Excision to be sent to Pathologist;NOT MOHS

› Forums › General Melanoma Community › Excision to be sent to Pathologist;NOT MOHS

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    • September 20, 2017 at 3:42 pm
    Gardengal
    Participant

      I have a Malignant melanoma,superficial spreading type, 0.33mm in depth on my back. Melanoma in situ involves the peripheral margin. My Dermatoligist is going to excise and send to Pathology. Why would'nt MOHS surgery be used instead? I asked during my consultation, and be basically said it wasnt the Standard of Care for this type, but everything I read seems to indicate MOHS, so I'm confused! 

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        • September 20, 2017 at 4:04 pm
        Jamie1960
        Participant

          If it were on the tip of your nose (or other highly visible location), then you might be offered MOHS for cosmetic purposes. Otherwise, WLE seems the way to go; much faster. Caveat here is that I am personally a proponent of cutting aggressively, and not concerned much about the cosmetic implications.

            • September 20, 2017 at 4:35 pm
            Gardengal
            Participant

              I am not opposed to WLE and not concerned with cosmetic implications. I guess piece of mind would come sooner with MOHS instead of waiting for PATH report. 

              • September 20, 2017 at 5:06 pm
              Julie in SoCal
              Participant

                The other reason MOHs isn't used in Melanoma is that the pathology takes a while to get (they can't just stain, freeze and look) so a MOHs for melanoma actually takes longer. I've heard this called "slow MOHs" as the patient keeps coming back for the procedure until they have vlear margins.

                Shalom

                Julie

                • September 20, 2017 at 7:00 pm
                Gardengal
                Participant

                  That makes sense. Thanks for the update.

                  • September 20, 2017 at 7:10 pm
                  Janner
                  Participant

                    Mohs uses "frozen section" technique.  WLE uses parafin with stains.  Stains show melanocytes much better than frozen section.  (If you can't see the melanocytes, how can you be sure you have good margins)?  Mohs is used for the other skin cancers and occasionally lentigo maligna but it is not really the best choice for melanoma – unless – as stated above – the area is in an extremely cosmetic/visible area.  In addition, Mohs is used when you are just trying to get CLEAN margins and melanoma also demands wide margins.

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