› Forums › Cutaneous Melanoma Community › OK to wait two months on Stage 0 Melanoma?
- This topic has 2 replies, 2 voices, and was last updated 6 years, 8 months ago by
doragsda.
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- September 24, 2018 at 11:42 pm
I am 71 years old and have just been diagnosed with my first melanoma. I've had a basal and a squamous cell cancer removed in the past (due to lots of sun damage in my early years), but this is the first time I've been told I have a melanoma. It's a small spot on my thigh — one of umpteen on my legs and arms — that my previous dermatologist has passed over for who knows how many years. But I changed dermatologists and my new one thought it looked suspicious (even though to my eye it looked just like all the others), had it biopsied and it came back as Stage 0, in situ melanoma. It took two weeks for the biopsy report to come back and now I face a dilemma because I have a trip-of-a-lifetime cruise to Antarctica (OMG — think hole in the ozone!!!) planned for the end of October, and there is barely any time to have the surgery needed to remove the melanoma with wide margins, and to have stitches removed before we leave. I have no idea how big an incision this will end of being or how long it will take to heal. The surgeon I saw on Friday said it could wait until we get back from our trip, but that won't be until the end of November. Dare I put this off for two more months? As of now, the surgery is scheduled for December 4. Am I risking having a Stage 0 tumor turn into something more dire and invasive? I am also terrified that I have more of these melanomas that have gone undiagnosed due to the inattention of my previous dermatologist. Where does one find a dermatologist to give me a really thorough exam, given my history, and how in the heck do I personally keep track of 20 or 30 different spots that might or might not be changing in tiny increments from month to month? The more I read about this, the more terrified I become.
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- September 25, 2018 at 1:39 am
You've probably had that lesion for years and it would probably take years to progress further. It's thought that in most older (and I don't mean 70 is older) people, some may actually have melanoma that never went further. The highest prevalence of melanoma is men over 60.
So my question is this, did your biopsy have clear margins? If it had clear margins, then I might be inclined to wait. If you didn't have clear margins, I'd have to think harder. In general, the WLE can be done at any time – usually within 90 days. With in situ, it's unlikely you won't have clear deep margins – it's hard to take a biopsy that only gets the epidermis. So the real question is if you have the peripheral margins clear. I'd be tempted to go on the trip but come back and ask for 1cm margins (the margins used for invasive melanomas). Then you're being overly cautious on the other end when you have ample time to heal.
Size: 5mm margins. Depending on anatomy, a 5mm margin means 1cm from the center. But to close a 1cm hole, you have to take an elliptical piece of skin. The general rule of thumb is 3x the width to close. So something like 3cm. Now it also depends on how much stress in in the area etc. I had an insitu removed from the inside of my lower leg, just below the knee. It's a little longer than 3cm.
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- September 26, 2018 at 2:55 am
Just a data point for you:
On December 7, 2016, my wife had a melanoma removed from her left calf. The primary was deep (>4mm) and ulcerated and the surgeon (who was excellent) did a large Z shaped cut to get her skin back together without a skin graft. She had at least 12 inches of suture line (glue and adhesive sutures on the surface). She also had a SLNB at the same time, with two incisions on her upper thigh and groin.
On December 21 we flew to New Orleans and got on a cruise ship for a week. She went ashore at every port and walked around. She iced everything down every night. She did have some discomfort when she was on her feet for a long period, but was able to handle it and really didn't sit out any part of the cruise. She never needed a wheelchair or crutch or cane. She was 54 at the time and in relatively good physical condition.
It does seem that waiting would be a fairly low risk alternative, but you should discuss that with your doctor. Enjoy your trip.
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Tagged: cutaneous melanoma
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