Need some feedback from people in this situation.

So the standard excision size is 1cm margins, not 2cm margins for any lesion under 2mm.   So if you have 1cm clear margins, then you are good.

What you don't know is if you are really stage I or stage III.  The SNB provides that info.  HOWEVER, the SNB is not generally considered accurate if done AFTER the wide excision.  The drainage paths to the sentinel lymph node may be altered by the wide excision.  So doing the SNB now may not give you the right results.  You may find that the sentinel node found now is negative, but you can never be totally positive that the sentinel node found now is the same one that would have been found prior to the wide excision you have already had.  You might consider asking about ultrasound monitoring of your lymph basin instead of the SNB.  Ultrasound is non-invasive and if done periodically, may show tumor growth (if any were to happen).

Just a little info – melanoma does not respond well to radiation or chemo.  Neither treatment is typically used for melanoma unless as a last resort.  Melanoma works best with immunotherapy.  This is where you stimulate the bodies own defenses to attack melanoma.  There are lots of new treatments released in the last few years and more on the horizon.  So if, in the worst case scenario, you were to progress to a different stage, do not dismiss treatments summarily.  Immunotherapy has different side effects from chemo.  Some tolerate it extremely well.  It's a whole different treatment regimen.  What you've seen others go through with chemo is not the same as you would experience with immunotherapy.  Seeing a melanoma specialist would be key in this situation.

I do not handle anesthesia well either so I understand your reluctance.  While the SNB would be indicated by the depth (1.2mm), again having it after the WLE has limited benefit.   If it is positive, you know you are stage III.  But if it were negative, you'll never know for certain that they got the right node to begin with.

Just my thoughts….

Janner

So the standard excision size is 1cm margins, not 2cm margins for any lesion under 2mm.   So if you have 1cm clear margins, then you are good.

What you don't know is if you are really stage I or stage III.  The SNB provides that info.  HOWEVER, the SNB is not generally considered accurate if done AFTER the wide excision.  The drainage paths to the sentinel lymph node may be altered by the wide excision.  So doing the SNB now may not give you the right results.  You may find that the sentinel node found now is negative, but you can never be totally positive that the sentinel node found now is the same one that would have been found prior to the wide excision you have already had.  You might consider asking about ultrasound monitoring of your lymph basin instead of the SNB.  Ultrasound is non-invasive and if done periodically, may show tumor growth (if any were to happen).

Just a little info – melanoma does not respond well to radiation or chemo.  Neither treatment is typically used for melanoma unless as a last resort.  Melanoma works best with immunotherapy.  This is where you stimulate the bodies own defenses to attack melanoma.  There are lots of new treatments released in the last few years and more on the horizon.  So if, in the worst case scenario, you were to progress to a different stage, do not dismiss treatments summarily.  Immunotherapy has different side effects from chemo.  Some tolerate it extremely well.  It's a whole different treatment regimen.  What you've seen others go through with chemo is not the same as you would experience with immunotherapy.  Seeing a melanoma specialist would be key in this situation.

I do not handle anesthesia well either so I understand your reluctance.  While the SNB would be indicated by the depth (1.2mm), again having it after the WLE has limited benefit.   If it is positive, you know you are stage III.  But if it were negative, you'll never know for certain that they got the right node to begin with.

Just my thoughts….

Janner

So the standard excision size is 1cm margins, not 2cm margins for any lesion under 2mm.   So if you have 1cm clear margins, then you are good.

What you don't know is if you are really stage I or stage III.  The SNB provides that info.  HOWEVER, the SNB is not generally considered accurate if done AFTER the wide excision.  The drainage paths to the sentinel lymph node may be altered by the wide excision.  So doing the SNB now may not give you the right results.  You may find that the sentinel node found now is negative, but you can never be totally positive that the sentinel node found now is the same one that would have been found prior to the wide excision you have already had.  You might consider asking about ultrasound monitoring of your lymph basin instead of the SNB.  Ultrasound is non-invasive and if done periodically, may show tumor growth (if any were to happen).

Just a little info – melanoma does not respond well to radiation or chemo.  Neither treatment is typically used for melanoma unless as a last resort.  Melanoma works best with immunotherapy.  This is where you stimulate the bodies own defenses to attack melanoma.  There are lots of new treatments released in the last few years and more on the horizon.  So if, in the worst case scenario, you were to progress to a different stage, do not dismiss treatments summarily.  Immunotherapy has different side effects from chemo.  Some tolerate it extremely well.  It's a whole different treatment regimen.  What you've seen others go through with chemo is not the same as you would experience with immunotherapy.  Seeing a melanoma specialist would be key in this situation.

I do not handle anesthesia well either so I understand your reluctance.  While the SNB would be indicated by the depth (1.2mm), again having it after the WLE has limited benefit.   If it is positive, you know you are stage III.  But if it were negative, you'll never know for certain that they got the right node to begin with.

Just my thoughts….

Janner

This was exactly what happened to me except mine was found to be over 2mm with a high mitotic rate rather than 0.7mm.

I did have the SLNB 2 weeks after the WLE and it was negative. They did 1cm margins which were clear and never suggested doing additional surgery on the WLE.

Like others said, it doesn't feel as definitive as if I had been able to have the SLNB before the WLE, but no way to go back. At this time I am not being monitored by ultrasound but maybe it's a possibility in the future.

