There also are cases where the pathologist is not able to give a specific diagnosis, given the undifferentiated nature of
the tumor. In these cases, the pathologist should be contacted to determine if there are additional special stains (i.e. Toluene
blue) or IHC that may be helpful in making a definitive diagnosis. The basis of IHC is the assumption that malignant cells
have cellular markers that also are present in normal cells of the same histologic type.
The pathologist should be able to suggest which marker(s) would be appropriate to request.
In many cases, a panel of IHC markers is more helpful than a single marker. There are additional charges for IHC and based
on the number and type of markers needed.
Turnaround time of IHC can vary, based on the lab and marker, but generally is between five and 10 business days. More than
one set of markers may be required if the initial set is negative.
A positive result is useful, but note that poorly differentiated tumors may have lost normal cellular markers so that a negative
result does not necessarily rule out a particular tumor type.
If a margin is incomplete or narrow, then additional surgery or radiation therapy can be considered for local control. Re-excision
of the scar typically is preferred over radiation therapy. Second surgeries are less expensive, require fewer visits and
may be potentially more effective than radiation therapy.
Radiation therapy may be an option when additional surgery is not possible. The exact protocol will depend on the tumor type
as well as the radiation oncologist, but treatment protocols typically are between 15 and 20 treatments over three to four
Success rates will depend on the tumor type, size and location. The cost can vary between facilities, although an average
cost for full-course radiation therapy would be between $3,500 and $5,000.
Radiation therapy would not be started until the surgical site has healed, as radiation therapy can slow the healing process.
In most cases, radiation therapy should be started two weeks to six weeks post-operatively in order to minimize the risk of
For those lesions that heal by second intention, radiation therapy needs to be delayed until the wound is closed.
For those tumors that have a high risk of metastatic or for those patients that already present with metastatic disease, adjuvant
chemotherapy may be recommended.
The chemotherapy protocol is tailored specifically to the tumor type and the individual patient.
Chemotherapy can slow the healing process as well as increase the risk of infection, so follow-up chemotherapy generally
is started at the time of suture removal, provided that the healing process is complete.
However, if the patient is compromised due to the cancer, chemotherapy can be started earlier at the discretion of the clinician.
As with any therapy, it is better to institute treatment early for the best chance of success.