How would you approach a patient with malignant spindle cell neoplasm of the scalp excised with a focally positive deep margin?
What dose and margins would you use? The patient is s/p a liver transplant on immunosuppression.
Answer from: Radiation Oncologist at Academic Institution
Although I agree that a re-excision would be helpful for margin clearance, it is probably unlikely that more tissue (which may be negative for Ca) would help delineate the pathology. An immunosuppressed transplant patient most likely has a cutaneous SCCa (with spindle cell features) and our surgeons...
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Answer from: Medical Oncologist at Academic Institution
Would recommend re-excision as well as a detailed pathologic examination of the "spindle cell neoplasm" as differentials may range from melanoma, sarcoma, squamous cell carcinoma with sarcomatoid features, and so on. These may have vastly different recommendations for adequate margins, RT, and adjuv...
Answer from: Radiation Oncologist at Academic Institution
Re-excise. Possible postop RT.