This was exactly what happened to me except mine was found to be over 2mm with a high mitotic rate rather than 0.7mm.

I did have the SLNB 2 weeks after the WLE and it was negative. They did 1cm margins which were clear and never suggested doing additional surgery on the WLE.

Like others said, it doesn't feel as definitive as if I had been able to have the SLNB before the WLE, but no way to go back. At this time I am not being monitored by ultrasound but maybe it's a possibility in the future.

This was exactly what happened to me except mine was found to be over 2mm with a high mitotic rate rather than 0.7mm.

I did have the SLNB 2 weeks after the WLE and it was negative. They did 1cm margins which were clear and never suggested doing additional surgery on the WLE.

Like others said, it doesn't feel as definitive as if I had been able to have the SLNB before the WLE, but no way to go back. At this time I am not being monitored by ultrasound but maybe it's a possibility in the future.

I'm sorry to hear that your original diagnosis – already scary enough – got worse after WLE. What a huge shock for you.

In Australia the guideline for a 1.2 mm melanoma would be a 1cm margin – at 2mm – 4mm it becomes a 2 cm margin. So, having 1cm clear margins would be enough for me unless my dr had a very convincing argument otherwise.

At the revised depth of 1.2mm a SLNB is recommended and does show a survival benefit. According to one source, SLNB is acceptable after WLE if extensive reconstruction has not been done:

http://emedicine.medscape.com/article/854424-overview

Given that SLNB is pretty minimally invasive and is recommended for melanomas like yours, I would do it. I would do it because once upon a time in the not too distant past, nothing could be done once melanoma started to spread, so why bother even finding out. Nowadays, we have some amazing science giving us treatment options that past melanoma patients could only dream of.

A SLNB provides is a much clearer picture of whether your melanoma has started to spread, and if it has you can nip it in the bud and can get into treatment that much quicker or change level of monitoring to suit. Like others have said, new melanoma therapies – which are to be honest pretty miraculous – cannot be compared to chemo or radiation. Good luck with this decision, the whole circumstance is not ideal but we just have to roll with the punches I guess.

I'm sorry to hear that your original diagnosis – already scary enough – got worse after WLE. What a huge shock for you.

In Australia the guideline for a 1.2 mm melanoma would be a 1cm margin – at 2mm – 4mm it becomes a 2 cm margin. So, having 1cm clear margins would be enough for me unless my dr had a very convincing argument otherwise.

At the revised depth of 1.2mm a SLNB is recommended and does show a survival benefit. According to one source, SLNB is acceptable after WLE if extensive reconstruction has not been done:

http://emedicine.medscape.com/article/854424-overview

Given that SLNB is pretty minimally invasive and is recommended for melanomas like yours, I would do it. I would do it because once upon a time in the not too distant past, nothing could be done once melanoma started to spread, so why bother even finding out. Nowadays, we have some amazing science giving us treatment options that past melanoma patients could only dream of.

A SLNB provides is a much clearer picture of whether your melanoma has started to spread, and if it has you can nip it in the bud and can get into treatment that much quicker or change level of monitoring to suit. Like others have said, new melanoma therapies – which are to be honest pretty miraculous – cannot be compared to chemo or radiation. Good luck with this decision, the whole circumstance is not ideal but we just have to roll with the punches I guess.

I'm sorry to hear that your original diagnosis – already scary enough – got worse after WLE. What a huge shock for you.

In Australia the guideline for a 1.2 mm melanoma would be a 1cm margin – at 2mm – 4mm it becomes a 2 cm margin. So, having 1cm clear margins would be enough for me unless my dr had a very convincing argument otherwise.

At the revised depth of 1.2mm a SLNB is recommended and does show a survival benefit. According to one source, SLNB is acceptable after WLE if extensive reconstruction has not been done:

http://emedicine.medscape.com/article/854424-overview

Given that SLNB is pretty minimally invasive and is recommended for melanomas like yours, I would do it. I would do it because once upon a time in the not too distant past, nothing could be done once melanoma started to spread, so why bother even finding out. Nowadays, we have some amazing science giving us treatment options that past melanoma patients could only dream of.

A SLNB provides is a much clearer picture of whether your melanoma has started to spread, and if it has you can nip it in the bud and can get into treatment that much quicker or change level of monitoring to suit. Like others have said, new melanoma therapies – which are to be honest pretty miraculous – cannot be compared to chemo or radiation. Good luck with this decision, the whole circumstance is not ideal but we just have to roll with the punches I guess.

Could someone recap exactly what the treatment options are currently for Stage III?  As far as I know, the best treatment options currently are reserved for Stage IV.  It might help sweetiejs to know what would be available for Stage III and any statistics on those treatments in deciding whether to find out if their status is Stage I or III.

Could someone recap exactly what the treatment options are currently for Stage III?  As far as I know, the best treatment options currently are reserved for Stage IV.  It might help sweetiejs to know what would be available for Stage III and any statistics on those treatments in deciding whether to find out if their status is Stage I or III.

Could someone recap exactly what the treatment options are currently for Stage III?  As far as I know, the best treatment options currently are reserved for Stage IV.  It might help sweetiejs to know what would be available for Stage III and any statistics on those treatments in deciding whether to find out if their status is Stage I or III.