Clear margin or not? 0.5mm or 1mm or 2mm?

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NVDobie
NVDobie Member Posts: 184
edited March 2018 in Surgery - Before, During, and After

Hi, ladies

Really could use your input and advice here.

Had surgery in early Jan and surgeon sent me on my way with clear margin at 0.5mm,Even though I had multi focal ( found 6 of them). Two of margins are 0.5mm.

First oncologist agreed and put me on chemo although he told me the margin was 1mm which is new standard. But my report says 0.5mm.

Met radiation oncologist first time yesterday, she said 2mm is minimal she believes should be clear margin.

I am confused and stuck in difffent opinions of Doc.

Waiting to see an different surgeon for 2nd opinion.

But would love to hear from everyone who can share their experience and perspectives

Thanks in advance!

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  • Veeder14
    Veeder14 Member Posts: 880
    edited March 2018

    Hi NVDobie,

    I've got the same question, what is the standard margins size to be considered clean margins. I clarified with my surgeon that the smallest margin was 1 mm but didn't ask about the size of the other ones. Of course Melanoma is different and I had 2.5 cm margins so 1 mm just seems too close to me for comfort.

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  • moth
    moth Member Posts: 4,800
    edited March 2018

    have you seen this: " clear margins, no matter how small as long as there was no ink on the cancer tumor, should be the standard for lumpectomy surgery. The guidelines also say that wider margins don't lower the risk of recurrence any more than narrower margins."

    http://www.breastcancer.org/research-news/20140402

    & the paper it's based on http://www.redjournal.org/article/S0360-3016(13)03315-4/pdf


    but - how margins are treated seems to vary. In BC (where I am) " A positive margin is defined as tumour touching ink. In British Columbia, a close margin is currently defined as less than 2 mm margin. " Close margins can lead to resection depending on the patient's risk of recurrence http://www.bccancer.bc.ca/books/breast/management/...


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  • gb2115
    gb2115 Member Posts: 1,894
    edited March 2018

    I think it also depends on where it is. I had a close one (I think 0.9) but because it was right up on the chest wall they were ok with that.

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  • NVDobie
    NVDobie Member Posts: 184
    edited March 2018

    Hi, Veeder 14

    The standard of radiation oncology association in US updated the standard a couple of years ago from 2mm to 1mm. But it is not uncommon some medical teams will consider less than 1mm to be clear. Just like the articles moth shared. Looks like depending on Doc.


    hi, moth

    Thanks. I am also in BC. Thanks for the articles. I did read them last night as well. The variance in standards or Doc opinions are making it hard for me or any patients.

    My GP said I should listen to oncologist as they study cancer more so than surgeon.

    The dilemma is also surgeon didn’t really explain anything about the margin during post op review. She actually said BC cancer agency will likely send me back to her for not going for mastectomy. She said she will put comment on my file as “ patient insists on preserving the breast” which is not correct. I never asked breast preservation to be a factor. Surgeon said both lumpectomy and mastectomy are options for me When she ask me to make a decision. This conversation in Post ops has left doubts in my mind.

    1st oncologist said is ok to not to do mastectomy in my case as new standard is 1mm. Now I just realize I have margins that is only 0.5mm based on pathology report. So not sure I take comfort in his words anymore given he misread my report?

    Radiation oncologist said her experiences make 0.5 mm too small for her liking.

    I would have worried less probably if my tumor wasn’t multi focal, the fact they are satellite to the main with distance at times 2.5cm, make 0.5mm very close call.

    When I asked my surgeon how do we know there isn’t more satellite tumors in the breast, she said we neve know anything for sure. Huh.

    Hi, gb2115

    Good point. I will look into the report further. Right now the closest margin of 0.5mm are both for IDC and DCIS. So definitely making me nervous for IDC to have such small margin in an multifocal situation

    Thanks for everyone ‘s comments.


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  • moth
    moth Member Posts: 4,800
    edited March 2018

    NVDobie - if you want recommendations for breast / oncology surgeons for second opinion I can give a few & also maybe post on the Canadians in BC thread for more. You can pm me if you want.

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  • NVDobie
    NVDobie Member Posts: 184
    edited March 2018

    awesome, moth.

    Just pm’ed you. Will post on BC site as well. Thanks for sharing that. I am new to the site and didn’t see it till you mention it. Great

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