Newly diagnosed - excision question

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Newly diagnosed - excision question

Postby barry_g » Wed Sep 27, 2017 12:27 pm

I'm newly diagnosed with a small melanoma in situ lesion on my face. My dermatologist wanted me to make an appointment for excision by him. In his description of the procedure, there was no indication that pathology at the margins would be checked microscopically during the surgical procedure. He also mentioned there could be a significant scar. I would appreciate information on two questions:

1. Don't some surgeons perform a stepped excision procedure and go slowly and check microscopically as they go along so it's a minimal but thorough excision? Perhaps I need to find such a surgeon in my area?

2. Do some patients opt to have a combined excision + plastic surgery procedure to take care of much of the scarring in advance?

Thanks very much.
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Re: Newly diagnosed - excision question

Postby Catherine Poole » Wed Sep 27, 2017 2:29 pm

For cosmetically sensitive areas, a plastic surgeon is preferred. I believe you are comparing MOHs surgery with a wide excision. MOHS is now being used for melanoma but still a bit controversial and better suited for basal cell or squamous cell, and it is where they take some layers of skin and look under the microscope until all of the "bad" cells are gone. If yours is insitu, I would get the opinion of a plastic surgeon and have them take care of it. You are smart to look into this!
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Melanoma International Foundation
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Re: Newly diagnosed - excision question

Postby barry_g » Thu Sep 28, 2017 5:39 am

Thanks very much Catherine! I appreciate the clarification on MOHS surgery. I have made an appointment to see a plastic surgeon with the necessary focus/skills.
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Re: Newly diagnosed - excision question

Postby Catherine Poole » Thu Sep 28, 2017 7:44 am

Great, please let us know how things go. Wishing you the best.
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Re: Newly diagnosed - excision question

Postby rcheek » Fri Sep 29, 2017 10:07 pm

Barry - I was diagnosed with a melanoma in situ on my right cheek, face that is, back in late 2013. I had surgery at university of Pennsylvania. The excised skin was examined by a pathologist before the surgeon closed the area with stiches - so I guess it was a type of MOHs surgery. The protocol however is set in how wide and deep they need to go to be sure. You are correct to consult a plastic surgeon. I had an excellent surgeon. You will have a scar, but depending, you will be surprised that over time it will hardly be noticeable. No one will know probably in a year or so. Sounds like a long time maybe but not.
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Re: Newly diagnosed - excision question

Postby rcheek » Fri Sep 29, 2017 10:15 pm

And Barry I would be derelict not to mention that it was this forum and Catherine that steered me in the right direction and gave me some pep when I needed it.
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Re: Newly diagnosed - excision question

Postby barry_g » Mon Oct 02, 2017 11:49 am

Thanks.

I met with the plastic surgeon today. He showed me a photo of a previous patient with a melanoma in a similar location on the face. To be honest, I was a bit freaked out by the extent of the scarring. It was VERY noticeable. Maybe it gets much better with time, but I couldn't tell by looking at the one photo and I sensed the doctor and nurse were subtly confirming that there was inevitable significant scarring :-(

From searching on the Web, it appears that there are some doctors performing Mohs surgery for melanoma in situ and that it's a fairly recent advancement. Here's an example of what I found: http://scopeblog.stanford.edu/2016/06/2 ... -medicine/

Do I have this right? This would seem a desirable option over blind 5mm margin excision, even if I had to travel for the surgery.

Thanks!
Last edited by barry_g on Mon Oct 02, 2017 7:20 pm, edited 1 time in total.
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Re: Newly diagnosed - excision question

Postby barry_g » Wed Oct 11, 2017 7:18 am

Update:

Based on a highly respected recommendation, I traveled to Cambridge MA and had an excision with 5mm margins and reconstruction done by Dr. Stephen Sullivan. Melanoma excision with reconstruction is a specialty of Dr. Sullivan and he has done specific work/research with Dr. Frank Isik in Seattle (both are plastic surgeons) on exactly this. I highly recommend both these doctors. My procedure was done under local anesthetic only (by my request) and I was impressed with the degree of care Dr. Sullivan exercised during all phases of the procedure, and particularly during the reconstruction (fitting with my facial contours, suturing in such a way that the scar would be minimal and flat, etc etc)
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Re: Newly diagnosed - excision question

Postby Catherine Poole » Thu Oct 12, 2017 7:22 am

I am happy to hear you had a good experience. MOHS is being used for melanoma more often. I don't know how accepted it is. I did have it for squamous and then had a plastics professional close it. I am happy you found a good expert to handle your excision.
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Melanoma International Foundation
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