Adequate Margins (Psalms 51:1-2)

“Dr. Smith is calling about this case. He is asking about your recommendations for margins.”


My secretary handed me a report that I issued a few days ago on a melanoma that I diagnosed for his patient. As I discussed the case with the doctor, we both acknowledged the difficulty in deciding upon adequate margins because of the lack of definitive published guidelines for cancers in this body site. The cancer was located near the patient’s eyelid and the usual recommendation for margins would impinge upon the normal eyelid, potentially resulting in a very difficult final repair.


What are adequate margins for a malignant skin tumor? This is a controversial area of skin cancer management but the basic premise is to determine what would be a sufficient amount of normal tissue to be taken around a malignant tumor that will minimize or eliminate the risk of local recurrence and still preserve a good cosmetic outcome for the patient. Numerous clinical trials have produced guidelines and treatment recommendations. However, there are still cases that even when adequate margins are taken, a local recurrence may occur. There is still more research that needs to be done to identify the biology of these cancers and prognostic factors that may predict treatment failures. The days of radical and disfiguring surgeries are diminishing and hopefully, the day will soon arrive when the precise distance margins will be agreed upon, minimizing the amount of normal tissue that needs to be taken around the cancers.


Have mercy on me, O God, according to your steadfast love; according to your abundant mercy blot out my transgressions. Wash me thoroughly from my iniquity, and cleanse me from my sin!

Psalms 51:1-2 (ESV)


God has needed to perform many radical spiritual surgeries in my life for the egregious sins that I have allowed to infect and corrupt my entire being. Unlike the uncertainty over the adequacy of margins with skin cancers, God is able to precisely remove the sins, the life-robbing cancers in my life, leaving me whole. He is able to do this because He paid the ultimate penalty for my sins by dying on the Cross and being resurrected by the power of God.


When I submit myself to God’s will, His mercy and grace precisely removes my sins and cleanses me through faith and belief in the death and resurrection of his Son, Jesus Christ.


Love and trust the Lord; seek His will in your life.


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