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Anyone know of a good doc in Pa?
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Anyone know of a good doc in Pa?

› Forums › General Melanoma Community › Anyone know of a good doc in Pa?

  • Post
    • September 17, 2010 at 11:01 pm
    Brandi
    Participant

      Hi everyone,

      Hi everyone,

      I am new here I just went to a surgeon today who wants to do a WLE and SLN on me for a spitzoid melanoma that I had removed on my calf. I also have an in situ on my rib cage he wants to do a larger excision on this one as well. My patho is as follows: calf: spitzoid melanoma 1.6cm, margins clear, mitotic rate 0, lymphovascular 0, lymphocytic ifiltrate non brisk, ulceration absent, regression absent. He agreed that the patho results look good and said there is a 10% chance my lymph nodes were affected. Rib cage melanoma in situ original amount taken was .5cm which from what I have read is the recommendation. This doc is supposed to an expert on melanoma he is at UPMC hospital in Pittsburgh. I am just confused as to why he needs to take more on the rib cage. I also want to know if it is standard procedure from what you all know to have the SLN done right off the bat? Thanks for any info you all have.

      Brandi

    Viewing 5 reply threads
    • Replies
        • September 18, 2010 at 1:22 am
        washoegal
        Participant

          At 1.6 mm a SNB usually not indicated see

          http://www.melanoma.org/learn-more/melanoma-101/melanoma-stages-treatment-options

          but I suspect that with 2 sites he is being ultra-conservative.    You could go for a second opinion, or you could follow  the conservative recommendation.  I found the WLE and SNB fairly easy. 

           

          Mary

          Stage 3

            • September 18, 2010 at 1:38 am
            W.
            Participant

              As far as I know, a SNB is usually done for melanomas with a depth of 1mm or  more. If ulceration is present, it is even recommended with a depth of 0.75mm or more.

              • October 11, 2010 at 10:33 pm
              Brandi
              Participant

                Hi You are right SNB is indicated over 1.0mm and less if there is ulceration present or with regression. I have done a ton of research on the subject since my dx. I talked with another specialist who yet again couldn't tell me anything I didn't already know. But to his credit I have read tons of peer reviewed researched articles. I have looked at all the guidelines and recommendations. I wanted to be armed when I put my body into the hands of another. I am in the medical field and I see way too much just to say "You're the doctor". I believe in educating patients as a means to empower them. He did tell me that most likely we got it all but have to have WLE and SNB to be 100% he said there is a 90% chance there will not be any affected lymph nodes and  I pray that is the case. Thanks to both of you for responding to my post. This doc I saw is supposedly a melanoma guru I guess we will see. I didn't like his PA she was condascending but I handled it. I hate it when healthcare professionals treat patients like idiots. I don't care if you know the patient is in the healthcare field or not each and every one of them should be treated with respect and dignity! It's funny and at the same time distugusting how attitudes of MD's, PA's NP's and nurses change once they find out you are one of them. Oh goodness back on my soap box yet again sorry!

                • October 11, 2010 at 10:33 pm
                Brandi
                Participant

                  Hi You are right SNB is indicated over 1.0mm and less if there is ulceration present or with regression. I have done a ton of research on the subject since my dx. I talked with another specialist who yet again couldn't tell me anything I didn't already know. But to his credit I have read tons of peer reviewed researched articles. I have looked at all the guidelines and recommendations. I wanted to be armed when I put my body into the hands of another. I am in the medical field and I see way too much just to say "You're the doctor". I believe in educating patients as a means to empower them. He did tell me that most likely we got it all but have to have WLE and SNB to be 100% he said there is a 90% chance there will not be any affected lymph nodes and  I pray that is the case. Thanks to both of you for responding to my post. This doc I saw is supposedly a melanoma guru I guess we will see. I didn't like his PA she was condascending but I handled it. I hate it when healthcare professionals treat patients like idiots. I don't care if you know the patient is in the healthcare field or not each and every one of them should be treated with respect and dignity! It's funny and at the same time distugusting how attitudes of MD's, PA's NP's and nurses change once they find out you are one of them. Oh goodness back on my soap box yet again sorry!

                  • September 18, 2010 at 1:38 am
                  W.
                  Participant

                    As far as I know, a SNB is usually done for melanomas with a depth of 1mm or  more. If ulceration is present, it is even recommended with a depth of 0.75mm or more.

                  • September 18, 2010 at 1:22 am
                  washoegal
                  Participant

                    At 1.6 mm a SNB usually not indicated see

                    http://www.melanoma.org/learn-more/melanoma-101/melanoma-stages-treatment-options

                    but I suspect that with 2 sites he is being ultra-conservative.    You could go for a second opinion, or you could follow  the conservative recommendation.  I found the WLE and SNB fairly easy. 

                     

                    Mary

                    Stage 3

                    • October 13, 2010 at 3:56 pm
                    EricNJill
                    Participant

                      Hi Brandi.  We live in Ohio and we were referred to John Kirkwood at UPMC HIllman Cancer Center in Pittsburgh.  He's one of the top specialists.  Eric has been seeing him since June, 2010.  I would highly recommend him.

                      • October 13, 2010 at 3:56 pm
                      EricNJill
                      Participant

                        Hi Brandi.  We live in Ohio and we were referred to John Kirkwood at UPMC HIllman Cancer Center in Pittsburgh.  He's one of the top specialists.  Eric has been seeing him since June, 2010.  I would highly recommend him.

                        • October 13, 2010 at 10:01 pm
                        Brandi
                        Participant

                          Hi Jill,

                          Thanks so much for responding. I actually did go to see him a week or so ago. I found him through a friend of a friend but thanks for your advice.

                          • October 13, 2010 at 10:01 pm
                          Brandi
                          Participant

                            Hi Jill,

                            Thanks so much for responding. I actually did go to see him a week or so ago. I found him through a friend of a friend but thanks for your advice.

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