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Accurate staging & steps in treatment?
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Accurate staging & steps in treatment?

› Forums › General Melanoma Community › Accurate staging & steps in treatment?

  • Post
    • April 15, 2017 at 1:01 pm
    BetsyM1214
    Participant

      I received a diagnosis of 1A last week and I'm scheduled for a WLE in 4 days. I received no information at the time of my diagnosis other than a voicemail and a copy of my path report from my detmatologist. Thank goodness for the information here! I met with the general surgeon yesterday to discuss the WLE and he offered me a basic explanation of the path report, WLE & follow up checks. The dermatologist also told me to met with an oncologist for a physical after the WLE.  

      Here is my question…the surgeon highlighted one concern when I asked if there would be a SLNB and if not, why? He said based on my path report, there is no need for SNLB BUT it's possible that my WLE could show that the original Breslow depth from the biopsy was incorrect (unlikely but possible) and the SLNB then should have been done before the WLE because the staging from the biopsy was wrong. He pointed to the following note in my path report – 'the lesion extends focally to the base of the biopsy'. 

      My gut is to postpone the WLE & get an appointment with a melanoma specialist in Chicago to get a second opinion on the SLNB before the WLE. I am now at a local suburban hospital cancer center with no specialty in melanoma. The drawback to this being I would be postponing the WLE for a few weeks while I wait for an appt with a 'better' doctor. My sister in law received treatment at MD Andersen and has urged me to go there as well.

      here's more info from my path:

      0.6mm thickness, no ulceration, no mitotic figures seen.

       

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    • Replies
        • April 15, 2017 at 1:02 pm
        BetsyM1214
        Participant

          Forgot to say thanks in advance!!

          • April 15, 2017 at 1:27 pm
          stars
          Participant

            Yes, I think your gut instinct is correct. If the base of your melanoma was bisected by the biopsy, there's no way now of telling true depth. The text 'lesion extends to base of biopsy' suggests this to be the case – your lesion is best described as 'at least 0.6mm' because it was bisected. The bad news is that there's no way that the WLE can establish true depth -that's not the way it works. It is now pretty much clinically impossible to determine true depth. I would follow your very good gut instinct to go to Chicago and see a specialist. You want to do this right first time (already a bit late for that… my suspicion is that you had a shave or punch biopsy instead of proper excisional biopsy, thus the bisected lesion).  Wait that week or two and get to Chicago – it may be prudent for you to get a SLNB, which is most likely going to be clear by the way, because of the now-missed chance of establishing true depth. It is really more likely than not that the lesion was shallow, and both WLE and SLNB will be clear – but you need to err on the side of caution and go with the specialists opinion.

              • April 15, 2017 at 3:06 pm
              BetsyM1214
              Participant

                Thanks! I'll go with my gut.

                One thing I wonder (which I will ask at my appointment) is the depth of the biopsy itself? I assume it to be .6mm then. 

                • April 15, 2017 at 3:28 pm
                BetsyM1214
                Participant

                  ''you to get a SLNB, which is most likely going to be clear by the way, because of the now-missed chance of establishing true depth''

                  I thought SLNB were preformed after biopsy but before WLE…so even if my depth is not accurate but the SLNB is done before WLE as a precaution, wouldnt that still be a valid test?

                  thabks so much!!

                  • April 15, 2017 at 6:23 pm
                  MmP15
                  Participant
                    Would certainly get SLNB, after all SLNB will most likely be clear, if not 2nd opinion is crucial because of possibility of false positive SLNB, potentially leading in wrong direction
                    • April 19, 2017 at 9:14 am
                    stars
                    Participant

                      I think generally SLNB and WLE is done during the same procedure. The SLNB is a valid test, and it is the best you can do in your circumstances. IMO the SLNB is probably necessary because there is no way of knowing how deep your melanoma was. And, even if your SLNB is clear, if your melanoma was truly deep you may have issues in future as risk of metastases is related to depth.. Depth is by far the biggest prognostic factor in melanoma and the depth of yours, unfortunately, now becomes impossible to guage.

                      • April 15, 2017 at 4:54 pm
                      Jamie1960
                      Participant

                        +1 on the above reply; be aggressive and err on the side of caution. The disease itself is indifferent; we cannot afford to be.

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