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November 10, 2012 at 9:58 am #20760
So glad to have found this forum. The biopsy my daughter had resulted in “conflicting criteria”, some consistent with melanoma, or compound atypical nevus, or other. They would like to do a complete excision, with her awake, but they cannot fit us in until February. The PA seemed to think my daughter could take it since she did so well for the biopsy, but given she could not say how many stitches, only that it would be around 30 minutes and then the fact they did not get enough the first time, I am wondering if there is not a better option. Pathology report says quite a lot I won’t detail here unless anyone is curious, but they did say they could utilize FISH or CHG to help predict the biologic behavior, but regardless, it extends to the peripheral and, via eccrine ductal epithelium, to the deep surgical margins, and given the unconventional changes, additional treatment to ensure complete removal would be prudent.
So my initial questions are just any thoughts for those who have had the procedure of the “football” cut given my daughter’s age, the PA’s only comments were that they would take it one layer at a time. I have not been able to find a lot on this online.
ThanksNovember 10, 2012 at 7:55 pm #57451TreeFrogParticipant
Sorry you are going through this with your 6-year-old. I had my biopsy site on the back of my thigh re-excised (WLE – wide local excision) a couple of years ago because the diagnosis was Stage 1a melanoma. It was done under a local and took under 15 minutes. Two layers of stitches were done: the inner were dissolving stitches, and the outer had to be removed by a nurse a few weeks later.
I’m not sure what part of the body your child’s excision will be on – this might affect how long the procedure will take.
Waiting three months seems very unusual – it’s a simple surgery that any surgeon can perform. However, you mention “taking it out in layers.” This makes me wonder if they are planning MOHs surgery. This is a technique where they examine each layer of tissue under a microscope before removing more. It’s not the usual technique for melanoma.
Others on the forum may have more information on this. Can you tell us: what part of the body is involved, and what city you are in? That might help forum members provide more advice.
~WendyNovember 10, 2012 at 11:32 pm #57452
Hi! Thank you for your reply.
It is on her tricep. I think the procedure you described is the same, by layers I think she was referring more about the anesthetic? I don’t know it was a very quick follow up. She had called to give detailed results but called a wrong number apparently so I did not know about any of it or the options before the appointment. We are in Eugene, Oregon (not the sun here that did it, it appeared when we lived in Wyoming). The pathology lab that analyzed was at OHSU in Portland. I am curious about the time since 15 minutes seems a little more doable for her to manage with just a local then 30. Any other advice on second opinions or anything welcome.
Thanks again so much for the reply,
MelissaNovember 11, 2012 at 12:02 am #57453Catherine PooleKeymaster
I would like to see her pathology report. Either it is melanoma or not. A six year old rarely can get melanoma. I would definitely get a second opinion, I would try Harvard based Dr. MIhm, who has an online service, http://www.drmihm.comfor a second opinion. Or have your slides sent to UCLA. Perhaps the wide excision won’t be needed at all. You need another opinion.November 11, 2012 at 9:59 pm #57454Lisa PParticipant I, of course, am with Catherine on this one. First, she’s the expert but, second, based on my experience, the information you’ve received is a bit confusing. By the way, I’m in Seattle and the sun can definitely contribute to melanoma, regardless of whether it’s bright and sunny or not. Use your sunscreen whenever you go out just to be safe. Please let us know what your second opinion comes back as. In the meantime, I’m wishing you and your daughter the best possible outcome — LisaNovember 12, 2012 at 2:52 pm #57455krissy424Participant Hello and welcome. Having a wIde local excision on my upper back was no more painful than going to the dentist. I heard the surgeon explain to my husband about closing the flap where it looked like a football. Well, sort of. Mine took a full hour to complete. Also, the healing took 3+ months. Second and third week there was a lot of drainage. Best of luck. Fingers crossed that your little one doesn’t need surgery. KrisNovember 13, 2012 at 9:59 pm #57456LaurieParticipant mmm325,
I agree that you should follow Catherine’s suggestion of second opinion of your daughter’s pathology report. It is warranted.
That said, if your daughter needs to have additional excision on her arm (or if she ever needs stitches in the future), the question of anesthesia with a child is because she may not be able to lie still. With the arm it is very difficult not to “look” at what the dr is doing. Having had four WLE’s on my own arms, I can tell you it is very hard not to look and I’m an adult. The additional time (15 vs 30 minutes) may also be an issue of stitch size (due to child) and not wanting to leave a pronounced scar on someone so young; or it may be a plastic surgeon. My WLE’s have ranged from 15 minutes to 30 minutes; depending on complexity.
