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Melanoma removed in the doctors office?

Melanoma removed in the doctors office?

Posted By
3/12/2019 1:26pm
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Replies: 11

Just returned from my consultation with the surgeon. He is just a general surgeon and is really applying pressure to me to just have my melanoma removed in his office with local anesthesia. I’ve had this surgery before and I know what size chunk they take... my anxiety is OFF THE CHARTS about being awake during something like this. Path report says it’s in situ, but I’ve not been able to see it for myself. I don’t know any numbers.  Also when I asked him “how much will you take” he basically said that he just ‘eyeballs it’... I said don’t you base it from the depth of the lesion and he said no.  I don’t feel confident about this at all. My Family is pressuring me to have it done in-office to save money.  Any advice? 

WLE should be performed in an OR; local anesthesia is fine (have done it this way twice). There is no way I can imagine this procedure being done in an office

So when you say local anesthesia is fine (in the OR), do you also mean that there is some sedation for the patient? 

No sedation as it's not needed; the anesthesiologist is present and you may require additional local at any time (the worst you will feel is a stinging sensation).

This said, I would have someone else drive you as any surgery is a shock to the body and the amount of local you may receive can be significant.

Anonymous - (3/12/2019 - 1:55pm)

I had an in situ along my jawline removed in October.  It does done under local anesthesia.  I was fully awake and even drove myself home. 

Anonymous - (3/12/2019 - 1:55pm)

I had an in situ along my jawline removed in October.  It does done under local anesthesia.  I was fully awake and even drove myself home. 

Anonymous - (3/12/2019 - 7:25pm)

First of all you should have access to your path report and have it explained in detail to you before there is talk of surgery.  I had in situ removed from my back and needed a skin graft as well to close the excision site.  I wouldn't have wanted to do that without general anesthesia.  Most melanomas are removed by general surgeons so that isn't a problem but you should not be pressured by anyone, Dr. or family, to have a procedure done in a way that you're not comfortable with.  I also dont think this is appropriate to do in an office setting unless they have a specialized sterile surgical room that is used just for this type of procedure.  As for "eyeballing it" I believe there are standardized clear margins that your surgeon should know about.

I'm a bit more hardcore than most around here given my history, but I can tell you when I had my second recurrence in 1996 I sat in a chair at my surgeons office (same one who did my surgery in 1987 in the OR), he shot me up and started cutting.

As I sat in the chair we were chatting when he plucked out a translucent marble about the size of a garbonzo bean from the six inch incision in my chest, he handed me the forceps,let me study it and then I plopped it into the specimen bottle.

You must remember that my surgeon and I, which I do with all surgeons that stick a knife in me, had a special relationship.

Turned out at pathology it was a recurrence still at Stage III.

I've always considered myself a leading contender for a yet to be announced series of "Scar Search".

Shortly after that office surgery I had a more extensive "asleep" surgery to acheive margins and some additional nodes removed.

Anyway, if you really TRUST the surgeon, I'm cool with what he proposes.

Forget your family, it is your chance so it is your choice.

Charlie S

Thank you, Charlie S. You are hard core! 

I'd be wanting to see the path report for depth... and his remark about "eyeballing it" is a pretty flippant way to respond to a patient question. I've had some reasonably good size chunks taken out of me in a doctor's office with only local injections to the surgical area. What size the lesion is, and its location would be questions in my book. Also... when the doc starts digging, if they find it is wider or deeper than expected, what is the procedure and/or accessibliity to some nitrous oxide, propofol, or (at the very least) some Ativan!

My thoughts exactly! I’m at that doctors office right now asking for a copy of my Pathology report.  I’m so grateful to people on this forum for responding! :) 

I had my Stage 1b wide excission performed by my dermatologist in her office under local anesthetic.  Location left calf.  Left a hole about the size of an 11" softball.   It could not be stitched so I left with a large gaping hole and had a skin graph a month later. That was under general anesthetic with a plastic surgeon.  

I think removal of early stage melanoma in an office setting under a local is common.  My problem would be "the eyeballing" comment.    There are guidelines  which doctors are supposed to use when calculating the area of removal around the melanoma lesion.  Maybe a second opinion from a derm or surgeon who has more experience with melanoma would be an option that would give you peace of mind.