Home Forums Melanoma: Stage III Newly diagnosed, question re excision margin …

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  • #20927
    bobgerard
    Participant

    Hello everyone. On Dec. 3rd I got the call that told me I had a nodular melanoma. It was on my scalp and was already quite large after being there a few months with me thinking it was an insect bite gone awry. The initial biopsy was “Skin lesion, crown: Ulcerated invasive malignant melanoma, maximum depth of invasion at least 3.3mm, 5 melanocytic mitoses per square millimeter, deep and peripheral margins involved”

    The 2cm excision occured on Dec. 21st, and the pathology report we received was no better.

    Thickness 3.8mm,

    Evidence of healing ulceration(with active ulceration confirmed in the previous biopsy),

    Mitotic rate 15 per mm sq,

    Multiple satellite metastases present in the underlying subcutaneous fat and superficial portion of the fascia, extending to within < 1mm of the deep excision margin, No perineural or vascular invation identified, No associated melanocytic nevus present, Non-brisk response by tumor-infiltrating lymphocytes, Regression absent, Peripheral cutaneous margins widely free of tumor. The doctors involved are concerned that the satellite metastases are potentially too close to the deep excision margin ( < 1mm) and that this may be cause for a re-excision all the way to the surface of my scull. They suggest that they do this AND the sentinal node removal during the same surgical session. But they are leaving the decision as to whether or not to do the re-excision up to me. I have calls into a number of physicians to help address my questions, but my main question for this forum is: “Does anybody with experience in this area believe there is a margin of error associated with these pathology reports such that, in my case, there could still be satellite metastases that were beyond the margin of excision, and that therefore redoing the excision to go even deeper is probably a good idea.” Many thanks everyone. Bob.

    #58518
    Catherine Poole
    Keymaster

    Are you in a center of true melanoma excellence?? I think you need to get to one pronto for an opinion if not. This is a serious situation that needs expert attention. We can help you find the right center. Let us know.

    #58519
    bobgerard
    Participant

    Thanks Catherine. I am in Vancouver, Canada. Our BC Cancer Agency is highly regarded, and I do have a melanoma specialist on my team. I have a call into him today, but haven’t heard back from him yet, but thought I’d give this forum a post for additional input. I hope I am in good hands and I am trusting they have an appreciation for the urgency.

    #58520
    Catherine Poole
    Keymaster

    We have a board member from the BC cancer agency, so I believe you are in good hands. I hope things move along quickly for you as I know there can be delays. Let us know things are going for you.

    #58521
    Shirley Z
    Participant

    Hi Bob,

    Sorry to hear about your diagnosis. I totally agree with Catherine. With it being on your scalp along with the depth and mitotic rate I would definitely try to move things along as quickly as possible.

    Good Luck to you and keep us posted.

    Shirley Z

    #58522
    hadriya9091
    Participant

    Great news Karen! It proves true what we discuss so often on here about the patient being their own best advocate. Good for you for asking to be retested.

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