Wide Local Excision for Atypical/Pre-Cancerous Cells?

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5/5/2011 7:55pm
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Replies: 10

Hello everyone. I was diagnosed with Melanoma in-situ last June. I had my wide local excision on my calf and everything has been fine since.

I just had my checkup and had two moles biopsied. One came back as squamous cell carcinoma which they say they will freeze the remaining borders.

The other came back as an atypical/precancerous mole (that was the words the nurse used). She said I will need to have an exicision for the atypical mole. I was kind of stunned at the time so I didn't really question it but the more I look into things this seems to be a very agressive treatment, even with my history of melanoma.

I left a message for the derm to call my back. The lesion in on the back of my shoulder- kind of where my bra strap sits. I also have concern about there being enough skin for an excision. I am pretty thin and it sits right on top of a bone.

Anyway, I am curious to see what everyone thinks of this treatment plan. I can't find much information at all about WLE's for atypical moles.

Thank you in advance.

Amanda

Here is some info on atypical moles:
http://www.acne-psoriasis-treatment.com/skin-disorders/atypical-moles.htm

It says that: "Atypical moles should be removed immediately if they are changing color, shape or
size over a period of weeks to months. These moles should also be removed immediately if they
bleed or itch. These signs all suggest that an atypical mole may have turned into a melanoma."

Therefore, it is always wise to be cautious with any lesion that could look suspicious.

Frank from Australia

I urge everyone to thoroughly educate themselves about melanoma. No part of this post should be considered to constitute any form of medical advice. Please consult a competent oncologist. (I think that prayer can help in ways that we don't always expect).

Amanda,

While I am not thin, I've had wide excision on my right shoulder, near my bra strap. I was still able to wear my bra, which is good as I'm large breasted. Please don't panic, it's not bad. I definitely would talk to your doctor directly.

My go to question is always: If this was YOU, or your wife, would you do this? The doctor's have always been honest when answering me, and it helps me put things in perspective.

If advised for wide excision, do it. I had my left shoulder done in 2005. Now I'm deeply into stage III, and had to have my right shoulder done. Mine is centered on my scalp though.

Good luck, stay calm, and take notes when talking to the doctor. Better yet, take a friend to help listen.

TracyLee

Never will I leave you, never will I forsake you. Hebrews 13:5
Cast all your anxiety on Him, because He cares. 1 Peter 5:7

Stage IV 5/16/11

Ipi - 4 rounds May - July 2011
BRAF expanded access trial 8/8/11

Precancerous is a misnomer.  This implies, if left alone, it would have become cancer.  That isn't the case.  The vast majority of atypical moles never become cancerous.

The general rule of thumb for atypical moles:  if it is mildly atypical, you want clear margins.  If it is moderately atypical, you want clear to conservative margins (2-3mm).  If it is severely atypical, you want 5mm margins - just like melanoma in situ.  There are some doctors who will just "watch" mild or even moderately atypical lesions even if they don't have clear margins, but most prefer at least clean margins.  My cutaneous oncologist doesn't leave any atypical cells hanging around for fear the trauma of the biopsy itself could cause them to mutate.  He prefers to play it safe.

So, for you, it basically depends on how atypical the lesion was, and if the margins are already clear.

Best wishes,

Janner

Thanks so much for this info. I have dysplastic nevi syndrome and have had lots of this type removed. I had heard others getting WLE for them and was wondering if I should be concerned that none of mine have had any further surgery. Now I understand that it has to do with the margins that they took.  Thanks soooo much!!

There is less fear in knowledge.

When in Doubt, Cut it Out!!
Do what you can, where you are, with what you have. (T. Roosevelt)

Is it mild, moderate, or severely atypical? That is how they are graded.

My derm watches mildly atypical, and re-excises moderate and severe. For moderately atypical, some derms may consider re-excision, or they may decide to leave it and watch for change, and severely atypical moles should always be re-excised. You may wish to discuss this with the doctor before continuing.

I had a moderately atypical mole re-excised on my left shoulder blade some time ago and it closed up just fine.

My fathers derm also used the term pre-cancerous and as I explained to him, that is a misnomer as most dysplastic nevi or atypical moles never do become melanoma.

Michael

Stage 1b

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

Thanks everyone for your responses. I knew I would get some great info on here. I knew the term pre-cancerous was not correct but like I said in my first post- I was a little taken by surprise by the call and didn't know what questions to ask for atypical moles. But I do know :o) I will find out if it is mild, moderate, or severe. I will also get a copy of my pathology report. That really helped me last time when I had the Melanoma in situ. I have a call into my doctor. 

So for the squamous cell carcinoma on my upper arm she is just going to freeze the borders. Does that sound like a typical course of treatment for squamous cell? 

With squamous cell, you are looking for clear margins.  You can get that by cutting it out, topical chemo, freezing, or other methods.  Any are fine.  Sometimes one is better than the other depending on the cancer and the anatomical site.  But having yours frozen doesn't ring any alarm bells.  I had one "scraped" off my forehead.  I was offered topical chemo but that would have been 6 weeks of an open sore versus one scraping (which would leave a small scar).  Freezing is a standard method for SCC. 

Best wishes,

Janner

My dad had squamous several years ago and did not freeze anything. I can't recall if they just made sure there were clear margins, or if they did any kind of wider excision. But I'm certain whatever they did was via an incision and not any kind of freezing or burning. I had a mole removed that was partially mildly atypical and partially severely. I go to MD Anderson which is 750 miles for me. My PA was so certain it would be atypical that he took enough out to cover the margins needed so I wouldn't have to come back, and of course the pathology confirmed if he took enough or not.

Hey everyone. I just wanted to let you guys know that I talked to my doctor. I asked her why she was recommending excision for the atypical moles. She said it was a combination of factors. The first is that the margins are not clear. The atypical cells extend deep and around the border. Also, the patholgy reported the cells were mild to moderate. She says anytime the word moderate is mentioned she leans towards excision. And lastly, she said it is in an area that is not easily seen and can't be watched as closely. So for those reasons combined she recommends a conservative reexcision.

I am happy with her reasoning and while I'm not happy about having to go through another excision I will move forward. I am, however, thrilled that the two lesions are NOT melanoma!!

I just had an excision on my upper right back, shoulder area, near the bra strap.  I was diagnosed as Stage IIC Malignant Nodular Melanoma of the Right Shoulder.  My actual scar is over 7inches long, and I did not require any skin grafting.  My surgery was done on 4/12/2011, and I still have a lot of tightness.  My arm movement is still limited, and at night I do have some trouble sleeping.  I have noticed a difference since surgery though, so the skin is gradually stretching.

Basically, if the doctor didn't believe I needed anything other than stitches.  Although, I did have the stitches in longer than normal, and he didn't remove them all at once.

Good luck...Michelle