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March 11, 2013 at 2:43 am #21097CcopeDParticipant
I realize you all are not necessarily medical professionals (or maybe you are!). I am asking for general experiences on when you decided to/not to get SLNB. What tipped the scale for you?
My first derm was not a very responsive nor informative doctor. He told me not to get further treatment for my melanoma. I sought a second opinion (mainly to just switch doctors) and this derm tells me that I’m right on the cusp of when to get a SLNB; therefore, he does not have a suggestion one way or the other. He says its up to me; but, I’m not a doctor and am having difficulty making this decision. I realize my melanoma is not advanced; but, any opinions you have will be appreciated.
I am a 30 year old female with no family history of melanoma; but lots a strange moles on my body. My melanoma was diagnosed last summer (2012) in my upper right arm. My current derm says I might consider getting it done due to my young age and mitoses rate.
Here is my pathology report:
Malignant melanoma arising in association with a compound nevus.
Anatomic Level: Early Clark’s Level IV
Radial Growth Phase: Present
Vertical Growth Phase: Present
Mitoses: 4 per MM2
Tumor Infiltrating Lymphocytes: Present, non-brisk
Margins: peripheral, positive; deep, negative
Again, just thoughts and anecdotes on your personal journey will be helpful!
Thank you in advanceMarch 11, 2013 at 9:22 am #59560cohanjaParticipant
Your melanoma was diagnosed last summer, so I’m assuming that’s when you 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 and VGP it wouldn’t be out of the question.March 11, 2013 at 1:49 pm #59561Catherine PooleKeymaster
I agree with Cohanja. But I might send the slides for a second opinion to a place of excellence, just to be sure of the original pathology. Then it will be up to you and what makes your comfortable.March 11, 2013 at 2:33 pm #59562itomParticipant I agree with what cohanja said. I would like to add that my melanoma was similar to yours. Mine was located on my neck, depth .65mm, mitosis 2/mm2, and I am 31 years old. So I am stage 1B, now I’m in Canada so here it seems they do the slnb if the dermatologist thinks its necessary. I had the slnb and they took only one lymph node which thankfully came back negative for melanoma. Now after all the research I’ve done now on melanoma, looking back if given the choice I definitely would have chosen to do the slnb. The reason is I am still worried about a recurrence even though according to my dermatologist my survival rate is 95% chance I’m alive in 10 years, but if I didn’t get the slnb done it would have been 80% for 10 years, so it gives you some peace of mind. Also they have done studies that show if your younger then 40 there is a higher chance of spread to the lymph nodes. As well your mitosis is a bit worrisome but in studies the mitosis is considered high when greater than 6. In the end though the most important factor is depth, and yours is less than .75 which they have found that melanomas thinner than this rarely metastasize and that’s why the ajcc recommends the slnb for melanomas that have mitosis or ulceration between .75 and 1 mm.
In the end there isn’t a right or wrong answer, it’s really up to you to decide.
JohnMarch 13, 2013 at 3:12 pm #59563CcopeDParticipant
I would like to extend a huge THANK YOU to everyone for your thoughtful replies. This information has given me more breadth for my decision.
ChristinaMarch 13, 2013 at 10:53 pm #59564krissy424Participant
I would defer on the SNLB. Doesn’t seem
necessary and I know a number of patients that ended up with serious lympthedema. Just my personal opinion.
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