New & Scared!

I'm not an expert but thought I would try to ease your mind a little bit.  After diagnosis of melanoma they will do a wide local excision where they remove the area of the melanoma.  (The problem with a shave biopsy followed by a punch biopsy is that they cannot accurately say what the initial depth was because they didn't get the entire depth during the shave.  They cannot just add the 2 together.)  The primary stage which is based on the biopsy results determines how wide the margins have to be (how much tissure they have to remove around the site of the melanoma).  A SNB is done based on the results of the initial biopsy as well.  The results of the SNB, if it is done, are used to determine staging so your stage may change after that tissue is biopsied.  As in everything SNB is not 100% accurate.  Up to this point most of these procedures are done by general surgeons or plastic surgeons unless the melanoma is in an area where a specialist is required (like head or face).  Melanoma specialists become very important once all the biopsy information is received because their knowledge of treatment options and drug trials is up to date.  I guess I would say you should start asking questions now.  Ask about everything.  Ask about the surgery.  Exactly what they are going to do, how they are going to do it and how long will it take to recover.  Ask/Demand a melanoma specialist for consultation after the biopsy results are in.  Start now so if they refuse you can appeal it while you are healing from surgery.  Melanoma is scary and time is important.  The sooner you take control of the course of your treatment the better.  There is a lot of information on this site.  In terms of treatment options for stages I and II there are none except watch and wait.  For stage III there are limited treatment options as most people at stage III are NED (no evidence of disease) after surgery.  This is where a melanoma specialist has knowledge that regular doctors or medical oncologists do not.  Oh, and don't read the statistics for survival on the internet.  They are no longer accurate and you are not a statistic.

I'm not an expert but thought I would try to ease your mind a little bit.  After diagnosis of melanoma they will do a wide local excision where they remove the area of the melanoma.  (The problem with a shave biopsy followed by a punch biopsy is that they cannot accurately say what the initial depth was because they didn't get the entire depth during the shave.  They cannot just add the 2 together.)  The primary stage which is based on the biopsy results determines how wide the margins have to be (how much tissure they have to remove around the site of the melanoma).  A SNB is done based on the results of the initial biopsy as well.  The results of the SNB, if it is done, are used to determine staging so your stage may change after that tissue is biopsied.  As in everything SNB is not 100% accurate.  Up to this point most of these procedures are done by general surgeons or plastic surgeons unless the melanoma is in an area where a specialist is required (like head or face).  Melanoma specialists become very important once all the biopsy information is received because their knowledge of treatment options and drug trials is up to date.  I guess I would say you should start asking questions now.  Ask about everything.  Ask about the surgery.  Exactly what they are going to do, how they are going to do it and how long will it take to recover.  Ask/Demand a melanoma specialist for consultation after the biopsy results are in.  Start now so if they refuse you can appeal it while you are healing from surgery.  Melanoma is scary and time is important.  The sooner you take control of the course of your treatment the better.  There is a lot of information on this site.  In terms of treatment options for stages I and II there are none except watch and wait.  For stage III there are limited treatment options as most people at stage III are NED (no evidence of disease) after surgery.  This is where a melanoma specialist has knowledge that regular doctors or medical oncologists do not.  Oh, and don't read the statistics for survival on the internet.  They are no longer accurate and you are not a statistic.

