Some of you have asked about this and I reached out to our scientific board for an opinion, here it is: As long as the wide excision and reconstruction was done in a manner that did not perturb the local lymphatics, the general experience is that SLNB after WE is acceptable (though not preferred), with roughly the same results (probability of a positive SLN, regional nodal failure rate after negative SLN) as SLNB done at the time of WE. Obviously, the experience with this approach is much more limited, and as such, the true decrease in accuracy, if any, is hard to know with precision. When done, we generally omit administration of blue dye, as that can leave a long lasting tattoo.
Thanks. I wonder if the scientific board can comment on this too: I have read many conflicting studies and comments about partial regression. Some say it’s common in thin melanomas and has no prognostic significance. However, some studies (Sondergaard, 486 cases, showed partial regression in thin lesions adversely affected survival) show it is a negative factor. Furthermore, different pathologists can look at the same lesion, one says “Regression: absent” while another says “Focal Partial Regression.”
shows how pathology is definitely not black or white: the pathologist that said no regression said, “I did not mention regression in my report, because I was not convinced about its presence when I examined the histology slides. Another histology report you mention states: “consistent with focal regression”, which in my opinion is not the same as “there is focal regression”. I like to see a degree of vascular proliferation in addition to those described in the other report before I am fully convinced about regression.”
always amazes me how pathology can be so subjective
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