› Forums › General Melanoma Community › Lymph Node Dissection for stage IB?
- This topic has 15 replies, 3 voices, and was last updated 9 years, 5 months ago by
amandak1026.
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- January 19, 2016 at 11:06 pm
Hello,
My mom was diagnosed a few weeks ago. Her first biopsy showed a melanoma on her leg with a Breslow's depth of .66mm and a mitotic rate of 1. They took the tumor out last week, and the path report came back with the Breslow's at 1.03 and a mitotic rate of 2, and assuming no spread, staged her at IB. She did NOT do the SNB.
Now they're recommending she go in for a lymph node dissection. I'm very confused, as I thought the dissection was a full removal of the nodes because cancer was found there. But they don't know that yet? Is it normal for a dissection to be done as a prognostic tool? My mom is terrified, and I'm trying to find out as much information as I can for her, so I'm sorry if this is a dumb question.
We meet with the surgeon on Thursday to discuss.
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- January 19, 2016 at 11:24 pm
From my understanding the SLNB isn't typically indicated for tumors less than 1mm, so presumably because the initial biopsy only showed .66mm, it wasn't done with the second because the depth wasn't known to be/expected to be greater than 1mm. Just a guess.
The SLNB is done to determine if any cancer cells from the melanoma are present in the lymph nodes, so yes, it is a diagnostic procedure to determine whether the cancer has spread, but no, they don't know that yet simply based on the tumor itself.
Lots more info here: http://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet
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- January 19, 2016 at 11:24 pm
From my understanding the SLNB isn't typically indicated for tumors less than 1mm, so presumably because the initial biopsy only showed .66mm, it wasn't done with the second because the depth wasn't known to be/expected to be greater than 1mm. Just a guess.
The SLNB is done to determine if any cancer cells from the melanoma are present in the lymph nodes, so yes, it is a diagnostic procedure to determine whether the cancer has spread, but no, they don't know that yet simply based on the tumor itself.
Lots more info here: http://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet
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- January 19, 2016 at 11:24 pm
From my understanding the SLNB isn't typically indicated for tumors less than 1mm, so presumably because the initial biopsy only showed .66mm, it wasn't done with the second because the depth wasn't known to be/expected to be greater than 1mm. Just a guess.
The SLNB is done to determine if any cancer cells from the melanoma are present in the lymph nodes, so yes, it is a diagnostic procedure to determine whether the cancer has spread, but no, they don't know that yet simply based on the tumor itself.
Lots more info here: http://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet
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- January 19, 2016 at 11:34 pm
If they wanted lymph nodes, they should have done the SLNB! They can't do it now because the WLE can change the drainage paths making any results done now questionable. Complete node dissection isn't curative – do your research because they aren't following normal protocols for ANY procedure yet. I'd consider a different doctor, truthfully. I'd suggest ultrasound monitoring of the lymph nodes over a dissection at this point. But they screwed up on the shave biopsy by not going deep enough, didn't do the SLNB when the deep margin was involved and are again going against protocol. My trust would be exhausted and I'm not usually that critical.
janner
stage 1b since 1992, 3 mm primaries
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- January 19, 2016 at 11:34 pm
If they wanted lymph nodes, they should have done the SLNB! They can't do it now because the WLE can change the drainage paths making any results done now questionable. Complete node dissection isn't curative – do your research because they aren't following normal protocols for ANY procedure yet. I'd consider a different doctor, truthfully. I'd suggest ultrasound monitoring of the lymph nodes over a dissection at this point. But they screwed up on the shave biopsy by not going deep enough, didn't do the SLNB when the deep margin was involved and are again going against protocol. My trust would be exhausted and I'm not usually that critical.
janner
stage 1b since 1992, 3 mm primaries
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- January 19, 2016 at 11:38 pm
Thank you for the honest response! They gave my mom the option of doing the SLNB, but she chose not to do it because they told her they were "very opitimistic" that the melanoma didn't go much deeper than the .66 and her mitotic rate was low. Even during the procedure last week, the doctor was telling her how clean it looked, how he didn't see an indication of deep invaders, how he was even more optimistic now than he was before they started and how she made the right choice by not doing the SLNB.
and now here we are, and they want to take her lymph nodes. She's understandably upset and feels her doctor misled her (and I can't say I blame her!) so i have a lot of questions when we go in on Thursday.
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- January 19, 2016 at 11:38 pm
Thank you for the honest response! They gave my mom the option of doing the SLNB, but she chose not to do it because they told her they were "very opitimistic" that the melanoma didn't go much deeper than the .66 and her mitotic rate was low. Even during the procedure last week, the doctor was telling her how clean it looked, how he didn't see an indication of deep invaders, how he was even more optimistic now than he was before they started and how she made the right choice by not doing the SLNB.
and now here we are, and they want to take her lymph nodes. She's understandably upset and feels her doctor misled her (and I can't say I blame her!) so i have a lot of questions when we go in on Thursday.
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- January 19, 2016 at 11:43 pm
Remember, surgeons like to cut so that will be recommended, but ultrasound monitoring has been studied as well and it has no side effects! Do a LOT of research before you commit to any path and again, I'd recommend a second opinion especially if the surgeon still wants to cut.
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- January 19, 2016 at 11:43 pm
Remember, surgeons like to cut so that will be recommended, but ultrasound monitoring has been studied as well and it has no side effects! Do a LOT of research before you commit to any path and again, I'd recommend a second opinion especially if the surgeon still wants to cut.
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- January 19, 2016 at 11:45 pm
Thank you so much!
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- January 19, 2016 at 11:45 pm
Thank you so much!
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- January 19, 2016 at 11:45 pm
Thank you so much!
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- January 19, 2016 at 11:43 pm
Remember, surgeons like to cut so that will be recommended, but ultrasound monitoring has been studied as well and it has no side effects! Do a LOT of research before you commit to any path and again, I'd recommend a second opinion especially if the surgeon still wants to cut.
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- January 19, 2016 at 11:38 pm
Thank you for the honest response! They gave my mom the option of doing the SLNB, but she chose not to do it because they told her they were "very opitimistic" that the melanoma didn't go much deeper than the .66 and her mitotic rate was low. Even during the procedure last week, the doctor was telling her how clean it looked, how he didn't see an indication of deep invaders, how he was even more optimistic now than he was before they started and how she made the right choice by not doing the SLNB.
and now here we are, and they want to take her lymph nodes. She's understandably upset and feels her doctor misled her (and I can't say I blame her!) so i have a lot of questions when we go in on Thursday.
-
- January 19, 2016 at 11:34 pm
If they wanted lymph nodes, they should have done the SLNB! They can't do it now because the WLE can change the drainage paths making any results done now questionable. Complete node dissection isn't curative – do your research because they aren't following normal protocols for ANY procedure yet. I'd consider a different doctor, truthfully. I'd suggest ultrasound monitoring of the lymph nodes over a dissection at this point. But they screwed up on the shave biopsy by not going deep enough, didn't do the SLNB when the deep margin was involved and are again going against protocol. My trust would be exhausted and I'm not usually that critical.
janner
stage 1b since 1992, 3 mm primaries
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