Home Forums Melanoma: Newly Diagnosed – Stages I & II Differing opinions from docs about SLNB?? Advice please?

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  • #21337
    Emoe18
    Participant

    Hi guys. I was diagnosed in mid may with a melanoma near my left ankle. They performed a wide local excision (looks like a shark took a bite out of me) and the pathology report found positive melanoma with Breslow depth of 0.5 mm Clark’s level II with no ulceration detected and mitotic rate around 1. The general surgeon said my margins are clear and in his opinion I am in the clear. I am a 22 year old female and this came to a big surprise to me as I am not a huge lover of tanning beds although I will admit I do love the beach but always wore sunscreen. The bugger is this was on the back of my ankle where I probably missed when putting on sunscreen. Anyways my general practitioner says because I am so young and this thing was only on my skin for less than a year (I literally watched it grow step by step) he thinks I should have the SLNB but the surgeon insists it isn’t needed. I live in MN and luckily we have the Mayo about 4 hours from us but sadly my parents happened to make a big life change the same week I got my diagnosis and I got kicked off of their insurance and now have crappy insurance. I guess my question is what does everyone else think? Should I be worried about getting the SLNB? Or not worry about moving forward with it? I am having a hard time being told at one point this cancer is extremely deadly And aggressive to “meh you are fine now move on.” It’s just extremely frustrating.

    #61075
    cohanja
    Participant

    Hello,

    You’ve already had the WLE? I’m not a doctor, but this is what I understand, others can correct me if I’m wrong: SNB should be done prior to the WLE to have the best value. The WLE removes a lot of tissue. It may alter the drainage paths to the sentinel node. The “sentinel node” they find after the WLE might not be the same one they would have found before the WLE. The SNB and WLE are typically done in the same setting with the SNB first, followed by the WLE.

    However, there are folks who do go for the SLNB later than the WLE. Catherine has stated before that there is no great amount of evidence really that it would be less accurate if you did opt for it later.

    By your Breslow, most probably would say SLNB is not clinically recommended; but, with mitotic rate not 0 it wouldn’t be out of the question.

    Female, melanoma on extremity. . . thin Breslow. . .usually good prognosis, probably statistically unlikely they would find anything in lymph nodes

    #61076
    Emoe18
    Participant

    Yeah I had the WLE on May 20th and the doc had a very “lets wait and see” approach. Which isn’t very comforting when they are throwing around words like “cancer” and “aggressive”. On everything I have read it seems the common consensus is that it’s fine for now but I keep coming across people’s news stories online who were assured it was done with and a few years down the road have mets all over. I am getting married in the fall and plan to start a family soon after and I just want to be sure I shouldn’t be holding off on kids for a while.

    #61077
    Catherine Poole
    Keymaster

    You should be fine not having the SLNB. As pointed out: you are female, it was on your lower leg(back of ankle just like mine 24 years ago!) thin lesion, low mitotic rate. You still might want to hold off on starting a family as they advised me, for a couple of years to be conservative. (PS mine was .76, vertical growth, mitotic over 1, Clark 4, and SLNB not invented!

    #61078
    Emoe18
    Participant

    Catherine was your melanoma a stage 1 then as well? Just curious. Thanks for your advice! I know SLNB can be very painful and menacing so I am kind of glad people seem to think I do not need it! I can’t really afford to miss that much work as it is. When I had my WLE I was at work 3 days later (I am a nanny though so I can sit if I need to). People thought I was crazy but I am not a “sit still” kind of person. The whole waiting for kids thing kind of confuses me just as I am not sure what I am waiting for. In case it shows up somewhere else? That’s a scary thought but an ever present one with this disease I suppose :) That’s the reality of melanoma. Thank you for your help though!

    #61079
    Worrywart
    Participant

    Have you gotten a second opinion on your initial pathology? I would do that first. I assume the Dr who says you should have SNB is saying to get one because it was on your leg for such a short time and was already a .5? So he/she is assuming it’s aggressive due to that. However, mitotic rate is what indicates how aggressive it is and yours was only 1. This is where second opinion comes in. If they concur with all the details of this low risk lesion, that will help you make the decision easier. The SNB is not a guarantee of anything. Your lesion generally does not call for a SNB. When you get the second opinion get it from a dermatopathologist that specializes in melanoma.

    #61080
    Emoe18
    Participant

    Ok I will contact a dermapathologist and get a second opinion just in case. Thanks for your input! My family all said I should have a second opinion as well. I am hoping that they can just look at my path reports and not need to see me, that way I won’t have to pay for an office visit ;)

    #61081
    Worrywart
    Participant

    No, you will not need an office visit. Call the derm or whomever biopsied the mole and tell them where to send your slides. Dr Mihm is good or just about any teaching school / university melanoma dermatopathologist. There is a list on this site too, I believe.

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