Question Title: melanoma

I recently had a melanoma removed from my face. The original biopsy report listed it as melanoma in situ. After removing the entire lesion, the pathology report described it as Breslow depth .44mm, Clark Level II - a bit more than in situ. The Plastic Surgeon who removed the lesion took minimal margins because it was on my face. Any more would have required a skin graft. While the final pathology report stated that the margins are clear with the closest margin being at 2.5mm from the lesion, my plastic surgeon is concern that this may not be enough. Although she and a local dermatologist aren't saying I should have more removed, they are leaving it up to me. Actually, my dermatologist, with some hesitation, said he would leave it alone if it were him, and watch it closely.

I would greatly appreciate your opinion.

Thanks -- Thomas

tom:

You ask a tough but important question, which goes beyond my area of specific expertise. The issue of margins in melanoma (or any cancer) has a lot to do with gut feelings and practicality, not just hard data. In breast cancer, for instance, old-fashioned surgeons thought it was a good idea to take off as much as possible, just to be safe, until women who thought keeping their breasts was important forced the profession to perform the studies which showed that more is not necessarily better. As a reult, margins taken in breast and other cancers, like melanoma, are much smaller than they were 25 years ago.

But what to do in your specific case? It's obvious that neither your surgeojn nor dermatologist feels certain, and I can understand why, since the stakes (a facial skin graft) are high. If it were me, I would consult an expert in melanoma (for instance, NYU in New York, Mass General in Boston, the Mayo Clinic) where surgeons ans dermatologists have a lot of experience with a wide variety of cases. (For perspective, in 20 years practicing dermatology, I've seen one or two melanomas on the face.)

I don't mean to suggest that these 3 are the only places, or that they are privy to some gopsel truth available to no one else, but I think their opinion would give you a level of comfort which you want and ought to have. Agter all, it's your life and your face, and the extra effort, even if it means some traveling, is propbably worth it. I don't know where you live, but a major medical center nearby would be a good place to start.

Good luck.

Dr. R

Keywords: melanoma, skin graft, Rockoff

Dr. R

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