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Melanoma In Situ: Residual Melanoma In-Situ After Mohs?
Melanoma In Situ: Should You Worry? Is one of the most frequently visited blog posts on PeopleBeatingCancer.org. I believe this is a good indicator that melanoma in-situ is a frequent diagnosis and, as a result, many people have questions about their diagnosis. So when Marilyn asks about melanoma in situ: residual melanomas, it is no surprise.
Marilyn asks: “I’ve had 2 surgeries for melanoma skin cancer on upper arm and there is still residual melanoma in situ. How many times can I continue to have surgeries safely? What is a normal number of surgeries? I am 90 and wonder if it’s worth it at this age.”
The short answer to your question, Marilyn, is that you are the only person who can answer the “is it worth it?” question. It’s you, your body, your skin, etc.
I consider it my job to give you the information needed to answer your questions fully. In my experience, information such as:
- what is normal?
- what is safe?
- what is my risk?
- what do I do if I want to undergo additional therapies?
Are questions and answers that may help.
In my experience as a long-term cancer survivor, the two main issues to consider are 1) risks and 2) potential side effects. By this I mean that, for example, is there any downside risk of additional Mohs surgeries when compared to the benefit of reducing the risk of melanoma becoming more advanced?
Granted, your risk of the current melanoma becoming more advanced is minimal. And different people have different tolerances for Mohs surgeries.
I hope this helps, Marilyn. Please be sure to ask me any questions you may have.
Thanks and good luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Managing melanoma can be difficult. Knowledge is power.-
- Melanoma vs. Non-Melanoma Skin Cancer: Diagnosis, Symptoms and Differences
- Malignant Melanoma-Stage Dictates Prognosis
- Melanoma- Integrative – Enhance Outcomes
- Melanoma Survivorship: A Long-Term Follow-Up Guide
- Skin Cancer: Need-to-Know
In order to reply to Marilyn, I have to make several assumptions.
- I am going to assume that the original diagnosis was “melanoma in situ” or skin cancer stage 0.
- I am going to assume that the previous diagnoses that you refer to, Marilyn, were also melanoma in situ. A diagnosis of melanoma at a later stage would warrant a different answer. A “wide excision” procedure would also warrant a different answer.
I will break down your question into separate questions so that I can address each fully.
How many times can I continue to have surgeries safely?
There is no lifetime limit on the number of times you can undergo Mohs surgery. Because it is performed under local anesthesia and preserves the maximum amount of healthy tissue, it can be safely repeated on new or recurrent skin cancers as many times as medically necessary. [1, 2, 3]
What is a normal number of surgeries?
There is no single “normal” number of Mohs surgeries a person can have in their lifetime. Because the procedure is safe, localized, and designed to save healthy skin, a person might have one Mohs surgery, three surgeries, or even dozens over a lifetime if they are prone to developing skin cancers.
Instead, “normal” is usually looked at in two distinct ways:
1. The Number of Procedures in a Lifetime
For someone with standard sun exposure, one or two lifelong procedures is common. However, for individuals with a history of multiple skin cancers or extensive sun damage—like having three separate diagnoses of melanoma in situ—undergoing three or more separate Mohs procedures is entirely normal and expected. Your personal “normal” is determined by your genetics, your past UV exposure, and how frequently your dermatologist catches new lesions.
2. The Number of “Rounds” During a Single Surgery
When doctors talk about numbers in a single Mohs surgery appointment, they usually refer to the stages or rounds required to completely clear one tumor: [1]
- 1 to 2 rounds: This is the statistical average. The surgeon removes a thin layer of skin, checks it under a microscope, and finding clear margins means the surgery is done. [1, 2]
- 3 or more rounds: If the cancer’s “roots” extend deeper or wider than they appear on the surface, the surgeon will repeat the process until 100% of the cancer is gone. [1, 2]
Because you have had three diagnoses, your dermatologist will likely keep you on an accelerated monitoring schedule to catch any future spots early. [1]
What Is Melanoma In-Situ?
- Definition: Abnormal cancer cells stay only in the top layer of skin (the epidermis) and have not moved deeper.
- Spread: It has zero risk of spreading (metastasis) to other parts of the body at this early stage. [1, 2]
Survival Statistics
- Cure Rate: The disease is considered non-life-threatening before it invades deeper tissue.
- 15-Year Survival: Studies show a 98.4% melanoma-specific survival rate over 15 years.
- Overall Life Expectancy: People diagnosed with melanoma in-situ often have a normal or even higher relative survival rate compared to the general population, largely because these patients tend to practice healthy, proactive self-care and get regular medical checkups. [1, 2, 3]
Treatment and Prevention
- Removal: Doctors usually cure the condition completely with a simple surgical excision to cut out the spot with a small safety margin of normal skin.
- Monitoring: Patients need ongoing skin checks because having one melanoma increases the chance of getting a new one later. [1, 2]
Next Steps and Treatment
- How wide of a margin do you need to take during the re-excision?
- Will this procedure be done in the office under local anesthesia?
- What is the timeline for scheduling and treatment?
Recovery and Wound Care
- How long will it take for the new surgical site to heal?
- What activity restrictions will I have after the procedure?
- Will I need stitches, and if so, when do they come out?
Future Monitoring
- How often will I need full-body skin checks moving forward?
- What specific changes should I look for during my own self-exams?
- Do you recommend using digital mole mapping or photography to track my skin?
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