New Diagnosis and SLN biopsy question

Hello,

If I was in your shoes I am not sure what I would do either!… its a tough one. I believe the Dr. is advising you that you have the choice of having a SLNB as a precautionary measure (Given the fact there is a mitotic rate and the depth is approaching 1mm).

For what its worth…. I had a 1.65mm primary with ulceration and 5 mitosis per mm2. (Stage 2b) I was told you have a 15 to 20% chance that this will spread to lymph nodes so we recommend a SLNB. Sure enough, one of the lymph nodes was positive with microscopic melanoma deposits. It was a no brainer for me to have my SLNB done and I am so glad I did given the outcome.

In the end you will decide what is right for you 🙂

Let me know if you have any more questions

Samuel

Hello,

If I was in your shoes I am not sure what I would do either!… its a tough one. I believe the Dr. is advising you that you have the choice of having a SLNB as a precautionary measure (Given the fact there is a mitotic rate and the depth is approaching 1mm).

For what its worth…. I had a 1.65mm primary with ulceration and 5 mitosis per mm2. (Stage 2b) I was told you have a 15 to 20% chance that this will spread to lymph nodes so we recommend a SLNB. Sure enough, one of the lymph nodes was positive with microscopic melanoma deposits. It was a no brainer for me to have my SLNB done and I am so glad I did given the outcome.

In the end you will decide what is right for you 🙂

Let me know if you have any more questions

Samuel

Hello,

If I was in your shoes I am not sure what I would do either!… its a tough one. I believe the Dr. is advising you that you have the choice of having a SLNB as a precautionary measure (Given the fact there is a mitotic rate and the depth is approaching 1mm).

For what its worth…. I had a 1.65mm primary with ulceration and 5 mitosis per mm2. (Stage 2b) I was told you have a 15 to 20% chance that this will spread to lymph nodes so we recommend a SLNB. Sure enough, one of the lymph nodes was positive with microscopic melanoma deposits. It was a no brainer for me to have my SLNB done and I am so glad I did given the outcome.

In the end you will decide what is right for you 🙂

Let me know if you have any more questions

Samuel

It used to be that a patient would not be offered a SLN unless the Breslow depth was > 0.76 mm. However, because positive SLN are so rare in thin melanomas, in recent years it has become more common not to offer an SLN unless the Breslow depth is >1.0 mm. In other words, if you had gone to another doctor, you might not have even been offered an SLN. So I guess the choice is up to you. 

Just remember 2 things: 1) the SLN has to be done at the same time they do the WLE; it can't be done later, and 2) SLNs are not 100% accurate– even if your sentinel lymph nodes are negative there is a slight (<5%) possibility that the melanoma will recur some day. Negative nodes are reassuring but not a 100% guarantee. But if the sentinel nodes are positive, you for sure will be glad you got them out of there.

It used to be that a patient would not be offered a SLN unless the Breslow depth was > 0.76 mm. However, because positive SLN are so rare in thin melanomas, in recent years it has become more common not to offer an SLN unless the Breslow depth is >1.0 mm. In other words, if you had gone to another doctor, you might not have even been offered an SLN. So I guess the choice is up to you. 

Just remember 2 things: 1) the SLN has to be done at the same time they do the WLE; it can't be done later, and 2) SLNs are not 100% accurate– even if your sentinel lymph nodes are negative there is a slight (<5%) possibility that the melanoma will recur some day. Negative nodes are reassuring but not a 100% guarantee. But if the sentinel nodes are positive, you for sure will be glad you got them out of there.

It used to be that a patient would not be offered a SLN unless the Breslow depth was > 0.76 mm. However, because positive SLN are so rare in thin melanomas, in recent years it has become more common not to offer an SLN unless the Breslow depth is >1.0 mm. In other words, if you had gone to another doctor, you might not have even been offered an SLN. So I guess the choice is up to you. 

Just remember 2 things: 1) the SLN has to be done at the same time they do the WLE; it can't be done later, and 2) SLNs are not 100% accurate– even if your sentinel lymph nodes are negative there is a slight (<5%) possibility that the melanoma will recur some day. Negative nodes are reassuring but not a 100% guarantee. But if the sentinel nodes are positive, you for sure will be glad you got them out of there.

This past summer I had a WLE and SLNB (which came back negative) on a 1.2mm deep melanoma on my back with no ulceration, 0 mitosis, mild lymphocytes present, and no regression.  Before the procedure, I was told that there was a ~12% chance that the mel had spread and was advised to get the SLNB done by my derm and my oncologist (my derm could have actually just done the WLE in his office if I didn't want the SLNB).

