Margins for Re-excision of Severe Dysplastic Nevus

[trishw148]

Hello,  I had a suspicious mole on my neck removed in June and it came back as mild-moderate dysplastic nevus with differential diagnosis of early melanoma in-situ.  The area was re-excised with 3mm margins.  Since then I have had the slides re-evaluated by UPenn Dermatopathology and their diagnosis was Severe dysplastic nevus with differential diagnosis of evolving melanoma in-situ.  My dermatologist says the 3mm margins is probably ok since that sample came back clear (just scar tissue) but it was up to me on whether to have an add'l 2mm taken around the scar.  I am uncomfortable with the work 'probably ok' when there is a differential diagnosis of melanoma in-situ.  Looking for another opinion.
Thanks.
Tricia

[paulocast]

I have found another interesting reference:

Lentigo maligna is treated with definitive surgical therapy. The actual margins of atypia usually extend beyond the clinically apparent margin; total removal may be difficult. National Comprehensive Cancer Network (NCCN) practice guidelines for melanoma in 2006 are as follows (tumor thickness, recommended clinical margin):11


Tumor in situ, margin 0.5 cm
Tumor less than 1 mm, margin 1 cm
Tumor 1-2 mm, margin 1-2 cm
Tumor 2-4 mm, margin 2 cm
Tumor >4 mm, margin at least 2 cm

http://emedicine.medscape.com/article/279839-treatment

[paulocast]

I suggest you see an oncologist surgeon, because dermatologists tend to underestimate  dangerous lesions. I lost half of my nose due to an irresponsible dermatologist; I needed a Mohs’ micrographic surgery. Please consult an oncologist. Also, using a larger margin will not cause problems...


"Mohs’ micrographic surgery might prove useful for excision of melanoma, especially lesions located on the head, neck, hands, and feet. However, there are no formal recommendations pending additional studies.4 Studies suggest that the current recommendation of 0.5-mm margins for lentigo maligna (melanoma in situ) is often insufficient. Mohs’ micrographic surgery and margin-controlled excision of lentigo maligna offer lower recurrence rates and allow tissue to be conserved."

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/cutaneous-malignant-melanoma/