ANSWER:
Hello,

This is a desperately unfortunate story. I’m sorry. I have tried looking up your Yahoo! account for some guide to your gender and to how old you are, – roughly, – but no luck, your Yahoo account is private. I’m assuming you’re female. I suppose it doesn’t matter that much, – just for the advice on facial scars, that is more important for a woman.

We don’t have all the details here, from the very first histology examination. Er, I suppose your first Family doctor, (your GP), did send the actual mole to histology? : ) If not, we have not proof that it ever was cancer, have we.

Presumably (but not necessarily), that first histology showed a malignant melanoma? But what about the various “depth” or “penetration” scores, how did it do on those? I mean, the Breslow or Clark scores, or the TNM score? – please see here if you don’t know what I’m talking about, (click and return) http://cancerhelp.cancerresearchuk.org/type/melanoma/treatment/stages-of-melanoma

We don’t know whether your second excision (removal) operation was undertaken (a) because the first excision was definitely histologically inadequate, – I mean, the histology found that some of the tumor was left behind, – or (b), because a wider local excision is just a normal part of your surgeon’s treatment plan.

I am saying that without that first histology, we don’t have *absolute proof* that a wider 2nd excision was essential. Although I agree it would be good surgical practice.

The temptation is always for a GP or Family doctor, to be too “conservative” in removing a mole, – I mean, for him/her not to remove enough tissue surrounding the mole too, – but this is not necessarily always the case. So was there any help on this from the first histology report? This “sideways” issue is described technically as the surgical “clearance,” – how good was the clearance on the first removal, according to the first Histologist? It should all be on his report.

I am trying to wrest the maximum amount of information out of the first histology report, – as this seems to be all the help we have. We should really be able to give you a good estimate of your outlook, solely from this first histology report, in my opinion.

Depending on the skill of the second surgeon, he/she may well have made a thoroughly good job of it, – I agree we don’t have the histology to tell us for sure, one way or the other, – but presumably it was a good, wide secondary excision, removing any remaining cancer cells.

The bad aspect of the second excision is the 4- pointed scar. I really think that if this was me, I would now be pushing for the opinion of a Consultant Plastic Surgeon, before the next operation, – plastic surgery is the specialty that deals with scars, and making them as unobtrusive as possible, as you know.

It must be clear to you that if everything has gone well, then the result of this 3rd operation, will be “nothing,” – quite literally, the histology will show nothing, because the 2nd surgeon will have removed it all.

So I think you should get the advice of your Skin Specialist on whether you should also have a “lymph node biopsy,” – that is where they remove one or 2 lymph nodes, from the nearby drainage area of the cancer. Clearly if there has been any local spread, this lymph node might be positive for cancer spread, even though the repeated (wider) excision of the scar shows nothing.

In summary, the vertical method from the 2nd removal, only affects the cosmetic appearance of your scar, and does not imply the quality of the cancer-removal surgery.

It might even be, (I can’t say), that the 2nd surgeon had a good surgical reason for doing the 2nd removal vertically, – the one that comes to mind is, that he wanted to avoid cutting any of your “frontal (5th) nerves,” which run vertically beneath the skin.

There is no reason to suppose that just because the scar is vertical, that the cancer hasn’t been removed by the surgery. You just need a Plastic Surgeon’s advice on ending up with the best possible 3rd scar, in my opinion.

As to your recent left sided upper abdominal pain, it would be most “elegant” if we could connect this pain to your worry and anxiety, – and the natural connection to that is via either a stomach ulcer or a duodenal ulcer. I am bound to say that your age, – your youth, – is much more in favor of an ulcer, than it is of a pancreatic cancer, – and the outlook for a pancreatic cancer is worse in the short term, than it is for a malignant melanoma, you know.

Postulating this second, completely different type of cancer, is unlikely according to the test of “Occam’s Razor.” This rule states that you shouldn’t create an additional, unconnected diagnosis unless you absolutely have to.

I hope this is of some help.

Best wishes,

Belliger
retired uk gp, and formerly plastic surgical SHO.