New Diagnosis – Next Steps (Help!)

The benefit of the SLNB is finding out either 1) good news, no spread to lymph nodes and she will just get regular skin checks and possibly scans for a while or 2) spread to lymph nodes, meaning she would be put in the Stage 3 category (which is what happened with me, I was initially T2b, I am now 3b since melanoma was found in my lymph nodes) and then she will have more decisions to make as far as treatment options. Her recurrence rate also goes up if she were to be Stage 3. It will give you both a piece of mind not having to wonder what may or may not be happening with her lymph nodes.

The WLE can be different depending on where on the body her biopsy site is located. Mine was on the side of my calf, which was pretty easy for removal of skin and tissue. They take all tissue down to the muscle and skin around the biopsy site usually 1-2cm around. It is a football shaped excision, since you can't close a circle, and then stitched up. My scar is about 4 inches long. There really aren't any negative effects, it will heal and she should have no problems with it. Depending on where on her body it is, she will have to be careful for a while using that part of her body, it is very tight since skin was removed. I had to be careful using stairs and such to make sure I didn't pop stitches. I had the SLNB and WLE done at the same time. 

The benefit of the SLNB is finding out either 1) good news, no spread to lymph nodes and she will just get regular skin checks and possibly scans for a while or 2) spread to lymph nodes, meaning she would be put in the Stage 3 category (which is what happened with me, I was initially T2b, I am now 3b since melanoma was found in my lymph nodes) and then she will have more decisions to make as far as treatment options. Her recurrence rate also goes up if she were to be Stage 3. It will give you both a piece of mind not having to wonder what may or may not be happening with her lymph nodes.

The WLE can be different depending on where on the body her biopsy site is located. Mine was on the side of my calf, which was pretty easy for removal of skin and tissue. They take all tissue down to the muscle and skin around the biopsy site usually 1-2cm around. It is a football shaped excision, since you can't close a circle, and then stitched up. My scar is about 4 inches long. There really aren't any negative effects, it will heal and she should have no problems with it. Depending on where on her body it is, she will have to be careful for a while using that part of her body, it is very tight since skin was removed. I had to be careful using stairs and such to make sure I didn't pop stitches. I had the SLNB and WLE done at the same time. 

You're welcome. It is a crazy and confusing time. She can get the SLNB and WLE at the same time, doesn't have to be before WLE but should be done before or at the same time. Sorry the doctor made it so much more confusing than it needed to be.

You're welcome. It is a crazy and confusing time. She can get the SLNB and WLE at the same time, doesn't have to be before WLE but should be done before or at the same time. Sorry the doctor made it so much more confusing than it needed to be.

I just realized that sounded kind of confusing. SLNB & WLE in same surgery OR SLNB before WLE. It's nice to get it all done at the same time. They do the SLNB and then when that's done they move on to the WLE part. 

I just realized that sounded kind of confusing. SLNB & WLE in same surgery OR SLNB before WLE. It's nice to get it all done at the same time. They do the SLNB and then when that's done they move on to the WLE part. 

I just realized that sounded kind of confusing. SLNB & WLE in same surgery OR SLNB before WLE. It's nice to get it all done at the same time. They do the SLNB and then when that's done they move on to the WLE part. 

You're welcome. It is a crazy and confusing time. She can get the SLNB and WLE at the same time, doesn't have to be before WLE but should be done before or at the same time. Sorry the doctor made it so much more confusing than it needed to be.

The benefit of the SLNB is finding out either 1) good news, no spread to lymph nodes and she will just get regular skin checks and possibly scans for a while or 2) spread to lymph nodes, meaning she would be put in the Stage 3 category (which is what happened with me, I was initially T2b, I am now 3b since melanoma was found in my lymph nodes) and then she will have more decisions to make as far as treatment options. Her recurrence rate also goes up if she were to be Stage 3. It will give you both a piece of mind not having to wonder what may or may not be happening with her lymph nodes.

