› Forums › General Melanoma Community › Changed biopsy- lentigo maligna instead of SS? Also, SLNB after excision- any experience with that?
- This topic has 6 replies, 2 voices, and was last updated 9 years, 11 months ago by
Svegas.
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- May 5, 2014 at 6:11 pm
I was diagnosed with melanoma on March 17, 2014. I had a small pink lesion on my nose that did not itch, did not bleed, but just did not go away. Finally in January I thought I felt something strange going on in that area, so made an appointment to have it checked out.
Dermatologist did shave biopsy because she did not think it was anything, but because of what I told her, she decided to send in biopsy. She was very surprised when it came back as melanoma. Tumor present in deep and lateral margins of the thin specimen. Diagnosed as superficial spreading by dermatopathologist (and even discussed at a dermatopathology conference).
Excision done on April 2. Plastic surgeon did not suspect tumor would be deep, and because of that and it being on my nose, he did not do a SLNB. He went for as close to 1 cm margins as he could without cutting into the cartilage. Did full thickness skin graft from clavicle area. Pathology (from a pathologist, not dermatopathologist) came back as superficial spreading, 1.95mm Breslow thickness, Clark's level IV. Only info on margins said "the closest margin is the underlying deep margin which is more than 2 mm from the invasive melanoma".
I decided to go to MD Anderson Houston to see if a SLNB could still be done, as I have read that lymph flow might change after reconstruction, and that finding SLNs in face can be difficult. Last week I had lymphoscintigraphy, and CT of neck. Also had chest Xray and LDH bloodwork. MD Anderson dermatopathologist reviewed slides and changed diagnosis to lentigo maligna melanoma, 2.5mm Breslow thickness.
I am waiting to hear from MD Anderson doctor as to whether SLNB can be done, and if the group of doctors (melanoma and head and neck) think further excision is necessary/ beneficial. I really find the lentgo maligna diagnosis strange after two superficial spreading diagnoses, and especially as it did not look like LMM (of course, it did not look like any melanoma I have ever seen pictures of). Everything seems to be moving so slow, I don't get any sense of urgency. The original dermatologist never contacted me again after giving melanoma diagnosis, and the plastic surgeon just cares about how well the skin graft looks.
I would appreciate any feedback on SLNB after excision, and also whether change to LMM seems strange after two SS pathology reports. Thank you.
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- May 6, 2014 at 1:57 am
As you've probably read, SNB after WLE can be problematic. No doc can GUARANTEE they will get the right sentinel node. Some may SAY they can, but ask them to write it and sign their name to it and I doubt that would happen. 🙂 Obviously, you know the lymph node basins where this would be – either side of the neck. You could try it, but I would always wonder for certain if the SNB came back negative. Positive isn't an issue. I think it comes down to what lets you sleep at night.
MDA sees a LOT of melanoma, I would probably go with their diagnosis and recommendations. Pathology is an art as well as a science and you've seen different docs read things with different interpretations. But since you have consulted with a major melanoma center, I think it makes sense to go with their diagnosis. In terms of treatment, there isn't going to be any difference regarding LMM vs SS. The discussion about margins and SNB are the things to focus on at this point in my mind.
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- May 9, 2014 at 8:05 am
Thank you for your reply, Janner. I understand what you are saying about the SLNB. I just don't know what my options are. If nothing shows cancer cells in my body, I can't really ask them to treat me with chemo or immunotherapy, nor would I want them to, right? As for peace of mind, I get the feeling I won't have that about the cancer for some time to come. I am relying on my faith in God to give me peace now in the uncertainty, and will keep relying on that faith for years to come (well, I hope for years to come!).
the lymphoscintigraphy showed drainage to one intraparotid node on right side, and one node in upper cervical. On CT scan, the node in parotid shows potential lesion. Doctor says removing this node may be difficult due to proximity to facial nerve, and she may have to do parotidectomy even before biopsy if the removal of the node is extremely complicated. She does not want to risk scar tissue if she had to do it in two operations.
my neurologist in AZ (whom I see for migraines) wanted brain MRI, so will have that at MD Anderson a couple days before SLNB. My chest X-Ray was clear, and LDH bloodwork relatively normal (slightly high monocyte percent).
I obviously have been reading everything I can about this interesting illness we have. I just don't know what options I have besides (in addition to) the SLNB and the scans. I have not even begun to look into treatment options in case cancer has spread; just taking it one step at a time.
thanks again for all the support you give to people here.
