Moh’s for Evolving Melanoma In-Situ
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Moh’s for Evolving Melanoma In-Situ

› Forums › General Melanoma Community › Moh’s for Evolving Melanoma In-Situ

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    • January 7, 2020 at 11:13 pm
    David6310
    Participant
      I had a basal cell carcinoma removed in Aug 2013(lower leg on shin). When I rec’d the pathology report it mentioned MART-1 stain was used to confirm the diagnosis. I always thought that was strange and asked several questions at the time and the only answer I rec’d is it was done to confirm the diagnosis.

      I noticed some pigmentation adjacent to the scar approximately 2 years later and pointed it out to my dermatologist multiple times since. I also experienced some itching in the area over the years. It was always dismissed as something that was unrelated to the previous procedure and appeared to be “normal” pigmentation. I was convinced it did have something to do with the previous procedure(MART staining for basal cell carcinoma). I was in two weeks ago for a routine check, pointed it out again, they said it looked fine but would biopsy if I wanted them to. I confirmed I wanted it removed and they performed a shave biopsy.

      Last week I rec’d a phone call from the dermatologist…and….

      *********
      B. Left anterior lower leg, shave of skin: ATYPICAL JUNCTIONAL MELANOCYTIC PROLIFERATION IN A BACKGROUND OF PIGMENTED ACTINIC KERATOSIS. SEE NOTE.

      NOTE: Immunohistochemical studies with MART-1 and Sox-10 show an increased density of melanocytes at the dermoepidermal junction along with pagetoid upward migration.
      Although not entirely developed, but the findings are worrisome for an evolving melanoma in situ in the background of pigmented actinic keratosis. The lesion is within less than
      0.1 mm from peripheral tissue edge.
      **********

      They have scheduled me for Moh’s surgery. I was surprised by this thinking a simple re-excision with 0.5-1 cm margins would be sufficient. I’ve had several in-situ diagnosed in the past that were simply re-excised. I understand the shin/front if the leg is a little tricky. I thought the purpose of the wle re-excision was “curative” and also diagnostic from the standpoint a larger “sample” is taken and evaluated which can confirm(or change) the original interpretation.

      I’m a little concerned about Moh’s as the follow-up for several reasons. I read 12-15 years ago Moh’s was not routinely used for melanoma due to some concerns about melanocytes “bridging” or jumping rete ridges(pardon my terminology if not correct) and also concerns about processing frozen specimens. I know technically it is a borderline lesion, but want to make sure that it is okay to have this re-excised via Moh’s. Also, they didn’t schedule me until Mid-March. Is it okay to wait this long?

      Sorry for the long post! Any/all comments are appreciated!

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