Looking back, I'm glad that I went through it for two reasons:

1) To get a more precise diagnosis and receive the most logical form of care moving forwards AND

2) To help curb my anxiety surrounding a possible recurrence now.  I didn't realize it then but its taken a while for my anxiety levels to gradually go down and having a negative SLNB has certainly helped me vs not knowing.  As others have stated, the negative SLNB doesn't definitively prove that it won't ever recur but if I hadn't had the SLNB done I'd be dealing with more "what ifs" in my mind right now.

For me, it was an outpatient procedure though it took me a week to get back to 85% (the SLNs were found under my arm, the mel was on my lower back, and I also had a WLE done on a severely atypical mole on my stomach at the same time so I was recovering from incisions on three sides of my body).  My WLE scars are still a little sore and itchy though my SLNB scar and site healed much faster.

Please let me know if you have any questions.

This past summer I had a WLE and SLNB (which came back negative) on a 1.2mm deep melanoma on my back with no ulceration, 0 mitosis, mild lymphocytes present, and no regression.  Before the procedure, I was told that there was a ~12% chance that the mel had spread and was advised to get the SLNB done by my derm and my oncologist (my derm could have actually just done the WLE in his office if I didn't want the SLNB).

Looking back, I'm glad that I went through it for two reasons:

1) To get a more precise diagnosis and receive the most logical form of care moving forwards AND

2) To help curb my anxiety surrounding a possible recurrence now.  I didn't realize it then but its taken a while for my anxiety levels to gradually go down and having a negative SLNB has certainly helped me vs not knowing.  As others have stated, the negative SLNB doesn't definitively prove that it won't ever recur but if I hadn't had the SLNB done I'd be dealing with more "what ifs" in my mind right now.

For me, it was an outpatient procedure though it took me a week to get back to 85% (the SLNs were found under my arm, the mel was on my lower back, and I also had a WLE done on a severely atypical mole on my stomach at the same time so I was recovering from incisions on three sides of my body).  My WLE scars are still a little sore and itchy though my SLNB scar and site healed much faster.

Please let me know if you have any questions.

This past summer I had a WLE and SLNB (which came back negative) on a 1.2mm deep melanoma on my back with no ulceration, 0 mitosis, mild lymphocytes present, and no regression.  Before the procedure, I was told that there was a ~12% chance that the mel had spread and was advised to get the SLNB done by my derm and my oncologist (my derm could have actually just done the WLE in his office if I didn't want the SLNB).

Looking back, I'm glad that I went through it for two reasons:

1) To get a more precise diagnosis and receive the most logical form of care moving forwards AND

2) To help curb my anxiety surrounding a possible recurrence now.  I didn't realize it then but its taken a while for my anxiety levels to gradually go down and having a negative SLNB has certainly helped me vs not knowing.  As others have stated, the negative SLNB doesn't definitively prove that it won't ever recur but if I hadn't had the SLNB done I'd be dealing with more "what ifs" in my mind right now.

For me, it was an outpatient procedure though it took me a week to get back to 85% (the SLNs were found under my arm, the mel was on my lower back, and I also had a WLE done on a severely atypical mole on my stomach at the same time so I was recovering from incisions on three sides of my body).  My WLE scars are still a little sore and itchy though my SLNB scar and site healed much faster.

Please let me know if you have any questions.

In years past, you probably wouldn't have even been offered the option.  I had a .88mm (1 mitosis) lesion 11 years ago and wasn't offered the SNB.  Still here, no recurrence.   SNB is surgery, requires general anesthesia and can have complications.  WLE for most only requires local anesthesia.   For me, I was not sorry I didn't have it done – either then or now.  Be aware it is only a diagnostic tool has no clinical benefit.  In the end, it matters not what answers you get for or against – it's all about what you can live with.  YOU are the only important one in this scenario so do what makes YOU comfortable.

In years past, you probably wouldn't have even been offered the option.  I had a .88mm (1 mitosis) lesion 11 years ago and wasn't offered the SNB.  Still here, no recurrence.   SNB is surgery, requires general anesthesia and can have complications.  WLE for most only requires local anesthesia.   For me, I was not sorry I didn't have it done – either then or now.  Be aware it is only a diagnostic tool has no clinical benefit.  In the end, it matters not what answers you get for or against – it's all about what you can live with.  YOU are the only important one in this scenario so do what makes YOU comfortable.

In years past, you probably wouldn't have even been offered the option.  I had a .88mm (1 mitosis) lesion 11 years ago and wasn't offered the SNB.  Still here, no recurrence.   SNB is surgery, requires general anesthesia and can have complications.  WLE for most only requires local anesthesia.   For me, I was not sorry I didn't have it done – either then or now.  Be aware it is only a diagnostic tool has no clinical benefit.  In the end, it matters not what answers you get for or against – it's all about what you can live with.  YOU are the only important one in this scenario so do what makes YOU comfortable.