Questions to ask at first appointment with surgeon for SNB/WLE?
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Questions to ask at first appointment with surgeon for SNB/WLE?

› Forums › General Melanoma Community › Questions to ask at first appointment with surgeon for SNB/WLE?

  • Post
    • July 5, 2014 at 5:37 pm
    ocelot
    Participant

      Hi everyone, 

      My fiancé has just gotten a melanoma diagnosis: Breslow 1.15, mitosis rate 1, no ulceration, Clark's either 3 or 4 depending on which report you look at, located behind ear, tumour removed with clear though very narrow (3 mm) margins, no symptoms, bloodwork and abdominal ultrasounds all clear. We are meeting this week with the surgeon who will do a WLE and SNB. 

      I'm trying to come up with questions to ask at this meeting. I don't want to waste the doctor's time, but I also want to use this opportunity to understand the info that's coming at us from all the reports. Any suggestions as to what are useful questions to ask here? So far I've got:

      1. The primary tumor was completely excised a couple of weeks ago (by a family doc who thought it was just a mole). Will that excision change the lymph drainage patterns? In other words, does the removal of the primary tumor affect the accuracy of the SNB?

      2. The location behind the ear seems to make it difficult to get the complete 1 cm margins, especially in depth  (there's really just bone under the skin there). Is this going to be a problem?

      3. When would the doctor recommend a complete lymphectomy? Does the location on the body have any bearing on next steps, if the SN is positive?

      4. Is it possible to do testing for the BRAF mutation, either from a positive lymph node (if one is found, which we really hope not) or from tissue from the WLE?

      Any other things I should be thinking about here? 

       

      Many thanks in advance. 

       

       

       

       

       

    Viewing 5 reply threads
    • Replies
        • July 7, 2014 at 12:38 am
        ed williams
        Participant

           Something to remember is that the surgeon is following standard of care guidelines. In other words when to cut and when not to cut. The report from the Node Biopsy is the next important step, is there any sign of Melanoma or not? If clear the process will probably slow down and they will do scans every 3 months or so. If they find something then the surgeon will want to take out the rest of the node in the region. At this point it would be a good idea to talk to the oncologist before making up your mind to go forward. The nodes are part of your immune system and the new treatments for later stage melanoma is immunotherapy, all about getting the T-cells going. Pd-1 or CTLA4 drugs are trying to get your own body to fight the cancer. There isn't a lot of research on if you should leave the nodes in or not, but it is something to think about or at least get the oncologist view point. I had one of three SNB nodes positive so the surgeon advised to take out the remaining lymph nodes in my arm (15) and all were clear of melanoma. I sure hope the nodes come back clear. Best of luck!!!! Ed

          • July 7, 2014 at 12:38 am
          ed williams
          Participant

             Something to remember is that the surgeon is following standard of care guidelines. In other words when to cut and when not to cut. The report from the Node Biopsy is the next important step, is there any sign of Melanoma or not? If clear the process will probably slow down and they will do scans every 3 months or so. If they find something then the surgeon will want to take out the rest of the node in the region. At this point it would be a good idea to talk to the oncologist before making up your mind to go forward. The nodes are part of your immune system and the new treatments for later stage melanoma is immunotherapy, all about getting the T-cells going. Pd-1 or CTLA4 drugs are trying to get your own body to fight the cancer. There isn't a lot of research on if you should leave the nodes in or not, but it is something to think about or at least get the oncologist view point. I had one of three SNB nodes positive so the surgeon advised to take out the remaining lymph nodes in my arm (15) and all were clear of melanoma. I sure hope the nodes come back clear. Best of luck!!!! Ed

            • July 7, 2014 at 12:38 am
            ed williams
            Participant

               Something to remember is that the surgeon is following standard of care guidelines. In other words when to cut and when not to cut. The report from the Node Biopsy is the next important step, is there any sign of Melanoma or not? If clear the process will probably slow down and they will do scans every 3 months or so. If they find something then the surgeon will want to take out the rest of the node in the region. At this point it would be a good idea to talk to the oncologist before making up your mind to go forward. The nodes are part of your immune system and the new treatments for later stage melanoma is immunotherapy, all about getting the T-cells going. Pd-1 or CTLA4 drugs are trying to get your own body to fight the cancer. There isn't a lot of research on if you should leave the nodes in or not, but it is something to think about or at least get the oncologist view point. I had one of three SNB nodes positive so the surgeon advised to take out the remaining lymph nodes in my arm (15) and all were clear of melanoma. I sure hope the nodes come back clear. Best of luck!!!! Ed

              • July 7, 2014 at 1:03 am
              hbecker
              Participant

                Hi, so sorry you've had to join us here, but I hope we are able to help you some.

                   Your questions are a good start. I would change the one about testing for BRAF  mutation – ask if the genetic testing can be done on the tissue that was already removed. They should (might) be able to get that process started before you go in for the WLE and SNB. It will likely be important when you get to talking about next steps after the WLE and SNB.

                   You might also want to ask the surgeon what the healing process will be like. What kind of bandage? How big and deep will the incision likely be? Will you need a graft, and if so, where will they take it from? How much will your activities be restricted and for how long?

                   Let us know if you have more questions. Best of luck!

                Hazel

                • July 7, 2014 at 1:03 am
                hbecker
                Participant

                  Hi, so sorry you've had to join us here, but I hope we are able to help you some.

                     Your questions are a good start. I would change the one about testing for BRAF  mutation – ask if the genetic testing can be done on the tissue that was already removed. They should (might) be able to get that process started before you go in for the WLE and SNB. It will likely be important when you get to talking about next steps after the WLE and SNB.

                     You might also want to ask the surgeon what the healing process will be like. What kind of bandage? How big and deep will the incision likely be? Will you need a graft, and if so, where will they take it from? How much will your activities be restricted and for how long?

                     Let us know if you have more questions. Best of luck!

                  Hazel

                  • July 7, 2014 at 1:03 am
                  hbecker
                  Participant

                    Hi, so sorry you've had to join us here, but I hope we are able to help you some.

                       Your questions are a good start. I would change the one about testing for BRAF  mutation – ask if the genetic testing can be done on the tissue that was already removed. They should (might) be able to get that process started before you go in for the WLE and SNB. It will likely be important when you get to talking about next steps after the WLE and SNB.

                       You might also want to ask the surgeon what the healing process will be like. What kind of bandage? How big and deep will the incision likely be? Will you need a graft, and if so, where will they take it from? How much will your activities be restricted and for how long?

                       Let us know if you have more questions. Best of luck!

                    Hazel

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