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- May 9, 2014 at 8:05 am
Thank you for your reply, Janner. I understand what you are saying about the SLNB. I just don't know what my options are. If nothing shows cancer cells in my body, I can't really ask them to treat me with chemo or immunotherapy, nor would I want them to, right? As for peace of mind, I get the feeling I won't have that about the cancer for some time to come. I am relying on my faith in God to give me peace now in the uncertainty, and will keep relying on that faith for years to come (well, I hope for years to come!).
the lymphoscintigraphy showed drainage to one intraparotid node on right side, and one node in upper cervical. On CT scan, the node in parotid shows potential lesion. Doctor says removing this node may be difficult due to proximity to facial nerve, and she may have to do parotidectomy even before biopsy if the removal of the node is extremely complicated. She does not want to risk scar tissue if she had to do it in two operations.
my neurologist in AZ (whom I see for migraines) wanted brain MRI, so will have that at MD Anderson a couple days before SLNB. My chest X-Ray was clear, and LDH bloodwork relatively normal (slightly high monocyte percent).
I obviously have been reading everything I can about this interesting illness we have. I just don't know what options I have besides (in addition to) the SLNB and the scans. I have not even begun to look into treatment options in case cancer has spread; just taking it one step at a time.
thanks again for all the support you give to people here.
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- May 9, 2014 at 8:05 am
Thank you for your reply, Janner. I understand what you are saying about the SLNB. I just don't know what my options are. If nothing shows cancer cells in my body, I can't really ask them to treat me with chemo or immunotherapy, nor would I want them to, right? As for peace of mind, I get the feeling I won't have that about the cancer for some time to come. I am relying on my faith in God to give me peace now in the uncertainty, and will keep relying on that faith for years to come (well, I hope for years to come!).
the lymphoscintigraphy showed drainage to one intraparotid node on right side, and one node in upper cervical. On CT scan, the node in parotid shows potential lesion. Doctor says removing this node may be difficult due to proximity to facial nerve, and she may have to do parotidectomy even before biopsy if the removal of the node is extremely complicated. She does not want to risk scar tissue if she had to do it in two operations.
my neurologist in AZ (whom I see for migraines) wanted brain MRI, so will have that at MD Anderson a couple days before SLNB. My chest X-Ray was clear, and LDH bloodwork relatively normal (slightly high monocyte percent).
I obviously have been reading everything I can about this interesting illness we have. I just don't know what options I have besides (in addition to) the SLNB and the scans. I have not even begun to look into treatment options in case cancer has spread; just taking it one step at a time.
thanks again for all the support you give to people here.
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- May 6, 2014 at 1:57 am
As you've probably read, SNB after WLE can be problematic. No doc can GUARANTEE they will get the right sentinel node. Some may SAY they can, but ask them to write it and sign their name to it and I doubt that would happen. 🙂 Obviously, you know the lymph node basins where this would be – either side of the neck. You could try it, but I would always wonder for certain if the SNB came back negative. Positive isn't an issue. I think it comes down to what lets you sleep at night.
MDA sees a LOT of melanoma, I would probably go with their diagnosis and recommendations. Pathology is an art as well as a science and you've seen different docs read things with different interpretations. But since you have consulted with a major melanoma center, I think it makes sense to go with their diagnosis. In terms of treatment, there isn't going to be any difference regarding LMM vs SS. The discussion about margins and SNB are the things to focus on at this point in my mind.
-
- May 6, 2014 at 1:57 am
As you've probably read, SNB after WLE can be problematic. No doc can GUARANTEE they will get the right sentinel node. Some may SAY they can, but ask them to write it and sign their name to it and I doubt that would happen. 🙂 Obviously, you know the lymph node basins where this would be – either side of the neck. You could try it, but I would always wonder for certain if the SNB came back negative. Positive isn't an issue. I think it comes down to what lets you sleep at night.
MDA sees a LOT of melanoma, I would probably go with their diagnosis and recommendations. Pathology is an art as well as a science and you've seen different docs read things with different interpretations. But since you have consulted with a major melanoma center, I think it makes sense to go with their diagnosis. In terms of treatment, there isn't going to be any difference regarding LMM vs SS. The discussion about margins and SNB are the things to focus on at this point in my mind.
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Tagged: cutaneous melanoma
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