The WLE can be different depending on where on the body her biopsy site is located. Mine was on the side of my calf, which was pretty easy for removal of skin and tissue. They take all tissue down to the muscle and skin around the biopsy site usually 1-2cm around. It is a football shaped excision, since you can't close a circle, and then stitched up. My scar is about 4 inches long. There really aren't any negative effects, it will heal and she should have no problems with it. Depending on where on her body it is, she will have to be careful for a while using that part of her body, it is very tight since skin was removed. I had to be careful using stairs and such to make sure I didn't pop stitches. I had the SLNB and WLE done at the same time. 

You do understand the SNB has to be done PRIOR to the WLE.  Otherwise, the results of the SNB may be compromised.  With a depth over 1mm, the standard of care is to have the SNB.  Obviously, you can refuse this course but the guidelines were developed using large amounts of data.  My elderly father was diagnosed with a stage 2 lesion years ago and we chose not to do the SNB because we knew he would not choose to do interferon (the only treatment that would have been available to him at that time) even if his SNB was positive. I fought the establishment on the SNB but I considered the WLE mandatory.  Melanoma likes to travel and, to date, surgery is still the most effective cure available.  You want to remove any cells that might be outside the original tumor to lower chances of spread.  I am pretty certain you'll find very few, if any, doctors who would advocate not having the WLE.  I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and he eventually passed away from the disease.  The WLE itself can be a large scar (depends a lot on location) but it is a relatively simple procedure and most have no lasting side effects.  I was 29 when originally diagnosed (22 years ago) and have had 8 or 9 WLEs (2 more primaries and other atypical moles) and consider them a minor inconvenience.  They leave a scar, can be tight for a while, may cause some local nerve damage but are otherwise typically simple procedures.  

You do understand the SNB has to be done PRIOR to the WLE.  Otherwise, the results of the SNB may be compromised.  With a depth over 1mm, the standard of care is to have the SNB.  Obviously, you can refuse this course but the guidelines were developed using large amounts of data.  My elderly father was diagnosed with a stage 2 lesion years ago and we chose not to do the SNB because we knew he would not choose to do interferon (the only treatment that would have been available to him at that time) even if his SNB was positive. I fought the establishment on the SNB but I considered the WLE mandatory.  Melanoma likes to travel and, to date, surgery is still the most effective cure available.  You want to remove any cells that might be outside the original tumor to lower chances of spread.  I am pretty certain you'll find very few, if any, doctors who would advocate not having the WLE.  I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and he eventually passed away from the disease.  The WLE itself can be a large scar (depends a lot on location) but it is a relatively simple procedure and most have no lasting side effects.  I was 29 when originally diagnosed (22 years ago) and have had 8 or 9 WLEs (2 more primaries and other atypical moles) and consider them a minor inconvenience.  They leave a scar, can be tight for a while, may cause some local nerve damage but are otherwise typically simple procedures.  

Gotcha.  SNB before WLE – mandatory.  Maybe time to get a second opinion.  I rarely advocate for people under 1mm get a SNB because it is surgery and can have side effects.  However, if it is over 1mm, that's pretty standard.  Some institutions even use 0.75mm instead of 1mm.  In addition, a mitosis of 2 is higher risk.  (<1 is what you'd like to see).  There is still a very good chance her SNB will be negative but she does fall within the parameters to have one at most every institution.

Gotcha.  SNB before WLE – mandatory.  Maybe time to get a second opinion.  I rarely advocate for people under 1mm get a SNB because it is surgery and can have side effects.  However, if it is over 1mm, that's pretty standard.  Some institutions even use 0.75mm instead of 1mm.  In addition, a mitosis of 2 is higher risk.  (<1 is what you'd like to see).  There is still a very good chance her SNB will be negative but she does fall within the parameters to have one at most every institution.

