Home Forums Melanoma: Newly Diagnosed – Stages I & II Catherine, SLNB clarification please for thin melanomas

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  • #21166
    bon15
    Participant

    Catherine, can you please clarify why in two recent posts you have inferred that a breslow depth of over 0.75mm indicates the need for a SLNB. The latest AJCC guidelines indicate that an SLNB should only be considered for stage 1b upwards, i.e a melanoma with a depth of between 1mm and 2mm or any depth melanoma up to 2mm with ulceration or a mitotic rate of more than 1 per sq mm. A stage 1a melanoma is not considered to require an SLNB as the procedure’s risks, although minimal, are more than the risks of a recurrence from a stage 1a melanoma.

    There are many with stage 1a melanomas between 0.76mm and 1mm and I think that if the AJCC guidelines were being followed there is only an argument for an SNLB if you are on the cusp of 1mm, not 0.75mm.

    #59960
    Catherine Poole
    Keymaster

    Sure, each cancer center sets their criteria and .76 is used at UPENN for one. Also in a recent study (http://www.modernmedicine.com/legacy/article/776725) they stated: “In contrast, he says that in T1b (less than or equal to 1 mm, with ulceration or at least one mitosis per mm2) melanomas measuring between 0.76 mm and 1 mm in thickness, “There is a somewhat higher risk of nodal involvement.”

    Others will state you need SLNB if you have mitosis and you are over as low as .5. So it can be a combination of factors on your pathology report. But most use from .76 to 1.0 for suggesting SLNB. I am not one to promote SLNB when it isn’t warranted, but do think a judicious look at more factors than depth can play a role in the decision.

    #59961
    bon15
    Participant

    Thank you for your reply Catherine.

    There still seems to be a lack of clarication, however, on the situation regarding SNLB and stage 1a melanomas between 0.75mm and 1mm in depth. By virtue of being staged a 1a, such melanomas have neither ulceration or mitoses.

    I have looked at the UPENN (Univerity of Pennsylvania?) website and have watched the melanoma video in respect of early stage melanomas. With regards SNLB, the video states 1mm as the start point for this procedure unless there are higher risk factors (presumeably ulceration or mitoses, which would be stage 1b anyway).

    The modernmedicine website link states;

    “Dr. Bichakjian says AAD guidelines do not recommend SLNB for patients with melanoma in situ or T1a melanoma (less than or equal to 1 mm thick, no ulceration, and mitotic rate (MR) less than 1 per mm2, according to American Joint Committee on Cancer/AJCC guidelines;”

    Therefore for stage 1a patients, who by definition of having no ulceration or mitoses, there still seems to be no basis in your reply for their having an SLNB if their depth is between 0.75 and 1mm. I can also find no recent research on the internet that promotes an SNLB in such cases. Indeed, this would contradict the AJCC guidelines.

    I do see that T1b melanomas less than 1mm should be offered SNLB in certain cases and this may well be where your 0.76mm cut off in previous posts is coming from.

    Sorry to labour the point regarding clarication but I do think that it is important that stage 1a patients with a depth between 0.75 and 1mm are clear that they do not need an SNLB.

    #59962
    7spider
    Participant

    I agree with you. Mine was 1b .88mm no ulceration, but I did have mitosis of greater than 1. Therfore it was recommended and I followed the advise and had the SLNB with my WLE. They wound up testing 4 lymph nodes everything came back clean and my skin checks have been fine a year later. If I didn’t have that slight mitosis I would of opted to hold on to my nodes and not have the SLNB done.

    #59963
    Catherine Poole
    Keymaster

    It is going to be a very individual decision. Not necessarily something stated on a website or in guidelines that are published. It is between the doctor, patient and pathology report. Please read the study I cited in my past post for clarification. There is no right or wrong answer, this is a gray area and much of medicine is based on an individual’s specific criteria, not the population at large.

    #59964
    marti
    Participant

    Thankfully I was offered a choice. (2009:Shave excision on ear-Breslow at least 0,6, no mitosis). SLNB: some melanoma cells in node, not enough for micro-metastasis. Explained to me as: cells came from the shave-excisions. No further actions required.

    Still happy that the node, with the cells , have taken out. Dont know if they could have formed a metastasis, but I am happy that I had a choice.

    Marti

    #59965
    cohanja
    Participant

    I don’t understand; the cells in the node came from the shave excision?

    #59966
    marti
    Participant

    It has puzzled me for a long time. The p.a. report after the SNB mentioned: In the periauxilar node to the ear where some melanoma cells,. The node in the neck where free of melanoma. The Breslow was finally measured at 0,64 mm.

    I was shocked, but the pathologist answered the question as followed: the cells came from “the knife”used by the initial shave excision. Have not seen that in any other PA report, mentioned on this forum.

    It makes me worried sometimes,

    Marti

    #59967
    Catherine Poole
    Keymaster

    Marti,

    I would have an expert dermatopathologist look at those slides, that just seems highly unlikely. Dr.Mihm is great http://www.drmihm.com and there are other specialists you might want to consider to take a look.

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