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Didn’t have SLNB procedure – have regrets now
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Didn’t have SLNB procedure – have regrets now

› Forums › General Melanoma Community › Didn’t have SLNB procedure – have regrets now

  • Post
    • April 21, 2018 at 4:27 pm
    Roxanne218
    Participant

      I was diagnosed in Feb. and had the WLE. I was advised by one dr. not to do the SLNB during that time because it doesn't affect survival, plus beng so new to all this I didn't know any better. I wish now I had gotten the procedure because I'm always wondering what stage I am, among other things. I was recently told by my derm. surgeon I can still do it. Another dr. thinks it's too late. Has anyone else been in this situation? I'm wondering what I can do at this point as I don't care for the idea of melanoma possibly in my nodes. Should I have a surgeon remove what he *thinks* could be the first nodes in line, or ask for a high resolution ultrasound, do nothing and "watch and wait," treat this as Stage 3 and go ahead with adjuvant therapy, etc.? Thank you for reading.

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        • April 21, 2018 at 6:29 pm
        Raco
        Participant

          When I was diagnosed with Melanoma, on 2/5/2018. My Surgeon automatically said he was going to removed tumor and  SLNB and they found Microscopic Melanoma in SLN. Classified as N1a  now classified as stage 3 Cancer.

          Next I went to see the Oncologist who immediately set up Brain MRI  and PET Scan. Both neg.

          Went back into surgery And Had CLND with drain tube A whole sack of lymph nodes were removed. All 15 came back normal.

          so now just had my second treatment of Opdivo and 24 more to go.

          i hope your Dr’s listen to your concerns to help you through this all. 

          Wish you all the best

          Raco

            • April 22, 2018 at 1:53 am
            Roxanne218
            Participant

              Thank you Raco. I wish you the best also. March on and keep strong.

            • April 21, 2018 at 7:19 pm
            ed williams
            Participant

              What did the pathology report say as far as a discription of tumor depth and ulceration and mitotic rate?

              • April 21, 2018 at 8:20 pm
              doragsda
              Participant

                What was your tumor depth and was it ulcerated?

                  • April 21, 2018 at 9:03 pm
                  Roxanne218
                  Participant

                    Depth was 2.6 mm with no ulceration. Mitotic rate 3.

                    • April 21, 2018 at 10:00 pm
                    ed williams
                    Participant

                      I have got to ask, what was the justification of your oncologist or surgeon for not doing SLNB at time of WLE. It is pretty much standard of care for staging for anything over 1mm, see link below. The topic of doing a SLNB after the WLE has come up on the forum before and Janner is a much better person to explain the pros and cons but  my understand is that it is hard to know for sure the drainage pattern after the  WLE, since they have to inject the radioactive tracer stuff into the skin to see where it drains to. Probably better to get the opinion of a surgeon that does the procedure on regular basis or an Ocologist as to the validity of results if WLE was done at a different time. https://www.aimatmelanoma.org/diagnosing-melanoma/sentinel-lymph-node-biopsy/

                    • April 21, 2018 at 11:07 pm
                    bjeans
                    Participant

                      Since your doctor referenced survival, I wonder if s/he was thinking about CLNDs (complete lymph node dissection), since many doctors stopped doing them after a study that came out in June 2017 (?) found that it did not improve survival.The doctors at my husband's melanoma center stopped doing them last July.

                      I wonder how the tracers would have a path to follow, or the correct path, anyway, if it's been cut by the WLE, but hope it's possible if it will be useful. I'm sorry you've got this added burden right now and hope it's resolved soon by doctors who are melanoma specialists or highly experienced. 

                      Beth

                        • April 22, 2018 at 1:51 am
                        Roxanne218
                        Participant

                          Beth, Thank you for your info. I read on here of someone who later had the SLNB after their WLE, where the WLE had not affected the path at all. My derm who performed my WLE said I could still have it done even though it wouldn't be in the correct order. Will be seeing him again next week to find out more. I do wish there was another way besides that invasive surgery to check the nodes. But, I guess there just isn't any other procedure as accurate.

                        • April 22, 2018 at 2:02 am
                        Janner
                        Participant

                          You can have it done.  But if they did the WLE like they should for a 2.6mm lesion, that means they took 2cm margins all around (with the addition of the skin needed to close the wound).  That is a hefty piece of skin.  You can do it, but there is no guarantee that the node they find now is the original sentinel node.  Of course, if it is positive, you are stage III.  But if it is negative, you won't know if that is because you are truly stage II, or if the WLE compromised the drainage path.  So postive is 100% but negative leaves you no better off than you are right now.  No doctor can GUARANTEE they can get the original sentinel node and any that tell you they can — I'd ask for it in writing.  You can certainly request close followup with periodic ultrasound – I think that is a realistic approach.  I'm not sure you qualify for adjuvant therapy at stage II – it isn't FDA approved for that stage. 

                            • April 22, 2018 at 3:53 pm
                            Roxanne218
                            Participant

                              Thank you Janner. I'll post what I end up doing. Best wishes to all!

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