I'm not an expert but thought I would try to ease your mind a little bit.  After diagnosis of melanoma they will do a wide local excision where they remove the area of the melanoma.  (The problem with a shave biopsy followed by a punch biopsy is that they cannot accurately say what the initial depth was because they didn't get the entire depth during the shave.  They cannot just add the 2 together.)  The primary stage which is based on the biopsy results determines how wide the margins have to be (how much tissure they have to remove around the site of the melanoma).  A SNB is done based on the results of the initial biopsy as well.  The results of the SNB, if it is done, are used to determine staging so your stage may change after that tissue is biopsied.  As in everything SNB is not 100% accurate.  Up to this point most of these procedures are done by general surgeons or plastic surgeons unless the melanoma is in an area where a specialist is required (like head or face).  Melanoma specialists become very important once all the biopsy information is received because their knowledge of treatment options and drug trials is up to date.  I guess I would say you should start asking questions now.  Ask about everything.  Ask about the surgery.  Exactly what they are going to do, how they are going to do it and how long will it take to recover.  Ask/Demand a melanoma specialist for consultation after the biopsy results are in.  Start now so if they refuse you can appeal it while you are healing from surgery.  Melanoma is scary and time is important.  The sooner you take control of the course of your treatment the better.  There is a lot of information on this site.  In terms of treatment options for stages I and II there are none except watch and wait.  For stage III there are limited treatment options as most people at stage III are NED (no evidence of disease) after surgery.  This is where a melanoma specialist has knowledge that regular doctors or medical oncologists do not.  Oh, and don't read the statistics for survival on the internet.  They are no longer accurate and you are not a statistic.

Hi Fressia

Sorry to hear you are in this situation – it must be hard being away from home. The thing with melanoma is that depth is all-important – even fractions of millimetres can make a difference. While it's confined to the very uppermost layer of the skin – epidermis – it's called 'in situ' and in theory has no potential to spread. The minute it starts to invade into deeper layers of skin – in other words, the minute someone gives you a Breslow depth – the melanoma has the potential to spread. Granted, in thin melanomas it's a very small potential, but anything with a Breslow depth is concerning. The difficult part of your predicament is that you have no accurate Breslow depth – that first shave biopsy cut the melanoma off at the base so there's no telling how deep it was. Maybe it was just a hair's breadth deeper, or mayber much deeper, you'll never know. Like someone else said, now that the first biopsy has been done, you can't just add the second to it and get an answer. The chance for accurate depth measurement is gone. So, to be prudent, a SLNB is a really great idea and it's excellent that it's being offered to you. Also, mitosis of anything equal to or more than one is considered riskier. Yours is 3, so again, it's really good advice to get that SLNB. Don't be scared of the WLE – it's just chunking out more skin – it's a bad hour and a few stitches and a big scar (8cm) but honestly, within a few weeks it's all behind you. I've never had a SLNB but it's very selective and hopefully not too hard to recover from. The WLE gets rid of any residual melanoma cells near the site of the mole, the SLNB tells you whether some cells have managed to reach the lymph system and make their way to the lymph node where this area drains. They do need to be done close together – you can't get a WLE and then months later a SLNB – I think often it's done same day or at least close together for increased accuracy. They need to inject die at the site and track it to see which lymph node the area drains to (the sentinel node) and this is the node they remove and test. Is the punch biopsy for a different mole? I don't really think you'd get a punch biopsy of the same site, you'd go from shave to WLE. If it's a different site, don't worry about it until you get the result. There's every chance its perfectly normal. Also, don't worry about that SLNB too much. There's a good chance it's clear, which makes you quite probably stage 1b, and nothing further is required. If the SLNB was not clear, that might be the time to get onto a melanoma specialist. It's horrible uncertainty right now, just hang in there and be strong and manage things if and when they happen. Hopes and prayers to you – you are not alone.

