Home Forums Melanoma: Newly Diagnosed – Stages I & II SNB after WLE, need advice

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  • #20889
    idahogirl
    Participant

    Hi there,

    I was just diagnosed 4 days ago with Stage I, Level I melanoma. The mole was not ulcerated and was not vascular. Breslow level 1.1 mm. I am 45 yrs old, with an 11 yr old and a 9 yr old and a great husband.

    The doctor called me at 7 in the morning and told me I had melanoma. I was sound asleep and had a hard time processing all that he was telling me. He said I needed to decided if I wanted to do a SNB or just the WLE and he did say I could do the SNB after the WLE, but that it’s not as accurate. I was confused as to why I wouldn’t want to know if it’s in my lymph nodes or not. He said there was only a 1 in ten chance that is was in the lymph nodes and that if it was, there’s not very effective treatment. He said he could get me in at 11:30 that day for the WLE, or he could refer me to a surgeon for the SNB. My mind was having a hard time processing all this and I was still back on the ” you have melanoma” statement. I asked him what he would do and he replied, ” well, I guess it depends on if you the type of person who would seek treatment at all costs… and you have 90% chance of surviving 5 yrs.” I felt like he thought I should just do the WLE. Without knowing anything about melanoma or treatments, or SNB, etc., I just went in 3 hrs after that phone call and did the WLE, thinking if it’s in my lymph nodes, there’s nothing they can do anyway. After the WLE, I came home and started my research on melanoma, talked to a few friends (whose reactions were–you have had the SNB– and am now second guessing my decision and feeling awful about my knee jerk reaction just to take if off, without thoroughly researching and talking to others. So here’s my questions:

    1) How inaccurate is the SNB after WLE? And what is involved in an SNB–risks, etc.

    2) If they find it in my lymph nodes, does removing the nodes up my chances of survival?

    3) Is there research to show that starting treatment earlier is more effective?

    4) Should I just assume I’m in the 90% and just relax and move on with my life?

    5) Would other doctors lean toward no SNB in this situation?

    Thanks so much for any advice and words of wisdom.

    #58270
    Lisa P
    Participant

    Idahogirl – first, I’m so sorry you’re going through this. It is a diffciult thing, to be sure. I can’t answer your questions and will leave those to Catherine or someone with more technical expertise than I have. What I can tell you is that the fact there is no ulceration is a very good thing. I have had three melanomas to-date, but have not had a SNB with any. Is your doctor an expert in melanoma? If so, I would think his statement about the 90% survival rate means he has fair confidence the nodes are clean. At any rate, try to breath deep and hang in there. There are many folks here to offer information and support. In the meantime, it always helps to get a second opinion, which is something you may want to look into just for peace of mind. Here’s wishing you and yours a happy, and very healthy, new year. Lisa

    #58271
    cohanja
    Participant

    Sorry we had to meet here.

    As far as your question about is it best to have the WLE and SNB done at the same time: 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.

    Either way, I would just make sure you get a second opinion on the pathology slides from an expert. This is an easy thing of shipping them to an expert for another opinion.

    #58272
    cohanja
    Participant

    Did your path report mention mitosis/mitotic rate?

    I wouldn’t beat yourself up too much about reacting quickly. It’s a lot to absorb, I remember my mind just going into a fog/blur, it was hard to process anything, and the natural reaction is to just want it cut out as quickly as possible

    #58273
    Catherine Poole
    Keymaster

    With a 1.1 depth, I would opt for the SNB with your wide excision. It can be truly life saving if they find cells in the node and remove the node. Please go to the BLUE areas and read up on Newly Diagnosed and Melanoma Terms. We also have a page that explains the Sentinal Node Biopsy in detail:http://www.melanomainternational.org/melanoma_info/sentinel_node_biopsy.html . I think you will get your questions answered. You do have time to get another opinion on the pathology and I agree it is a good idea. Be sure a dermatopathologist reads the pathology at a teaching institution. Slides are easily shipped and they should be covered by your insurance. Or you can try: http://www.drmihm.com Harvard based and excellent place to get your slides read.

    I hope this helps and having someone to help you absorb all of the info is great too!

