› Forums › Cutaneous Melanoma Community › Melanoma returns to original site aftersuccessful MOHS four years ago
- This topic has 4 replies, 3 voices, and was last updated 6 years, 8 months ago by
Terry Palardy.
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- September 21, 2018 at 2:49 pm
I've had eleven skin cancer primary sites: four melanoma, four squamous and three basal, all different body parts … but the melanoma on my forearm, which looked like a cafe au lait birthmark, has returned. The staining began reappearing two years ago, in the same place and odd shape as the original, despite its having been completely removed by repeated Mohs surgeries five years ago…I go every four months for a skin checkup with the dermatologist, and when he finds something he biopsies it, and if positive ssend me on to the sin surgeon. The surgeon told me today that he has never, in twenty years of practice, seen a cancer that had been successfully removed by repeated Mohs, reoccur in the same place and style. I am totally worn down by the repetition of skin cancers at new sites, and now to know that they can come back after Mohs has really lowered my confidence and strength. Your thoughts?
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- September 21, 2018 at 3:04 pm
When you had your Mohs for melanoma, was it a "slow Mohs"? Did they do frozen section analysis or did they take longer and do staining and standard paraffin preparation? Squamous and basal cells show up fine with frozen section techniques – that's the standard for Mohs. Melanocytes don't show up nearly as well. That's why the WLE is more common because staining the sample allows better viewing of melanocytes. I've heard where some Mohs docs will do an excision and over several days, stain/analyze the tissue. Maybe your "repeated Mohs" is essentially what I'm saying with slow Mohs.
My next question is did your surgeon achieve CLEAN margins or WIDE margins? WLE is wide margins, Mohs is usually clean margins. Since you had a local recurrence, I'd wonder at how wide the margins were – making sure that any stray cells were also removed.
My derm is a Mohs surgeon and he only does Mohs for melanoma if it is lentigo maligna melanoma (LMM). He also typically uses Aldara cream first to reduce the size of the LMM lesion prior to Mohs, especially if it is on the face. LMM has the highest local recurrence rate. He does WLEs for all the other types of of melanoma. Your description of cafe au late may be LMM. Again, that type of melanoma has the highest local recurrence rate so if that is the type you had, recurrence is probably not as rare as the surgeon said.
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- September 21, 2018 at 6:18 pm
Yes, he called it slow Mohs … originallly it took place over five days (cut, wait for path, cut again, wait for path, suture.) This time he decided to repeat slow Mohs but divided the site into two separate sites (there are two separate 'stains' of melanoma) and took a third sample outside the borders of the stains, and said he will call the pathologist at the lab to discuss the results, of both the original biopsies and this current set, so I'm confident in his skill … I reminded him that, before any of these skin cancers 'bloomed,' I had complied with four years of nightly self injections of a DMD (disease modifying drug) (chemo) for multiple sclerosis, which I believe decimated my immune system … he did say a weakened immune system would affect recurrence rates. A multiple sclerosis blog friend has suggested I ask about LDN (low dose naltrexone) which some MS patients take to rebuild their immune systems; she said that LDN also reduces tumor size … I'm not sure what type of tumor she was referring to.
I so appreciate your answering, Jenner, and will let you know next week what Monday's visit yields…
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- September 22, 2018 at 6:15 pm
Hi Terry, nice to meet you, well, under our “shared” circumstances anyways! I can only offer up prayers, strength & good vibes your way, i see youve been playing the “skin” desease for awhile just stay on the bright side We are STILL here! Somethings working in our favor right? Hurdles are a common place we know this, no matter how “strange” our “re-occurrences” can be! What i think, and im no Dr, having to go back into “scar tissue” may be of a sucky nature, but what do i know..stay strong sis! Keep us informed! 🙂-
- September 25, 2018 at 8:31 pm
Today I left the house agaih at 5:15 am for my 7:30 am sutures. Yesterday I went in for a noon time dressing change … the drive only takes an hour when commuter traffic isn't involved. I picked up a copy of the recent post-surgery biopsy … Janner, you are correct – it is lentiginous … two separate melanoma sites side by side, two separate cafe au lait stains, same as six years ago in 2012. Surgeon advises that if ANY staining reappears, get it biopsied immediately (I reminded him that I did have a biopsy a year ago that was returned negative despite the reappearance of the stains … repeat biopsy this year and it came back positive for melanoma. He said 'it is unusual for that to happen." Next week, I'll have a squamous site surgically removed … I'm guess Mohs but could be wide excision … I forgot to ask which he'll do.
So very tired of all of these surgeries, and dismayed to hear that it could continue to return to old sites in addition to continuing to appear in new sites.
Mike, I appreciate your alliance. People tell me I am strong. Not feeling so strong right now. I'll be going to sleep early tonight.
Be well, all. I'm sure I'll be back.
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Tagged: cutaneous melanoma
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