Hi, Will try to avoid sticking my foot in it- as I have with some previous posts under "Overtreatment?".... First primary, a "lentigo maligna melanoma", was excised two years ago. No recurrence- that I am aware of. Second primary "superficial spreading malignant melanoma" I've been tracking 8 months, located 20 cm from the first primary, was excised three days ago. Pathology received today is neither entirely innocuous nor very serious. Breslow, mitotic rate and Clark are all "ok" or better.
QUESTION: What are "adequate margins", given the diagnosis/description below? ("very close to the lateral margin...very narrow margins..narrowly excised")
DIAGNOSIS: "Malignant Melanoma, 0.74mm Breslow's Depth, Clark's Level III. The lesion has been completely excised, although it extends VERY CLOSE TO THE LATERAL MARGIN.
DESCRIPTION: There is an asymmetric proliferation of atypical melanocytes arranged in nests and singly at the dermoepidermal junction as well as above it, with extension into the papillary dermis. The lesion measures 0.74mm in depth and would be classified as Clark's level III, as the papillary dermis is filled and expanded. There is pigment deposition throught the lesion. There are less than one mitoses per millimeter squared. There is brisk tumor infiltrating lymphocytic inflammation. There is no evidence of ulceration or lymphovascular invasion in the sections examined. The findings represnt superficial spreading malignant melanoma, which has been completely excised, albeit WITH VERY NARROW MARGINS. One of the sections also shows small nodular masses of basal neoplastic cells with nuclear pleomorphism attached to the basal layer and surrounded by a loose fibrous stroma and mild inflammation in the superficial dermis, findings typical for a superficial type of basal cell carcinoma. This has also been completely, BUT NARROWLY, EXCISED.
Surgeon's recommendation: Re excision, increasing margins by 1 cm each side.
I requested of pathology: Quantified definition of "VERY CLOSE TO THE LATERAL MARGIN....NARROWLY EXCISED....VERY NARROW MARGINS".
Response to "Overtreatment?" post was overwhelming. And enlightening, particularly from Janner, JerryfromFauq and Minnesota. Many thanks! I would much appreciate your opinions about "Margins?", in light of the pathology. Thanks very much!