Question:
I am 49 years old. My
daughter, Amy, is 20, and she was just diagnosed with "melanoma in situ
(at least)". I talked to the pathologist. He said that he thinks the
cancer cells are in the top portion, "the superficial" layer of the
nevus. The deeper cells of the compound nevus (I think that means
partly in the epidermis and partly in the dermis) he thinks are regular
nevus (mole) cells. He recommended 1 cm margins for reexcision of the
mole site.
I talked to the dermatologist who did the biopsy. She told Amy that
she will have a 3 inch scar. The scar is the least of my worries,
although it is a worry. What I've read in only the last two days, it
seems that a 3 inch scar for 1 cm margins from a mole site that is only
1-2 cm is excessive. If anybody knows anything about that I would be
very appreciative. She said that the pathology report was very unusual.
Most pathology reports are black or white. This one is uncertain, and
even though she still thinks that Amy's prognosis is good, the
uncertainty is what is leading them to a more conservative treatment,
i.e. the wider margins.
I asked her if we should get a second opinion. She said wait until the
surgery (scheduled Oct. 28). I talked to my parents who know a doctor
that used to be on the teaching staff at Stanford, and he will look at
Amy's case for us. He is a plastic surgeon. He treats my dad for his
skin cancers - basal and squamos, he's up to four or five now - my dad.
My folks feel this doctor is very good.
After telling Amy's doctor to send her records to Doctor Pardoe, they
called her cellphone and left a message asking her to confirm that she
wanted to cancel her surgery. I told her to call them back and tell
them no. I don't know why they jumped to that conclusion so quickly.
I might do that, but not yet. I just want a second opinion. Now, of
course, Amy is more upset. She is a student at UC Santa Barbara. Her
dad and I live in Yuba City, CA (by Sacramento).
I think I want to send her to Melanoma Center UCSF. But I want to know
what Doctor Pardoe says.
Sorry - just rambling. Don't really know what I need to know from
anyone. Just wondering what anyone might know that I don't. Please
tell me whatever you think will be of use.
Thanks to all for your help. Take care.
Answer:
Standard management for melanoma of any sort is wide local excision. Most
dermatologists and oncologists think 1 cm margin is adequate, and there is
no evidence to suggest otherwise.
In situ melanoma carries a VERY good prognosis, btw.
