Newly diagnosed. Supposed Stage 1. SLNB question.

I am in a somewhat similar situation, as I believe spindle cell is spitzoid, which is my diagnosis.  Mine was .6mm and came on quickly, pink with some spots.  If you can confirm spitzoid, I would love to chat.  I just had wide excision two weeks ago.  I am a 44 year old female, and spitzoid/spindle are rare in this age group so I am having trouble getting helpful information.     

First thought is who is going to pay for it, since I don't think any insurance company would cover it due to the depth of the tumor being only 0.38mm. Money aside, you would then have to convince a surgeon to do a procedure that is not standard of care, good luck with that one. When tumors are close to standard of care and the medical team is on board then some do get SLNB but those usually have ulceration and high mitosis rates which are more concerning medically. I get the mental side of things, wanting to know as much information as possible. Some thing to consider is the good news that you have so many positive characteristics going for you, low depth, no mitosis, no ulceration. Best Wishes!!!Ed 

In melanoma. there is always someone who has done "that thing".  Melanoma doesn't play nice or by very many rules.  That said, your chance of a positive node given the depth of your lesion was 0.38 mm per your report is very, very small.  Current recommendations are that folks with thin melanomas of 0.8mm – 1.0mm (less if there is ulceration) may consider SLNB.  This is important information, not only because it represents the best practice for the individual patient in that circumstance, but it is also the guideline upon which insurance companies base paying for the procedure.  That said…if you like data…here you go:

This is a link to a recent in-depth discussion of the topic on this forum:  https://www.melanoma.org/find-support/patient-community/mpip-melanoma-patients-information-page/new-slnb-post-ptgal-and-any  

And a zillion other reports on the subject:  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=SLNB&max-results=20&by-date=true

Melanoma is not for sissies.  Neither is SLNB.  Most of the time it is not that bad of a procedure, but infections and changes in lymph flow can cause problems as well.  That said, I certainly believe in being your own best advocate and doing what you feel is right for you.  I think the other signs and symptoms you note are unlikely to have anything to do with melanoma.  So most of all…..LIVE. LARGE.  I wish you my best.  Celeste

Hi there!  Being newly diagnosed reeks havoc on your mind.  I was diagnosed 5/15 Stage 1b, .44 mm with focal ulceration, 0 mitotic rate, upper left calf.  The ulceration made me a "b".  I shut down for 2 months.  Was a google freak.  I educated myself, but scared myself to death.  I have diagnosed myself with every symptom of any kind of cancer you can think of!!   My derm and 1st oncologist said no SLNB for my depth.  Had the excission.   Got 2nd opinion from another oncologist who said he would have performed a SLNB because of the ulceration (not because of depth).  He added, however, that most would not for a Stage 1.  Insurance sure won't pay for it. Since my excission was complete, my new oncologist advised an ultrasound of my lymph nodes every 3 months.  In his opinion and things I have read, ultrasounds are very good at picking up lymph node issues.  So, I have peace of mind that I am doing "something" to check the "inside" and i do not have the risk of any issues with my leg due to a lymph node biopsy.  Oh…and insurance covers the ultrasounds.  So this may be an option for you as well if you cannot or do not get the SLNB done.

The worry and anxiety does get better with time.  You have to have some faith and start focusing more on the positives of your situation…like the 90% chance of not having a recurrence/2nd primary.  Speaking from experience – not judging you at all..I was there.  It helped me to focus on my overall health..changing my diet, etc.  Push to be your best IF you get a second primary or recurrence.  Yes, someone has to be that 5-10%, there are some on here who know very well.  But you can't live life in fear.  It will wear your body down.  I was diagnosed with a brain aneurysm 3 years ago.  Too small to risk surgery.  Less than 5% chance of rupture.  Check it every year with no evidence of growth in 3 years.  Now, I have a melanoma diagnosis.  Talk about snake bit.  But after 2 months of panic attacks, anxiety and web searching, I finally realized I cannot control everything.  I nor anyone else has a crystal ball with my future etched in it.  I put my faith in the good Lord that no matter what, I will handle whatever MIGHT come my way.  You will get there.  The urgency that the fear and anxiety of this initial diagnosis puts upon your shoulders will begin to decrease.   The best thing you can do is have a clear understanding of your diagnosis, be vigilent with follow ups and monitoring, be your own advocate, trust in your medical team and have some faith so you can sleep at night.  At my last oncology appt, my dr looked me in the face and said, 'you and I are on top of this, if it rears its ugly head again, we will know early and will be ready'.   Something he knew I needed to hear.   

Keep us updated.  I would like to know how you are doing.   Everyone here is in my prayers and you are as well.

From my experience here in the US, most doctors would probably not agree to do a SLNB for you. I had 1A and all my Melanoma doctors declined to do it even when I insisted. The chances of complications and a false negative are higher than a true positive. Even with a negative SLNB, the cancer can still spread through the blood. A positive SLNB does not improve prognosis but just improves accuracy of staging. From the research papers I’ve read, the chances of the Melanoma spreading for you is similar to me, probably less than 1-5% based on the growth phase: no ulceration, no mitosis, and very thin. The risk of complications from the surgery is about 5%, and a SLNB has only 97% accuracy. 

I know it’s tough but you may have to just live with the uncertainty. Of course please follow up with your doctors until you feel adequately informed.

One thing my doctor told me was that even without Melanoma, there’s no guarantee I’ll be here in a couple years. According my insurance company they think there’s a 5% chance I’ll kick the bucket unrelated to a Melanoma in the next five years! With or without Melanoma there’s no guarantee any of us will be here tomorrow! So I just try to appreciate every day. It gets easier.

I'm in that range at 0.9mm right now on my 4th melanoma primary and was advised to do the SLNB. Which is crazy to me and I know it was 14 years ago, but my 6mm nodular got a sigh, a refusal to do node biospy and advice to live life.

I'd say if it's in range do it.