Mohs surgery - diagnosed Melanoma in situ, early lesion

Posted By
Anonymous
2/9/2014 8:22am
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Replies: 8

Anyone familiar with Mohs where the first layer was down to the fat layer, silver dollar size.  On my face, 25 stituches externally.  I am in shock, scared and need some suggestions or comments from someone who can explain why just one layer, so deep.  Not sure what happens next, other than wiating for pathology.  Mohs surgeon said to call them in one week.  

 I had a silver dollar sized stage I splotch on my forehead. Somehow Dr. Jessica Fewkes, of MGH, got it off with MOHS and two subsequent surgeries, and threw it into a pail. I think she had to use a carpet layer knee kicker to get the skin to close up after she got it out. She also sings beautiful arias as she does a running stitch closure. Now I have no wrinkles on my left forehead, and can't cock the left eyebrow and I love it. I think it was pretty deep because the MOHS is like an open mining pit with concentric circles getting deeper as it goes down. She started cutting about an inch away from the splotch and left me with no discernible scar unless one looks very closely. 

Normally they would just leave it alone for a fellow with stage IV melanoma in the lungs, but my Taflinar and Mekinist seems to have killed the numerous tumors, so they had to write up a new protocol for all us who remain undead and have new stage I melanoma appear. I am in my fourth year as a warrior and it feels grand. The MOHS just takes a bit longer than normal surgeries as they put the tissue under the scope during the operation, and come back for more when it is indicated. All these little cuts are nothing compared to the lung biopsy I had in December of 2010 that was my ticket into the wonderful GSK combo trial that I am so proud of.

I insist on taking out anything new that appears because I feel like Mark Twain's cat that sat on a hot stove lid, and then wouldn't  even sit on a cold one. Don't worry if they have to trim it up a bit more as it is impossible to get the real results during the actual MOHS, just a probable indication that they got it all. Just stay on the fight, and load your backpack with vigilance, hope and gratitude. Fear, doubt, and worry only saps your strength, and then it is harder to keep your spirit which is an important, maybe essential, part of our recovery.

The history of the world is the battle between superstition and intelligence.

I am reading a couple posts here about Mel in Situ and MOHS. This post is very positive for me as I face MOHS in a week for MIS on my scalp. Sounds like my "open mine" will be about 2 inches and may have to be closed up with another piece of hair bearing scalp from somewhere... 

 

But the piece here that makes me laugh is the "carpet layer knee kicker." And, I too, am hoping this gives me a free facelift.

CFenton

Melanoma in Situ

 I had a silver dollar sized stage I splotch on my forehead. Somehow Dr. Jessica Fewkes, of MGH, got it off with MOHS and two subsequent surgeries, and threw it into a pail. I think she had to use a carpet layer knee kicker to get the skin to close up after she got it out. She also sings beautiful arias as she does a running stitch closure. Now I have no wrinkles on my left forehead, and can't cock the left eyebrow and I love it. I think it was pretty deep because the MOHS is like an open mining pit with concentric circles getting deeper as it goes down. She started cutting about an inch away from the splotch and left me with no discernible scar unless one looks very closely. 

Normally they would just leave it alone for a fellow with stage IV melanoma in the lungs, but my Taflinar and Mekinist seems to have killed the numerous tumors, so they had to write up a new protocol for all us who remain undead and have new stage I melanoma appear. I am in my fourth year as a warrior and it feels grand. The MOHS just takes a bit longer than normal surgeries as they put the tissue under the scope during the operation, and come back for more when it is indicated. All these little cuts are nothing compared to the lung biopsy I had in December of 2010 that was my ticket into the wonderful GSK combo trial that I am so proud of.

I insist on taking out anything new that appears because I feel like Mark Twain's cat that sat on a hot stove lid, and then wouldn't  even sit on a cold one. Don't worry if they have to trim it up a bit more as it is impossible to get the real results during the actual MOHS, just a probable indication that they got it all. Just stay on the fight, and load your backpack with vigilance, hope and gratitude. Fear, doubt, and worry only saps your strength, and then it is harder to keep your spirit which is an important, maybe essential, part of our recovery.

The history of the world is the battle between superstition and intelligence.

Thank you for your strength, determination and keeping it real.  Knee kicker, lol.  May I ask, could you work shortly after your forehead excisions?  I thought I could slowly go back to being active one week after, but my face (and body) is saying rest.  I know, listen to my body.  Will you call my boss?  

Wishing you all the best as we fight to live a long, happy, grateful and blessed life.  

 

I went about my life as if it never happened each time I had the surgery. The sutures come out in a week, and then I didn't have to keep it dry any longer. Make sure it isn't something else that your body is saying, as this surgery is no big deal as far as pain, after affects etc. I only felt pain when I turned over in my sleep and pressed on the bandage. So keeping it dry is the rule to follow, get the stitches out after a week, and that was it. That was my instructions but you must check with your doctor to see if it is the same for you. I thought mine must have been as deep as yours, but didn't want to say so. That's why I love it when Janner gently come in here and tells us what is really happening. My doctor ordered a small tube of white cream for me to apply and it is soothing and maybe helps the scarring. It is packed right now so I can't  tell you the name of it. Better not have me talk to your boss.

The history of the world is the battle between superstition and intelligence.

Love your last 2 sentences...... always find it hard to put my thoughts into words, but you hit the nail on the head!

First, Mohs isn't done all that often for melanoma but I'm sure the reason they used it was to save as much tissue as possible.  Second, all wide excisions (whether Mohs or excisional) go down to the muscle fascia - they take all the skin and subcutaneous fat.  That's standard procedure.  Was your lesion Lentigo Maligna?  It generally has a higher local recurrence rate so they try to get clean margins and EXTRA margins just in case.  Most melanomas require at least 5mm margins for in situ and more for deeper lesions.  You want to remove all those melanoma cells and have nothing left behind.  Cells left behind have the possibility to grow again.  Melanoma isn't something to trifle with so the goal is to get everything possible at this time.  Having this on your face sucks, but hopefully it will heal quickly and this will be the only experience you have with melanoma.

Best wishes,

Janner

Thank you for your insight and sharing your strength!   Put a smile on my face :)