There is no problem with waiting, it has been studied.  The surgical risks?  General anesthesia vs local.  Typically one or two lymph nods are removed.  There is a chance of lymphedema, but that risk is very low with the SNB.  It is higher if you choose to do the CLND if the nodes are positive.  Obviously a risk of infection but in general, the SNB is well tolerated and few have any real side effects.  Sounds like he was justifying his decision with scare tactics.  I have been on this site for 14 years and I have seen a lot of people come and go.  Complications from the SNB isn't something that would be high on my list of discussion topics here.  What to expect?  Yes.  But true complications?  Just not that much.

There is no problem with waiting, it has been studied.  The surgical risks?  General anesthesia vs local.  Typically one or two lymph nods are removed.  There is a chance of lymphedema, but that risk is very low with the SNB.  It is higher if you choose to do the CLND if the nodes are positive.  Obviously a risk of infection but in general, the SNB is well tolerated and few have any real side effects.  Sounds like he was justifying his decision with scare tactics.  I have been on this site for 14 years and I have seen a lot of people come and go.  Complications from the SNB isn't something that would be high on my list of discussion topics here.  What to expect?  Yes.  But true complications?  Just not that much.

There is no problem with waiting, it has been studied.  The surgical risks?  General anesthesia vs local.  Typically one or two lymph nods are removed.  There is a chance of lymphedema, but that risk is very low with the SNB.  It is higher if you choose to do the CLND if the nodes are positive.  Obviously a risk of infection but in general, the SNB is well tolerated and few have any real side effects.  Sounds like he was justifying his decision with scare tactics.  I have been on this site for 14 years and I have seen a lot of people come and go.  Complications from the SNB isn't something that would be high on my list of discussion topics here.  What to expect?  Yes.  But true complications?  Just not that much.

The surgery is not more dangerous than most standard surgeries. Most people get put under general anesthesia which has it's potential dangers, but is usually very safe for most young and healthy people. I did not have general, so I was just highly drugged (don't remember the medical term) and it was easier waking up from it. 

The surgery is not more dangerous than most standard surgeries. Most people get put under general anesthesia which has it's potential dangers, but is usually very safe for most young and healthy people. I did not have general, so I was just highly drugged (don't remember the medical term) and it was easier waking up from it. 

Age:32, thickness:2.1mm, clark level:IV, location:extremity, positive for ulceration. It stated I have a 27% chance of lymph node involvement.

Interesting, because when I had my CLDN, I had 6 positive nodes out of 30, with 2 nodes being “grossly positive” with extracapsular extension. So I had a pretty high amount of lymph node involvement, shown with the surgery.

Moral of the story? Don’t put all your faith in an algorithm. Melanoma doesn’t play by the rules.

Age:32, thickness:2.1mm, clark level:IV, location:extremity, positive for ulceration. It stated I have a 27% chance of lymph node involvement.

Interesting, because when I had my CLDN, I had 6 positive nodes out of 30, with 2 nodes being “grossly positive” with extracapsular extension. So I had a pretty high amount of lymph node involvement, shown with the surgery.

Moral of the story? Don’t put all your faith in an algorithm. Melanoma doesn’t play by the rules.

Age:32, thickness:2.1mm, clark level:IV, location:extremity, positive for ulceration. It stated I have a 27% chance of lymph node involvement.

Interesting, because when I had my CLDN, I had 6 positive nodes out of 30, with 2 nodes being “grossly positive” with extracapsular extension. So I had a pretty high amount of lymph node involvement, shown with the surgery.

Moral of the story? Don’t put all your faith in an algorithm. Melanoma doesn’t play by the rules.

The surgery is not more dangerous than most standard surgeries. Most people get put under general anesthesia which has it's potential dangers, but is usually very safe for most young and healthy people. I did not have general, so I was just highly drugged (don't remember the medical term) and it was easier waking up from it. 

