serious has happened to me" and "maybe I'm over-reacting because most people who get cancer don't get to remove some skin and probably be cured?"
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- August 13, 2012 at 5:16 pm
That's a fair warning. My dermatologist has definitely emphasized how serious this is and mentioned the risks of recurrance and metastization that do still exist. Struggling to find the right emotional balance right now between "holy #$@% something very serious has happened to me" and "maybe I'm over-reacting because most people who get cancer don't get to remove some skin and probably be cured?"
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- August 13, 2012 at 5:16 pm
That's a fair warning. My dermatologist has definitely emphasized how serious this is and mentioned the risks of recurrance and metastization that do still exist. Struggling to find the right emotional balance right now between "holy #$@% something very serious has happened to me" and "maybe I'm over-reacting because most people who get cancer don't get to remove some skin and probably be cured?"
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- August 13, 2012 at 4:37 pm
Lucky it was early, yes. But, don't get fooled into thinking this absolutely 100% cannot come back/recur/metastasize. Chances are it won't, but when all the doctors say, "don't worry, you're cured, you won't have to worry about this", etc…. you will find people who had Stage I early thin lesions that did end up causing trouble later. It's a very tricky unpredictable and misbehaving cancer, don't let your guard down and stay vigilant.
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- August 13, 2012 at 4:37 pm
Lucky it was early, yes. But, don't get fooled into thinking this absolutely 100% cannot come back/recur/metastasize. Chances are it won't, but when all the doctors say, "don't worry, you're cured, you won't have to worry about this", etc…. you will find people who had Stage I early thin lesions that did end up causing trouble later. It's a very tricky unpredictable and misbehaving cancer, don't let your guard down and stay vigilant.
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- August 13, 2012 at 2:51 pm
That explanation makes a lot of sense; I'm familiar with the elliptical principle from my first evaluative excision, so I ought to have been able to figure that out myself.
Ugh. It's really ridiculous that I can't hold on to the proper perspective, here, which is that I'm incredibly lucky to have it be stage I. Already I'm feeling sorry for myself about the followup WLE.
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- August 13, 2012 at 2:51 pm
That explanation makes a lot of sense; I'm familiar with the elliptical principle from my first evaluative excision, so I ought to have been able to figure that out myself.
Ugh. It's really ridiculous that I can't hold on to the proper perspective, here, which is that I'm incredibly lucky to have it be stage I. Already I'm feeling sorry for myself about the followup WLE.
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- August 13, 2012 at 2:26 pm
I'll answer for Natasha here. When they do a WLE (wide local excision), they remove an elliptical piece of skin. If they only removed a circular piece (1 cm margins all around), they'd have to try to pinch together skin and stitches would never hold it. (Try it with a piece of cloth or paper and you'll see what I mean). So they remove the tissue in an elliptical shape so they can close the wound with stitches. In general, an excision length is 3 times the width. So 1cm margins on both sides means a wound is 2cm high and 6cm long. Sometimes longer, sometimes shorter depending on the anatomy. Obviously, the height part is stitched together so the wound is only that large before stitches.
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- August 13, 2012 at 2:26 pm
I'll answer for Natasha here. When they do a WLE (wide local excision), they remove an elliptical piece of skin. If they only removed a circular piece (1 cm margins all around), they'd have to try to pinch together skin and stitches would never hold it. (Try it with a piece of cloth or paper and you'll see what I mean). So they remove the tissue in an elliptical shape so they can close the wound with stitches. In general, an excision length is 3 times the width. So 1cm margins on both sides means a wound is 2cm high and 6cm long. Sometimes longer, sometimes shorter depending on the anatomy. Obviously, the height part is stitched together so the wound is only that large before stitches.
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- August 13, 2012 at 1:14 pm
Natasha – thanks for your response. If I may ask, why did the scar for a 1cm-margin excision grow to be 5cm?
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- August 13, 2012 at 1:14 pm
Natasha – thanks for your response. If I may ask, why did the scar for a 1cm-margin excision grow to be 5cm?
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- August 13, 2012 at 12:29 am
1cm margins have been pretty standard for a stage I lesion for quite some time. If you had significant clear margins on the biopsy, your excision might not need to be the full 1cm. As for a skin graft, it might be needed and might not be. I've had 3 WLEs for stage I melanomas and none required a skin graft. One was on my shin, one just below the knee and the other on my shoulder blade. The need for a graft is determined by the amount of the skin available… and if without it, you will lose mobility or it will not be possible to close the wound. If it is behind your ear, you might be able to coverup some with hair – but being able to turn your head is important. The WLE I had on my shin was extremely tight – it was right on top of the bone. I noticed it every time I walked for quite some time. But it generally loosened as was no longer an issue. If you don't have to have one on your neck, it will still be tight to start out. But it, too, will get better over time. Good luck, and congrats on catching this one early.
Janner
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- August 13, 2012 at 1:19 pm
Janner – thanks very much for your reply. Thanks for the introduction to the term WLE, too. The wound is definitely in a great place for hair coverup, but, yeah, even this initial excision has restricted my head movement a bit. It's good to know that even if there's significant initial tightness that it'll get better over time.
Thanks for the congratulations, and thanks again for sharing those details.
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- August 13, 2012 at 1:19 pm
Janner – thanks very much for your reply. Thanks for the introduction to the term WLE, too. The wound is definitely in a great place for hair coverup, but, yeah, even this initial excision has restricted my head movement a bit. It's good to know that even if there's significant initial tightness that it'll get better over time.