Hi Fressia

Sorry to hear you are in this situation – it must be hard being away from home. The thing with melanoma is that depth is all-important – even fractions of millimetres can make a difference. While it's confined to the very uppermost layer of the skin – epidermis – it's called 'in situ' and in theory has no potential to spread. The minute it starts to invade into deeper layers of skin – in other words, the minute someone gives you a Breslow depth – the melanoma has the potential to spread. Granted, in thin melanomas it's a very small potential, but anything with a Breslow depth is concerning. The difficult part of your predicament is that you have no accurate Breslow depth – that first shave biopsy cut the melanoma off at the base so there's no telling how deep it was. Maybe it was just a hair's breadth deeper, or mayber much deeper, you'll never know. Like someone else said, now that the first biopsy has been done, you can't just add the second to it and get an answer. The chance for accurate depth measurement is gone. So, to be prudent, a SLNB is a really great idea and it's excellent that it's being offered to you. Also, mitosis of anything equal to or more than one is considered riskier. Yours is 3, so again, it's really good advice to get that SLNB. Don't be scared of the WLE – it's just chunking out more skin – it's a bad hour and a few stitches and a big scar (8cm) but honestly, within a few weeks it's all behind you. I've never had a SLNB but it's very selective and hopefully not too hard to recover from. The WLE gets rid of any residual melanoma cells near the site of the mole, the SLNB tells you whether some cells have managed to reach the lymph system and make their way to the lymph node where this area drains. They do need to be done close together – you can't get a WLE and then months later a SLNB – I think often it's done same day or at least close together for increased accuracy. They need to inject die at the site and track it to see which lymph node the area drains to (the sentinel node) and this is the node they remove and test. Is the punch biopsy for a different mole? I don't really think you'd get a punch biopsy of the same site, you'd go from shave to WLE. If it's a different site, don't worry about it until you get the result. There's every chance its perfectly normal. Also, don't worry about that SLNB too much. There's a good chance it's clear, which makes you quite probably stage 1b, and nothing further is required. If the SLNB was not clear, that might be the time to get onto a melanoma specialist. It's horrible uncertainty right now, just hang in there and be strong and manage things if and when they happen. Hopes and prayers to you – you are not alone.

Hi Fressia

Sorry to hear you are in this situation – it must be hard being away from home. The thing with melanoma is that depth is all-important – even fractions of millimetres can make a difference. While it's confined to the very uppermost layer of the skin – epidermis – it's called 'in situ' and in theory has no potential to spread. The minute it starts to invade into deeper layers of skin – in other words, the minute someone gives you a Breslow depth – the melanoma has the potential to spread. Granted, in thin melanomas it's a very small potential, but anything with a Breslow depth is concerning. The difficult part of your predicament is that you have no accurate Breslow depth – that first shave biopsy cut the melanoma off at the base so there's no telling how deep it was. Maybe it was just a hair's breadth deeper, or mayber much deeper, you'll never know. Like someone else said, now that the first biopsy has been done, you can't just add the second to it and get an answer. The chance for accurate depth measurement is gone. So, to be prudent, a SLNB is a really great idea and it's excellent that it's being offered to you. Also, mitosis of anything equal to or more than one is considered riskier. Yours is 3, so again, it's really good advice to get that SLNB. Don't be scared of the WLE – it's just chunking out more skin – it's a bad hour and a few stitches and a big scar (8cm) but honestly, within a few weeks it's all behind you. I've never had a SLNB but it's very selective and hopefully not too hard to recover from. The WLE gets rid of any residual melanoma cells near the site of the mole, the SLNB tells you whether some cells have managed to reach the lymph system and make their way to the lymph node where this area drains. They do need to be done close together – you can't get a WLE and then months later a SLNB – I think often it's done same day or at least close together for increased accuracy. They need to inject die at the site and track it to see which lymph node the area drains to (the sentinel node) and this is the node they remove and test. Is the punch biopsy for a different mole? I don't really think you'd get a punch biopsy of the same site, you'd go from shave to WLE. If it's a different site, don't worry about it until you get the result. There's every chance its perfectly normal. Also, don't worry about that SLNB too much. There's a good chance it's clear, which makes you quite probably stage 1b, and nothing further is required. If the SLNB was not clear, that might be the time to get onto a melanoma specialist. It's horrible uncertainty right now, just hang in there and be strong and manage things if and when they happen. Hopes and prayers to you – you are not alone.