    #58274
    idahogirl
    Participant

    Catherine–

    Thanks for replying. Okay. So I messed up in not having the SNB with the wide excision, which has already been done 4 days ago. Darn. It all happened so fast. Why did my doctor sway me to not have it done? At any rate, now I’ll have to have it done AFTER the wide excision. Is that right, Catherine, what conhanja said—that there is no great amount of evidence really that it would be less accurate if you did opt for it after the wide excision, since that’s already done. :( I read the section on this site about Sentinel Node Biopsies and can’t find any statistics about SNB after WLE, since that is now my only choice.

    That’s good to know removing a node with cancer in it could save my life. Seems logical, and that was my initial thought, but my doctor seemed to think if it’s there then it’s elsewhere and then I’d only be looking at experimental treatments.

    #58275
    idahogirl
    Participant

    P.S. the mitotic rate on my file was listed as greater than 1 per mm squared. Whatever that means. My doctor said once it’s beyond 1 mm Brelsow than the mitotic rate doesn’t tell you much. ??

    #58276
    cohanja
    Participant

    The mitotic rate is a measurement of how fast tumor cells are dividing ( an indication of how fast the cancer cells are dividing). Ideally, you’d like a mitotic rate of 0. I’m not sure if that is correct that beyond 1 mm Breslow, the mitotic rate doesn’t tell you much. I believe mitotic rate was incorporated into the 2009 AJCC staging.

    #58277
    Lisa P
    Participant

    Just curious– is your doc a specialist familiar with skin cancer? I don’t think there’s a need to panic, by any means but another opinion from an expert couldn’t hurt. In the meantime, try to relax as best you can. The good news is that its out and you can begin your long-term strategy starting on Wednesday. Hang in there– we’re right there with you, Lisa

    #58278
    Jess_TN
    Participant

    I sometimes wonder whether or not I made the right decision by opting to not do the SLNB. I, like you, seemed to be talked out of it by my Dr.

    My tumor was ulcerated, which would put me in the running for a SLNB… but, my Dr. advised that with my Breslow Depth being only .55, she didn’t feel that it was a “must do” situation. She told me that the ulceration was likely caused by irritation from my duty belt. I’m a police officer, and my duty belt is positioned in the exact spot that my melanoma was (lower right back/hip area).

    She talked to me about how invasive the SLNB is and the recovery time involved, and none of it sounded good. I’m unable to return to work with ANY restrictions. We don’t have any type of “light duty”, so we must be cleared to return with no restrictions. The WLE left me with multiple interior stitches along with an exterior line of 18 stitches. That, alone, had me out of work for quite some time. I’m also a single mother… I have a second mouth to feed. I had to make sure I could return to work asap after all of my sick time had been spent, and my savings tapped out. At the time, a SLNB didn’t seem like something I HAD to add to the mix.

    Looking back from time to time, I wish I had done a little more research. I would have figured out some way to make it happen. The peace of mind alone would be worth the missed work and asking friends for help. (that’s saying a lot… I’m one of those stubbornly independent chicks. Ha!)

    So, I guess what I’m saying is… if you are being offered the option, take it. :)

    Best of luck!!!

    #58279
    Lisa P
    Participant

    Try not to beat yourself up. 1.1 mm is very borderline on whether an SNB is given so think good thoughts and get to a specialist who can talk about whether having one done now is wise. They can palpate the lymphnodes and detect swelling so you may want to have them to do that, which might put your mind at ease. Take good care and keep us posted. Sending good thoughts, Lisa

    #58280
    cohanja
    Participant

    You can also sometimes have ultrasound on lymph nodes too

    #58281
    idahogirl
    Participant

    Didn’t know they could use ultrasound to check nodes, so thanks for that bit of info. And, yes, Lisa, I need to find a specialist. I’ve been searching on the internet for specialists in my area but haven’t found any. Any tips on how to find a specialist?

    Thanks for all your advice so far.

    #58282
    cohanja
    Participant

    http://www.melanomainternational.org/resources/cancercenters2.html

    I think this is more oncologists, surgical oncologists, etc. . cancer centers. For a derm, you could try http://www.aad.org/find-a-derm

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