Thanks for the congratulations, and thanks again for sharing those details.
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- August 13, 2012 at 1:19 pm
Janner – thanks very much for your reply. Thanks for the introduction to the term WLE, too. The wound is definitely in a great place for hair coverup, but, yeah, even this initial excision has restricted my head movement a bit. It's good to know that even if there's significant initial tightness that it'll get better over time.
Thanks for the congratulations, and thanks again for sharing those details.
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- August 13, 2012 at 12:29 am
1cm margins have been pretty standard for a stage I lesion for quite some time. If you had significant clear margins on the biopsy, your excision might not need to be the full 1cm. As for a skin graft, it might be needed and might not be. I've had 3 WLEs for stage I melanomas and none required a skin graft. One was on my shin, one just below the knee and the other on my shoulder blade. The need for a graft is determined by the amount of the skin available… and if without it, you will lose mobility or it will not be possible to close the wound. If it is behind your ear, you might be able to coverup some with hair – but being able to turn your head is important. The WLE I had on my shin was extremely tight – it was right on top of the bone. I noticed it every time I walked for quite some time. But it generally loosened as was no longer an issue. If you don't have to have one on your neck, it will still be tight to start out. But it, too, will get better over time. Good luck, and congrats on catching this one early.
Janner
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- August 13, 2012 at 12:29 am
1cm margins have been pretty standard for a stage I lesion for quite some time. If you had significant clear margins on the biopsy, your excision might not need to be the full 1cm. As for a skin graft, it might be needed and might not be. I've had 3 WLEs for stage I melanomas and none required a skin graft. One was on my shin, one just below the knee and the other on my shoulder blade. The need for a graft is determined by the amount of the skin available… and if without it, you will lose mobility or it will not be possible to close the wound. If it is behind your ear, you might be able to coverup some with hair – but being able to turn your head is important. The WLE I had on my shin was extremely tight – it was right on top of the bone. I noticed it every time I walked for quite some time. But it generally loosened as was no longer an issue. If you don't have to have one on your neck, it will still be tight to start out. But it, too, will get better over time. Good luck, and congrats on catching this one early.
Janner
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- September 2, 2012 at 11:38 am
Hey – just thought I'd leave a follow-up post here for the sake of anyone in the future who might have similar questions. I had my follow-up excision on Friday (August 31, 2012) at DaVinci surgery.
In my consultation, Dr. Steven Davison said that my .56 melanoma was, of course, Stage IA and that – other than it being on my head / neck, it was the least bad way to have melanoma. He said that, in general, he wouldn't look at doing a sentinel node biopsy until .75mm depth. He asked whether I was a scientific-type who wanted to know all the answers or someone who wanted to go by the numbers. I didn't immediately understand his meaning, so I just answered honestly: that I believe in going by the numbers. So he said he definitely wouldn't do the sentinal node biopsy.
The surgery did not require a skin graft – they said I had enough skin and pliability that it wouldn't be a problem. Recovery is definitely not fun – the whole left side of my head and neck feel like a giant, throbbing bruise. But it's getting better, and my range of motion isn't actually that restricted… the skin itself doesn't feel tighter than with my original excision.
Anyway – thanks again for the comments on my original post. I'm very grateful!
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- September 2, 2012 at 11:38 am
Hey – just thought I'd leave a follow-up post here for the sake of anyone in the future who might have similar questions. I had my follow-up excision on Friday (August 31, 2012) at DaVinci surgery.
In my consultation, Dr. Steven Davison said that my .56 melanoma was, of course, Stage IA and that – other than it being on my head / neck, it was the least bad way to have melanoma. He said that, in general, he wouldn't look at doing a sentinel node biopsy until .75mm depth. He asked whether I was a scientific-type who wanted to know all the answers or someone who wanted to go by the numbers. I didn't immediately understand his meaning, so I just answered honestly: that I believe in going by the numbers. So he said he definitely wouldn't do the sentinal node biopsy.
The surgery did not require a skin graft – they said I had enough skin and pliability that it wouldn't be a problem. Recovery is definitely not fun – the whole left side of my head and neck feel like a giant, throbbing bruise. But it's getting better, and my range of motion isn't actually that restricted… the skin itself doesn't feel tighter than with my original excision.
Anyway – thanks again for the comments on my original post. I'm very grateful!
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- September 2, 2012 at 11:38 am
Hey – just thought I'd leave a follow-up post here for the sake of anyone in the future who might have similar questions. I had my follow-up excision on Friday (August 31, 2012) at DaVinci surgery.
In my consultation, Dr. Steven Davison said that my .56 melanoma was, of course, Stage IA and that – other than it being on my head / neck, it was the least bad way to have melanoma. He said that, in general, he wouldn't look at doing a sentinel node biopsy until .75mm depth. He asked whether I was a scientific-type who wanted to know all the answers or someone who wanted to go by the numbers. I didn't immediately understand his meaning, so I just answered honestly: that I believe in going by the numbers. So he said he definitely wouldn't do the sentinal node biopsy.
The surgery did not require a skin graft – they said I had enough skin and pliability that it wouldn't be a problem. Recovery is definitely not fun – the whole left side of my head and neck feel like a giant, throbbing bruise. But it's getting better, and my range of motion isn't actually that restricted… the skin itself doesn't feel tighter than with my original excision.
Anyway – thanks again for the comments on my original post. I'm very grateful!
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Tagged: cutaneous melanoma
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