Gotcha.  SNB before WLE – mandatory.  Maybe time to get a second opinion.  I rarely advocate for people under 1mm get a SNB because it is surgery and can have side effects.  However, if it is over 1mm, that's pretty standard.  Some institutions even use 0.75mm instead of 1mm.  In addition, a mitosis of 2 is higher risk.  (<1 is what you'd like to see).  There is still a very good chance her SNB will be negative but she does fall within the parameters to have one at most every institution.

"I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and eventually passed away from the disease."  I know many people on this site that did everything their doctors suggested and they passed away from their disease so what is your point?

"I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and eventually passed away from the disease."  I know many people on this site that did everything their doctors suggested and they passed away from their disease so what is your point?

The point is the WLE has a purpose.  Surgery can be curative.  The OP appeared to be asking whether or not it was in the best interest to have a WLE.  That was since clarified that that was not the question, only the SNB.  But my answer was to state the WLE is important.  The gentleman I mentioned chose not to do the WLE/SNB, had obvious spread at the original site and only chose alternate treatments and no convention treatments beside the biopsy.   Surgery like the WLE may have cured or delayed the spread.  My father had the WLE, no SNB but years later had spread to the lymph nodes and it eventually took him.  I believe the WLE possibly delayed his spread but who knows.  He was at least stage II at diagnosis but showed no obivous lymph node involvement for over 5 years.  I  have had 3 primary WLEs with no spread – so for me (so far) surgery has been curative.

The point is the WLE has a purpose.  Surgery can be curative.  The OP appeared to be asking whether or not it was in the best interest to have a WLE.  That was since clarified that that was not the question, only the SNB.  But my answer was to state the WLE is important.  The gentleman I mentioned chose not to do the WLE/SNB, had obvious spread at the original site and only chose alternate treatments and no convention treatments beside the biopsy.   Surgery like the WLE may have cured or delayed the spread.  My father had the WLE, no SNB but years later had spread to the lymph nodes and it eventually took him.  I believe the WLE possibly delayed his spread but who knows.  He was at least stage II at diagnosis but showed no obivous lymph node involvement for over 5 years.  I  have had 3 primary WLEs with no spread – so for me (so far) surgery has been curative.

Given the number of people on this site who have undergone WLE/SNB and had their disease progress you cannot say with any certainty that the gentleman you referenced would have been better off if he had undergone the procedure.  I understand your point that WLE can be curative.  That is absolutely true.  No need to bring alternate treatments into the discussion.

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Sorry about that, Ed.  I know they can be annoying.  Did you try to unsubscribe?  I confess to being embarrassed now about my response to Janner.  I absolutely adore Janner which is probably why I was overly defensive when she used a negative example of alternate treatment.  I have to resolve to myself that people I have tremendous respect for (yourself, Celeste, Janner) will likely always be opposed to treatments that don't originate in (or haven't yet been validated by) the conventional medicine model.  That's just the way it is.  Sorry to Janner for my defensiveness.

Cheers,

Maggie

Sorry about that, Ed.  I know they can be annoying.  Did you try to unsubscribe?  I confess to being embarrassed now about my response to Janner.  I absolutely adore Janner which is probably why I was overly defensive when she used a negative example of alternate treatment.  I have to resolve to myself that people I have tremendous respect for (yourself, Celeste, Janner) will likely always be opposed to treatments that don't originate in (or haven't yet been validated by) the conventional medicine model.  That's just the way it is.  Sorry to Janner for my defensiveness.

Cheers,

Maggie

Sorry about that, Ed.  I know they can be annoying.  Did you try to unsubscribe?  I confess to being embarrassed now about my response to Janner.  I absolutely adore Janner which is probably why I was overly defensive when she used a negative example of alternate treatment.  I have to resolve to myself that people I have tremendous respect for (yourself, Celeste, Janner) will likely always be opposed to treatments that don't originate in (or haven't yet been validated by) the conventional medicine model.  That's just the way it is.  Sorry to Janner for my defensiveness.

