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  • #21992
    Bdeck1
    Participant

    Hey guys!

    After much research, I think I am going to get a second opinion on my pathology report. I plan on contacting Dr. Mihm’s office on Monday to figure out how I need to go about this. For others that have done this, how long does it take for the results? I have an appointment on June 12th with my surgical oncologist. I wanted to have results to help decide for or against the SNB.

    Second question: just curious…would you do the SNB with a breslow 0.7mm, clark 4, non-ulcerated, mitosis <1, radial growth, no vascular or lymph invasion lesion?

    Third question: does SNB require general anesthesia?

    Thank you!

    Brittany

    #64470
    cohanja
    Participant

    I had 2 nodes removed and WLE, and I was put under general.

    Contact Mihm’s office first before sending your slides, I think there is a form to also fill out with demographics, billing info, etc…

    Martin C. Mihm Jr., M.D., F.A.C.P.

    SKADA

    One Broadway

    Suite 14

    Cambridge, MA 02142

    Phone-617-401-2231

    You might have better luck and a quicker response by sending an email directly to this person:

    Rolanda Flammia

    Assistant to Martin C. Mihm Jr., M.D.

    Director, Melanoma Program

    Department of Dermatology

    Brigham and Women’s Hospital

    41 Avenue Louis Pasteur

    Alumnae Hall, Room 317

    Boston, MA 02115

    Phone-617-264-5910

    Fax-617-264-3021

    E-mail- rflammia@partners.org

    #64471
    Bdeck1
    Participant

    Cohanna – what made you have the SNB? I looked at some of your other posts and saw that your breslow depth was very low. Just curious what made you decided to do it. Also, how did the results turn out?

    #64472
    cohanja
    Participant

    Yes, typically at my Breslow a SNB would not be done, it was a personal decision – I wanted every piece of diagnostic information possible including a result on SNB (knowing a negative result is not a guarantee). I had 2 nodes removed from under left arm, negative.

    #64473
    Catherine Poole
    Keymaster

    You do not sound like a candidate for a SLNB but I would get the second opinion before you decide. I had a .76, vertical growth phase, 24 years ago and never had a recur. SLNB was not an option then. See what Mihm says, if the mitotic factor was higher you might consider it.

    #64474
    Joanie60
    Participant

    I had a SNB in Feb under general while they were doing wide excision. We were unsure of depth (first biopsy was shave and did not get all of it) but mitosis was 3 and dermo as well as oncologist wanted to be safe.

    I am glad I did it, but boy oh boy it was not a walk in the park. I had a very large wide excision (7′ long, about 4″ wide, 2″ deep) on chest along with SNB. Had to have re-excision because margins were not clear, and most uncomfortable part of the whole thing was SNB

    I had them removed from my left arm. Bad timing (or good timing, depending on your point of view), my husband and I went to Germany in between the two surgeries. My left arm was of no use. Could not lift it higher than 90 degrees, had to wear compression sleeve while flying (and will for rest of my life). Pain involved in putting that on would make a sailor blush at the time. Could not haul suitcases, etc. Very uncomfortable getting dressed and washing hair for the first month. Got bit by my cat on left hand and had to go on antibiotics. Basically will have to “baby” my left arm, infection wise, for rest of my life.

    Now, it doesn’t hurt at all of course, but I did not have my expectations in check. If you decide to do it, know going in that there are ramifications. I guess the ramifications depend on location of SNB but I wish I had known going into it that it was going to hurt like the devil.

    There again, I am a wimp!!!

    Best of luck to you :-)

    #64475
    Joanie60
    Participant

    Wow. Seven INCHES, not seven feet lol

    #64476
    TreeFrog
    Participant

    Hi Brittany,

    My derm and surgeon weren’t very up-to-date on melanoma and wanted to schedule me for an SLNB for my .47mm Stage I mel. I did the research myself and refused the SLNB, at which point they checked and said, “oh, OK, it’s low-risk so that’s fine.” So I had the WLE without the SLNB.

    The reason I was so cautious about it is that there CAN be long-term side-effects, not that there always are. It’s just a diagnostic and not a therapy. If I’d had a higher-risk mel, say, one over 1mm deep, I would more likely have said yes.

    Best wishes,

    ~Wendy

    #64477
    Bdeck1
    Participant

    Oh my Joanie! That definitely makes me re-think pushing the SLNB. Did they just take one lymph node or all of them in that arm?

    #64478
    Joanie60
    Participant

    They took two from underarm area and two from middle chest area. I forgot to mention that my depth was at least 0.63. That was measured from shave biopsy (with melanoma still on bottom edge) so we’ll never know how deep it was.

    Other than bruising, I had no problems with lymph nodes taken from chest. That is why I think it depends on where they come from.

    Before the wide excision, I had some kind of dye injected at the biopsy point and laid down (in MRI machine perhaps?) for an hour or so while they traced where the dye went. Apparently it went to underarm and chest node system.

    The good news is that all four were clear.

    This is my second bout with melanoma…last one was over 14 years ago. I did not have any lymph nodes removed but depth was only 0.35mm I think. I think the key is vigilance and a chop-happy dermo (which I have…I am convinced she has saved me from several rounds by taking off moles which come back severely a-typical which may have progressed into Melanoma but don’t because she has cut them off!!)

    No guarantees with this cancer but early detection is the key!!

    Best of luck in your decision :-)

    #64479
    farang100
    Participant

    You should be aware that the use of SNB is still a source of contention amongst many melanoma researchers.

