American Society of Plastic Surgeons
For Medical Professionals
3 years ago

Appropriate margins

Just been diagnosed with invasive melanoma (Breslow 1.4 mm) on helix of ear. Wondering what the appropriate margins are for surgical excision. I understand there is some controversy about whether conservative excision is better or not. Also whether sentinel lymph node biopsy is indicated. Thanks!

Procedure: Ear Surgery
Location: macomb, MI

Replies 3

Gary Culbertson
ASPS Surgeon
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Sorry to hear about your recient situation. Fortunately, something can be done about it. Consider discusing your concerns with your surgeon but, here are some referances that should be of assistance: (1) Marins of resection on ear- 1 to 2 cm ( ) (2) SLNB- YES ( ). Best,

Gary R Culbertson, MD, FACS

Samir Shureih

Agree with Dr. Culbertson

2 cm margins in all directions and sentinel node biopsy.

A Breslow 1.4 mm needs aggressive treatment. I tend to believe that type of melanoma is a surgical disease first then a n oncologic condition.

The slides needs to be reviewed by a specialist dermatopathologist at the center of your choice for cell type, vascular invasion or lymphatic invasion.

In my patients a PET CT is indicated.

In my patients a second opinion with MD Anderson, Mayo Clinic, or the Sloan Kattering , Johns Hopkins. to see both the plastic surgeon and the oncologist. Hope that will help

Alexander Anzarut
ASPS Surgeon

I am in agreement. The guidelines suggest suggest a 1-2 mm wide (clinical) resection margin based on 1.4 mm depth. Most guidelines would also suggest sentinel node biopsy be done prior. Your local cancer agency may use slightly different protocols. You should have ongoing screening for new lesions every 6-12 months. Best wishes on your road to recovery.



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