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Biopsy for a Second Melanoma

Biopsy for a Second Melanoma

Question

Dear OncoLink "Ask The Experts,"
My husband had surgery for melanoma in October 2006 on his back. It was extensive surgery but no melanoma [was seen] in lymph nodes. He had another spot close to where the original melanoma was that was biopsied and was pre-cancer. Now it has changed some, and the doctor wants to do another extensive surgery, but he hasn't performed a biopsy and we don't know if it is melanoma or not. Is this standard practice?

Answer

Christopher J. Miller, MD, Assistant Professor of Dermatology at the Abramson Cancer Center of the University of Pennsylvania, responds:

If a patient develops a second melanoma, it is most frequently detected in the first couple of years after the original melanoma. This probably results simply from increased surveillance by the patient and his or her physicians once the patient already has a diagnosis of melanoma.

This patient's new lesion of concern should be treated no differently than any other lesion. If there is suspicion for a melanoma, a biopsy is appropriate. The doctors will have to discuss the most appropriate biopsy method with the patient. If there is a high index of suspicion for a melanoma, the preferred method of biopsy is an excision with 1-3 mm margins around all clinically visible pigment. From the patient's perspective, this might seem like another "big" surgery. I would not advocate a wide excision (e.g. 5 mm or 1 cm) without obtaining a more conservative biopsy first.