I wish your daughter and yourself all the best and hopefully the second opinion will provide a clear diagnosis for you both.November 13, 2012 at 11:52 pm #57457krissy424Participant
My ‘football excision’ not sure the correct term , went very deep and the incision was over 6″ long. I’ve not seen one of these with a pleasent scar. I’m would think the results would look better on a tiny arm.November 14, 2012 at 8:38 am #57458 Thank you all for your replies. I don’t have slides, only the path report, but I will look into the link you gave and see if I can get them, Catherine, thank you very much.
With the holiday it took a little time to get the ball rolling on call backs from the doctors. I spoke with my daughter’s primary to request a second opinion, she felt strongly about staying with the current dermatologist and agreed with his assistant that he is very good, however she did not have the pathology report, so I tried to describe my concerns and then brought her a copy, waiting for a call back. The derm’s office did call back today which I appreciated.
The PA made it clear that additional removal was absolutely necessary, and that there was no point in doing further testing of the biopsy since it would need to be be excised based on the existing findings. She was pretty clear that there would not be more information until that procedure was done and that there was nothing else they could have done differently. So at that point I felt more confident the procedure was indeed needed and asked about the logistics. She informed me the WLE would be 4 fold the biopsy site, and considering that and how tiny my daughter’s arm is I thought that sounded like a good reason to go ahead with the anesthesia which is the norm for kids I guess, but the PA and I had hoped to avoid.
Given this I requested Doernbecher Children’s Hospital (OHSU) in Portland for the procedure since her sister and her are being seen there already for other things. I have not been able to find any reviews or information on the doctors there in that clinic, but I am hoping they will be the best option since they specialize in kids. After reading the posts from Lisa, Kris and Laurie I am encouraged this is the right decision as well. Thank you for sharing your experiences, that was helpful.
Anyone familiar with the clinic at this hospital? Or have any advice on a resource for reviews or feedback? I have some hesitation since the PA was persistent in that Dr. Knapp here being so good at minimizing scarring. Just a mommy’s incessant worrying you know, sigh. For now the PA said a scheduler will call me with a date tomorrow for the excision. I know this isn’t a melanoma I & II proper post, so I do greatly appreciate the feedback. It is so nice to have a “conversation” with some understanding and knowledgable folks during an anxious time of “wait and see”. Thank you.
MelissaNovember 14, 2012 at 2:33 pm #57459Lisa PParticipant
I’m glad you’re feeling better about your derm and your decision, Melissa. The anxiety surrounding all of this stuff can be overwhelming. If you have the path report, can you transcribe some of it here? It would be interesting to see what they meant by conflicting info that is consistent with melanoma. In the meantime, take good care of yourself and your daughters. Sounds like you’re all in good hands. LisaNovember 14, 2012 at 10:25 pm #57460Catherine PooleKeymaster I want to say this as gently as possible, but a PA (physician’s assistant) should not be making any judgement calls. I highly respect this profession, but there are very few melanoma specialists in this country and I doubt she truly knows this disease as specialist physician would. I would still highly suggest you call and have the slides read by a true melanoma specialist dermatopathologist. They are rare too, but you will find them at UCLA, Hopkins, PENN, Sloan Kettering, or Dr. Mihm from Harvard. ( http://www.drmihm.com)
The re-excision is done to pick up any stray cells, it is not necessarily a truely needed procedure for lesions that are low risk or not certain to be melanoma. The biopsy normally picks up all of the lesion. You have plenty of time to get another opinion from a specialist before putting your daughter through this procedure. Melanoma is extremely rare in children and it would be questionable that she has it. Do not let a PA pressure into a procedure without checking with a specialist. You are a normal mom looking out for the best interest of your child. I understand what you are going through. But you need specialist advice.November 15, 2012 at 2:54 pm #57461WorrywartParticipant
How many opinions did you get on your daughter’s pathology? Just the one? Forgive me if I missed something. Who read the initial slides? Regardless, you need to get those slides sent to an expert before proceeding. Call your derm office and have them send them to Dr Mihm. It should not take long for results. Based on those results, you can go ahead with a wider excision or not. I would definitely use anesthesia if the wider excision is necessary.
Let us know how things go!
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