One (of six) close, but still negative margin

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dl1129
dl1129 Member Posts: 19
edited February 2019 in DCIS (Ductal Carcinoma In Situ)

I had my first follow-up post lumpectomy today. Final pathology was pure DCIS, 1.2 cm, intermediate grade.

Five of six margins were clear by 2mm or more. The margin right next to the skin was negative, but by 1 mm. My surgeon, who I don't consider to be particularly conservative, pretty much left the decision to go back and clear that last margin up to me. I haven't fixated on anything since this process started (which is my usual tendency about things) but I am stuck on this. He doesn't seem to feel it will confer a clear benefit, but still left me the option, which is messing with my head. He said he already took as much as possible without taking skin, and that the layer of skin was thin and translucent. So going back would mean taking skin, which he said creates another set of possible issues -- namely the potential for damaging the blood supply to the skin, and creating a cosmetic imbalance such that I'd have to have some kind of cosmetic surgery on the other side.

I will have radiation, though don't have that initial appointment for a couple weeks, so don't know what is planned. My logical brain says it's obvious there is no need for more surgery, but part of me is stuck on that one millimeter.

I'm wondering what others' surgeons have recommended in similar instances?

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  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited February 2019

    I think a lot of places now consider 1 mm sufficient. And since radiation will zap any stray cells in the area, it sounds like a re-excision in your circumstance might create more problems than it would solve.

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  • Ingerp
    Ingerp Member Posts: 2,624
    edited February 2019

    I agree with Alice.

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  • dl1129
    dl1129 Member Posts: 19
    edited February 2019

    Thank you both! Had the surgeon simply said "this is good" and sent me on my way, I would have been satisfied. Him giving me an option for something apparently so small was what threw me for a loop.

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  • momzr
    momzr Member Posts: 111
    edited February 2019

    I had DCIS and lumpectomy (left breast) back in 2008 - my area of DCIS was 1.6 mm and I had one margin that was 1.3 mm (so under that 2 mm 'guideline' on margins, but the whole area of DCIS was actually under 2 mm as well). I did not have re-excision and also did not choose to have radiation either. This summer will be eleven years since that lumpectomy - I have had one additional lumpectomy and a stereotactic biopsy to the left side (within three years of original lumpectomy) but all showed benign conditions. So far, so good in my particular case. Good luck to you!

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