How would you approach a patient with malignant spindle cell neoplasm of the scalp excised with a focally positive deep margin?

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...

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...

Re-excise. Possible postop RT.