I don't have a whole lot to add to the other comments, but wanted to say hang in there! You've come to the right place to find others that know exactly how you're feeling. I think you're already getting the best care you can get at the moment, for them to suggest a SLNB is great. You will get the WLE and SLNB done the same day, most get general anesthesia. It's an outpatient thing, you don't spend the night in the hospital. Not sure where your mole is located, but if it is on your legs/feet, then mostly likely the lymph nodes biopsied will be in your groin. If it is on your trunk/arms, then the armpits are the typical spot for sentinel nodes, and if it is on your shoulders/head then the neck is the typical area. Mine was on my thigh, so I had my SLNB done in my groin. Had 4 lymph nodes "light up" with the radioactive dye they inject around the mole biopsy site to find the sentinel lymph nodes. (some only have 1 light up and some have multiple). 3 of the 4 were positive for micro met melanoma, meaning it was very small microscopic melanoma cells, putting me at stage 3B. I have been doing Yervoy (Ipi) adjuvant treatment. Just wanted to give you a bit of my story so you know that it's not too scary and you're definitely not alone. (if you want more info on my story you can check out my profile).

Hoping for a clear SLNB, but if not, no worries, there's options out there. I know military insurance can be limiting, I grew up with military insurance, but I am sure there are ways to find a specialist if you so need it. Right now, you just need to focus on getting your surgery and finding out the results of the SLNB. Then, if you have a positive SLNB, finding a melanoma specialist would be the next step.

All the best,

I don't have a whole lot to add to the other comments, but wanted to say hang in there! You've come to the right place to find others that know exactly how you're feeling. I think you're already getting the best care you can get at the moment, for them to suggest a SLNB is great. You will get the WLE and SLNB done the same day, most get general anesthesia. It's an outpatient thing, you don't spend the night in the hospital. Not sure where your mole is located, but if it is on your legs/feet, then mostly likely the lymph nodes biopsied will be in your groin. If it is on your trunk/arms, then the armpits are the typical spot for sentinel nodes, and if it is on your shoulders/head then the neck is the typical area. Mine was on my thigh, so I had my SLNB done in my groin. Had 4 lymph nodes "light up" with the radioactive dye they inject around the mole biopsy site to find the sentinel lymph nodes. (some only have 1 light up and some have multiple). 3 of the 4 were positive for micro met melanoma, meaning it was very small microscopic melanoma cells, putting me at stage 3B. I have been doing Yervoy (Ipi) adjuvant treatment. Just wanted to give you a bit of my story so you know that it's not too scary and you're definitely not alone. (if you want more info on my story you can check out my profile).

Hoping for a clear SLNB, but if not, no worries, there's options out there. I know military insurance can be limiting, I grew up with military insurance, but I am sure there are ways to find a specialist if you so need it. Right now, you just need to focus on getting your surgery and finding out the results of the SLNB. Then, if you have a positive SLNB, finding a melanoma specialist would be the next step.

All the best,

I don't have a whole lot to add to the other comments, but wanted to say hang in there! You've come to the right place to find others that know exactly how you're feeling. I think you're already getting the best care you can get at the moment, for them to suggest a SLNB is great. You will get the WLE and SLNB done the same day, most get general anesthesia. It's an outpatient thing, you don't spend the night in the hospital. Not sure where your mole is located, but if it is on your legs/feet, then mostly likely the lymph nodes biopsied will be in your groin. If it is on your trunk/arms, then the armpits are the typical spot for sentinel nodes, and if it is on your shoulders/head then the neck is the typical area. Mine was on my thigh, so I had my SLNB done in my groin. Had 4 lymph nodes "light up" with the radioactive dye they inject around the mole biopsy site to find the sentinel lymph nodes. (some only have 1 light up and some have multiple). 3 of the 4 were positive for micro met melanoma, meaning it was very small microscopic melanoma cells, putting me at stage 3B. I have been doing Yervoy (Ipi) adjuvant treatment. Just wanted to give you a bit of my story so you know that it's not too scary and you're definitely not alone. (if you want more info on my story you can check out my profile).

Hoping for a clear SLNB, but if not, no worries, there's options out there. I know military insurance can be limiting, I grew up with military insurance, but I am sure there are ways to find a specialist if you so need it. Right now, you just need to focus on getting your surgery and finding out the results of the SLNB. Then, if you have a positive SLNB, finding a melanoma specialist would be the next step.

All the best,