Close margins

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joyandpiece
joyandpiece Member Posts: 72
edited October 2016 in Surgery - Before, During, and After

I talked to my surgeon on Wednesday. All of the IDC is gone after my lumpectomy last week. High and mid grade DCIS also removed. There was a close margin - less than 1mm close to mid grade DCIS. I know the guidelines put out in August say 2mm. My surgeon says it is my choice, but if it were her, she would not do added surgery, especially since I would get rads and hormonal therapy. She is consulting with the tumor board and will get back to me.

Does anyone have words of wisdom about your own experiences?I am especially concerned about HER2+ status even though my tumor is small.

Thanks! Laurie

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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited October 2016

    I heard that my tumor board basically voted on whether I should have a re-excision for close margins, and they were not unanimous. The surgeon was against it, and I think it was partly because he didn't want to mess with a very nice cosmetic outcome. But I wanted to be as careful as possible, so I did the re-excision. I have never had any recurrence in that quadrant. In your position I would try to get recommendations and detailed reasons from each doctor on your case (surgeon, radiation oncologist, medical oncologist, maybe pathologist).

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited October 2016

    According to UCLA, “no tumor on ink" is the new standard for “clear" margins—even .5mm. The growing consensus is that given radiation and systemic therapy, there is no survival benefit or even lessened chance of recurrence from re-excision when the tumor cells don't touch the ink mark. .5mm can be as “clear" a margin as 1cm. I say this ruefully as someone who had nearly 3cm. margins.

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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited October 2016

    Yes, it is important to consult with doctors who know what the latest research says, and how it applies your own situation. One disadvantage of re-excision is the added healing time delays the radiation and systemic therapy (if recommended). Your team has to weigh everything.

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  • joyandpiece
    joyandpiece Member Posts: 72
    edited October 2016

    Thank you all for weighing in. I talked to my surgeon last nights night, the tumor board concluded no more surgery. It sounds like they were unanimous, which is surprising. I have decided to go with this recommendation. It feels like the right thing for m

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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited October 2016

    Good.

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  • Houston2016
    Houston2016 Member Posts: 317
    edited October 2016

    Hi all, I would like to get your opinion on my situation. I had neoadjuvant chemo since April thru September 01,2016. UMX of left breast on 10/5 and positive margin was found with one single cell touching the tissue under the skin. Three sentinel lymph nodes taken out were negative due to tissue were gone after chemo. I had skin sparring mastectomy with tissue expander. BS said RE-excision is rare for MX but he suggested another surgery. So I went for the second surgery 10/24/16. I'm dreading waiting for the pathology I never thought I have to go through more than one surgery after the MX. Is this common and what happened if the path came back positive again. I know I'm not gonna do another RE-excision but take my treatment somewhere else. At this point I think it's more the issue of competence of the doctor. Any ideas or suggestions? Thanks.


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  • agfischer
    agfischer Member Posts: 18
    edited October 2016

    My pathology noted that "lesion is ...adjacent to superficial." Does this mean a close margin?

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