Treatment for finding second DCIS

[Judythe]

Want to know what treatment is recommended after having a partial mastectomy in right breast because of one biopsy of
DCIS and pathologist finding after operation of another one on a margin of specimen that was high grade DCIS?

[CCF-RN,MSN-rf]

Dear Judythe:  There are two issues here.  One is that most would agree that it is desired to have margins free of tumor.  In this case, a wider excision can sometimes be done if there is ample tissue remaining.  If the surgeon does not believe he/she cannot accomplish this with a good consmetic result, then a mastectomy may be recommended.  The second issue is whether this is one focus of DCIS or whether this represents a separate focus of DCIS from the original tumor.  If this represents multifocal disease, a mastectomy may be recommended to be certain that there are no additional foci.

[surgeon]

Most people feel margins of the lumpectomy ought to be free of cancer cells; so most would, at minimum, recommend repeat excision of that edge. If the surgeon feels she/he has taken all that's possible without significant compromise of the cosmetic result, then one has to consider simple mastectomy.