    Most agree that it is a great staging tool ie it accurately predicts your survival but there is no consensus that taking a SNB improves your overall survival prospects.

    And there can be some life time side effects from the procedure.

    Stage 1 is not usually even considered for SNB in any case unless there are extenuating circumstances.

    #64480
    Bdeck1
    Participant

    So, I sent my slides to Dr Mihm. I got the exact same pathology report. My melanoma is superficial spreading 0.7mm, no mitosis, no ulceration, Clark level 3/early level 4 (this was the only difference from my first pathology report.But, in my opinion, early level 4 is level 4). No comment on radial versus vertical growth. It sounds consistent with radial growth. The margins were “close”. The first pathology report stated margins are clear. Again, pretty much the same thing.

    The report said SNB should be decided by patient and clinician. I wish it would have said, “not recommended”.

    I go June 12th to get the WLE.

    I’m so ready to have this done and over it. Emotionally, this is so hard to handle. I know it will never be officially “gone”. I will constantly worry and compulse over every mole I have. I will feel, re-feel, and then re-check again every lymph node I possibly can. I just hope that I can get through a conversation or even a thought process about Melanoma with breaking out in tears.

    #64481
    Catherine Poole
    Keymaster

    Counseling, meditation, and medication for anxiety/depression can all help you through this rough stretch. We’ve all been there. Dr. Mihm knows the SLNB is controversial for these lower risk lesions. You need to see yourself as very low risk and the odds of the SLNB showing anything are very low. Try to enjoy each moment, and take the time to savor the good things that go on in your life. We are always here for you to vent as well. You are not alone.

    #64482
    Bdeck1
    Participant

    I want to thank everyone who took the time to reply to my post. I appreciate every response. Emotionally, I am doing much better than the last time I posted. But, I do continue to have some weak moments.

    I figured I would give an update since 1000 people have read this thread (half of those were probably me – checking and re-checking for responses).

    I want to start by saying that I KNOW that this is not what most of you would do and for good reason. The review of the literature does not support the ultimate decision that I made with my husband and the surgeon. But, here is the story:

    I went to see the surgical oncologist, Dr. Corsetti. He is a melanoma specialist and really knew his stuff. He seemed to quote all the stats and information verbatim from the studies that I have read. He went over the pathology report, explaining all the different aspects and what they mean – ie ulceration, clark’s level, depth, mitotic rate, etc. Of course, I had a thorough understanding of this prior to my appointment. He said, “based off your pathology report, there is only a 5 percent chance that this melanoma has metastasized to a lymph node. In fact, the literature states NOT to perform the SLNB.” He went on to say that if my lesion was 0.75mm or even if it was the same size (0.7mm) but had any bad characteristics (ulceration, mitosis >1) he would recommend the SLNB. He continued, “But, if you wanted to the do the SLNB I would not be opposed to doing it since your are borderline with the depth being 0.7mm.” This is not what I wanted to hear. I was convinced before the appointment that I was NOT going to do the SLNB. He told me that I couldn’t make a wrong decision either way. I then asked, “If this were you, your daughter, wife, etc, what would you do?” Hands down, he said he would absolutely do the SLNB. He went on to say that he did a study (granted it was 14 years ago) that stated that clark’s level 4 had a 15 percent of metastasis. He said that studies are not very consistent, but that is what his own study found. Maybe he could sense my anxiety and fear (probably wasn’t hard – I did start crying after I heard that he would do it if he was in my place). He said that if I was a 70 year old person, he would suggest waiting. But, since I am very young and have two very small kids (1.5 and 3 years old) it would give me piece of mind. He said that I would have a 2 percent chance of this primary lesion ever bothering me again if a SLNB was negative. All I kept hearing from him towards the end of the conversation was ‘there is no harm in doing it’. He said if the SLNB came back positive, just removing the lymph nodes would increase my survival rate rather than watchful waiting. The conversation continued. He spend about 45 minutes with me. At NO time did I feel like he was pressuring me. He continued to re-iterate that there was no wrong decision.

    After some prayer and thought, I decided with my husband to do the SLNB. I know that this is against the literature. But, I have WAY too much to lose in this situation. I have two small children and I need that reassurance. I went to the dermatologist randomly. I don’t have an primary care doctor, haven’t been to the GYN since I had my last baby. Why on earth would I feel compelled to go to the dermatologist for a random skin check when I couldn’t even see the concerning mole because it was on my back?!? I believe it was because there is was a higher power who was urging me to go. I truly feel like I am going to be okay. Everything is going to be fine and the SLNB is going to be negative (even if it is positive – I just know I’ll be fine). So, I feel like I am being lead to do the SLNB. So far, God has lead me to the person who found this melanoma. I’m trying to trust my instinct…after all, my “instinct” lead me to the dermatologist for no reason (I thought) in the first place.

    I know that there are risks to the surgery. He quoted those stats (just as small as a positive node result). I am willing to take that chance. I need to take this head on and not just wait and hope nothing spread.

    So, that is it! I am not nervous about the results (well, maybe a little bit) or the surgery itself. I am scared of general anesthesia! My surgery is Wednesday, June 25th.

    Again, thanks for reading. I truly love reading the responses!

    #64483
    cohanja
    Participant

    I think you are making perfect sense. Listen, I did a SLNB with a 0.3 mm lesion! I had 2 nodes removed from under my left arm and it was not really a big deal recovery. I didn’t want to wish later I had done it & had a result (if for nothing else peace of mind). Do what is right for you, what you are comfortable with, and don’t look back.

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