Cheers,

Maggie

Maggie, it is always great to have the alternative medicine police keeping the scientiific types in line. One other thing, I am still mad at you about " The truth about Cancer" video series, I am still getting emails from them months later!!!! Ed 

Given the number of people on this site who have undergone WLE/SNB and had their disease progress you cannot say with any certainty that the gentleman you referenced would have been better off if he had undergone the procedure.  I understand your point that WLE can be curative.  That is absolutely true.  No need to bring alternate treatments into the discussion.

Given the number of people on this site who have undergone WLE/SNB and had their disease progress you cannot say with any certainty that the gentleman you referenced would have been better off if he had undergone the procedure.  I understand your point that WLE can be curative.  That is absolutely true.  No need to bring alternate treatments into the discussion.

The point is the WLE has a purpose.  Surgery can be curative.  The OP appeared to be asking whether or not it was in the best interest to have a WLE.  That was since clarified that that was not the question, only the SNB.  But my answer was to state the WLE is important.  The gentleman I mentioned chose not to do the WLE/SNB, had obvious spread at the original site and only chose alternate treatments and no convention treatments beside the biopsy.   Surgery like the WLE may have cured or delayed the spread.  My father had the WLE, no SNB but years later had spread to the lymph nodes and it eventually took him.  I believe the WLE possibly delayed his spread but who knows.  He was at least stage II at diagnosis but showed no obivous lymph node involvement for over 5 years.  I  have had 3 primary WLEs with no spread – so for me (so far) surgery has been curative.

"I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and eventually passed away from the disease."  I know many people on this site that did everything their doctors suggested and they passed away from their disease so what is your point?

You do understand the SNB has to be done PRIOR to the WLE.  Otherwise, the results of the SNB may be compromised.  With a depth over 1mm, the standard of care is to have the SNB.  Obviously, you can refuse this course but the guidelines were developed using large amounts of data.  My elderly father was diagnosed with a stage 2 lesion years ago and we chose not to do the SNB because we knew he would not choose to do interferon (the only treatment that would have been available to him at that time) even if his SNB was positive. I fought the establishment on the SNB but I considered the WLE mandatory.  Melanoma likes to travel and, to date, surgery is still the most effective cure available.  You want to remove any cells that might be outside the original tumor to lower chances of spread.  I am pretty certain you'll find very few, if any, doctors who would advocate not having the WLE.  I know one gentleman on this site who chose this route avoiding surgery and take alternate treatments.  His melanoma spread and he eventually passed away from the disease.  The WLE itself can be a large scar (depends a lot on location) but it is a relatively simple procedure and most have no lasting side effects.  I was 29 when originally diagnosed (22 years ago) and have had 8 or 9 WLEs (2 more primaries and other atypical moles) and consider them a minor inconvenience.  They leave a scar, can be tight for a while, may cause some local nerve damage but are otherwise typically simple procedures.  

No, the full removal would not be done during the SLNB. And, I personally would not recommend one. She still needs her lymph nodes and there is plenty of studies showing that it isn't neccessary. But, that can be a very personal choice, so just know that no choice is a bad choice, everyone is different. I am glad you were able to get an informal second opinion and have made the decision to do the SLNB. Best of luck to her on Tuesday!

No, the full removal would not be done during the SLNB. And, I personally would not recommend one. She still needs her lymph nodes and there is plenty of studies showing that it isn't neccessary. But, that can be a very personal choice, so just know that no choice is a bad choice, everyone is different. I am glad you were able to get an informal second opinion and have made the decision to do the SLNB. Best of luck to her on Tuesday!

No, the full removal would not be done during the SLNB. And, I personally would not recommend one. She still needs her lymph nodes and there is plenty of studies showing that it isn't neccessary. But, that can be a very personal choice, so just know that no choice is a bad choice, everyone is different. I am glad you were able to get an informal second opinion and have made the decision to do the SLNB. Best of luck to her on Tuesday!