View Full Version : Local recurrence of “lentigo maligna melanoma on face”—larger excision needed now?

10-05-2007, 12:21 AM
I had a “lentigo maligna melanoma” on my face below my right eye and next to my nose that has been removed twice but with narrow margins. I want the peace of mind that will come with knowing I have done everything humanly possible to eradicate the beast and will be grateful for your input about what next steps I should consider undertaking.

It was first removed in June 2006 following presentation as a slightly discolored area (changing from an innocent patch of tiny freckles into a distinct patch of very prominent brown dots) in the vicinity of a mole removed 20 years ago. The path report says it was excised with narrow margins and further states: “the sections show skin biopsied into the deep reticular dermis. Across the epidermis at the dermoepidermal junction are seen increased numbers of large atypical melanocytes, which focally form nests. This proliferation extends to the lateral biopsy margin. On the outside slide, the sections show skin biopsied into the reticular dermis. At the dermoepidermal junction are seen enlarged pleomorphic melanocytes, increased in number and extending to the peripheral biopsy margin. A small eccrine hidrocystoma is also present in the biopsy specimen. The section of the skin reexcision specimen shows skin excised into the subcutaneous tissue. The epidermis has a somewhat flattened ridge pattern. At the dermoepidermal junction are seen confluent atypical melanocytes, which form nests. These extend to within 0.9 mm of one lateral biopsy margin in the central portion. Biopsy site changes are evident.”

In July 2007, pale brown patches reappeared and were excised on September 25. The path report reads: “Predominantly within the central portions, there remain an atypical basilar melanoctic proliferation that consists predominantly of single cells and harbors severe cytologic atypia compatible with melanoma in situ, lentigo maligna type. Although the lesion is technically excised, it does approach to within less than 1 mm of multiple lateral side section margins. Therefore, close clinical follow-up of this patient is recommended. Should a pigmented lesion recur or persist at this site, a conservative reexcision procedure would be warranted.”

During the September 2007 procedure, the doctor excised a section off my right cheek about the size of a quarter. He did a right eyelid lift in order to use that tissue for a graft to help close the wound. Stitches were moved 10/1/07, and it appears the graft has taken.

Some questions I have thought of so far are:

1. I live in Northern California and have used a sole practitioner dermatologist. Should I consider getting a second opinion from UCSF or another melanoma center? Can you recommend a contact there?

2. Should I consider a further excision NOW to totally be safe? ( I do not care about scars.)

3. Should I consider any procedure related to lymph nodes?

4. Can anyone tell me succinctly what the path reports mean?

Thank you very much for any thoughts you have!