› Forums › General Melanoma Community › Do I need SLNB? Dr says “your choice”
- This topic has 33 replies, 7 voices, and was last updated 7 years, 3 months ago by
Nemesis.
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- January 7, 2017 at 5:02 am
Hello everyone,
I always had a mole above my anglebone of my leg. It turned whitish, and I do not know how long ago, fast or slow. Dx-ed and removed Nov 2016, two weeks later – 0,5 mm margin cut. Path.report is very short: "m.melanoma, margins are free of malignancy". Dr.Porres of Rockville, MD. additionally said: 1.5 mm cancer spot, mole is 4 x 6 mm, no ulceration, "now live ur life, nothing else is needed", no even regular visits. Report does not say anything anout mitotic rate or stage.
I moved out early Dec 2016 to a new area. Now my new Dr wants more cut done, another 0,5 mm. I requested PET scanning, he agreed. He says I COULD make SLNBiopcy, it is optional and my decision to have it or not. In such case SLNBiopcy shall be made around inner thigh\groin (? not sure)
So pls pls pls share your thoughts if I need such SLNB and experience with it.
Thank you for listening.
George, 26 yo
- Replies
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- January 7, 2017 at 6:10 am
Let me make sure I understand. The melanoma was 1.5mm deep and you had 5mm margins?
Typically the SNB isn't done after margins are taken because they can disrupt the lymph flow to the sentinel node. Since your margins were quite small, doing it now means that the results could not guarantee the right sentinel node but "probably" the right one. You should have been offered the SNB prior to the 5mm margins being taken because, at 1.5mm, the lesion was deep enough to indicate having it.
I would also send the slides to a dermatopathologist and get a good pathology report that states all the characteristics. Then you know for certain what you are dealing with. I would do that regardless of what you decide to do with the SNB.
As for whether or not to go there, it's a tough call. You should definitely have additional margins taken – 5mm is not considered adequate for a lesion as deep as yours. I would probably have the SNB as well if your depth was truly 1.5mm with the knowledge that there is some probability of an inaccurate result based on the previous excision.
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- January 7, 2017 at 6:54 am
Thank you for responding. Yes, I asked for the slides with biosample or at least their images, but Dr refused. He even got irritated that I am questioning his report or followup plan (or the lack of it, I'd say). And yes, I am inclining to have the SLNB done. First removal was Nov 10th, and now is almost mid Jan….
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- January 7, 2017 at 8:51 am
MIne was almost 1 mm, so I had a choice too. All my research says that with thin melanomas, there is a 5%ish possibility that the SNL comes back as malign. All of that is for melanomas between 0.75-1 mm. It's almost unheard of for thinner than that. Take it with a grain of salt, but in your case I wouldn't do it.
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- January 7, 2017 at 8:51 am
MIne was almost 1 mm, so I had a choice too. All my research says that with thin melanomas, there is a 5%ish possibility that the SNL comes back as malign. All of that is for melanomas between 0.75-1 mm. It's almost unheard of for thinner than that. Take it with a grain of salt, but in your case I wouldn't do it.
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- January 7, 2017 at 11:29 am
Mine was 1,5 mm . . . So-o, what you'd recommend in such case? I'd appreciate your input very much.
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- January 7, 2017 at 11:29 am
Mine was 1,5 mm . . . So-o, what you'd recommend in such case? I'd appreciate your input very much.
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- January 7, 2017 at 2:27 pm
Most likely it is too late for the SLNB and the SLNB is no guarantee of preventing further disease. However you could opt for ultrasound of your nodes and I would certainly go for follow up feeling of nodes from knees up. This doc who wants to do pet scans is the other extreme from the first, both being out of date.
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- January 7, 2017 at 2:27 pm
Most likely it is too late for the SLNB and the SLNB is no guarantee of preventing further disease. However you could opt for ultrasound of your nodes and I would certainly go for follow up feeling of nodes from knees up. This doc who wants to do pet scans is the other extreme from the first, both being out of date.
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- January 7, 2017 at 2:27 pm
Most likely it is too late for the SLNB and the SLNB is no guarantee of preventing further disease. However you could opt for ultrasound of your nodes and I would certainly go for follow up feeling of nodes from knees up. This doc who wants to do pet scans is the other extreme from the first, both being out of date.
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- January 8, 2017 at 3:48 am
I am sorry, I misunderstood, and thought you were at 0.5 mm. Yes, you needed a SNB, but unfortunately it is too late now, since the wide excision might have altered the draining paths.
I would probably ask for a PET scan (and a repeat in a 6 months or so, just in case it did get to the lymph nodes, but did not have enough time to grow enough to show up on the scans at the moment), and change doctors ASAP.
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- January 8, 2017 at 3:48 am
I am sorry, I misunderstood, and thought you were at 0.5 mm. Yes, you needed a SNB, but unfortunately it is too late now, since the wide excision might have altered the draining paths.
I would probably ask for a PET scan (and a repeat in a 6 months or so, just in case it did get to the lymph nodes, but did not have enough time to grow enough to show up on the scans at the moment), and change doctors ASAP.
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- January 8, 2017 at 3:48 am
I am sorry, I misunderstood, and thought you were at 0.5 mm. Yes, you needed a SNB, but unfortunately it is too late now, since the wide excision might have altered the draining paths.
I would probably ask for a PET scan (and a repeat in a 6 months or so, just in case it did get to the lymph nodes, but did not have enough time to grow enough to show up on the scans at the moment), and change doctors ASAP.
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- January 7, 2017 at 11:29 am
Mine was 1,5 mm . . . So-o, what you'd recommend in such case? I'd appreciate your input very much.
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- January 7, 2017 at 8:51 am
MIne was almost 1 mm, so I had a choice too. All my research says that with thin melanomas, there is a 5%ish possibility that the SNL comes back as malign. All of that is for melanomas between 0.75-1 mm. It's almost unheard of for thinner than that. Take it with a grain of salt, but in your case I wouldn't do it.
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- January 7, 2017 at 2:44 pm
Timing has been studied and while there is a sense of urgency for the patient, the outcome isn't likely to change as you wait. I know it's frustrating – the hardest part is always waiting.
Did your doctor do the pathology himself or has someone else signed off on the report? I'd contact the lab they were sent to and ask either to obtain the slides yourself to deliver elsewhere or ask them to send to another lab (preferably a lab at a local who deals with lots of melanoma).
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- January 7, 2017 at 2:44 pm
Timing has been studied and while there is a sense of urgency for the patient, the outcome isn't likely to change as you wait. I know it's frustrating – the hardest part is always waiting.
Did your doctor do the pathology himself or has someone else signed off on the report? I'd contact the lab they were sent to and ask either to obtain the slides yourself to deliver elsewhere or ask them to send to another lab (preferably a lab at a local who deals with lots of melanoma).
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- January 7, 2017 at 2:44 pm
Timing has been studied and while there is a sense of urgency for the patient, the outcome isn't likely to change as you wait. I know it's frustrating – the hardest part is always waiting.
Did your doctor do the pathology himself or has someone else signed off on the report? I'd contact the lab they were sent to and ask either to obtain the slides yourself to deliver elsewhere or ask them to send to another lab (preferably a lab at a local who deals with lots of melanoma).
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- January 7, 2017 at 6:54 am
Thank you for responding. Yes, I asked for the slides with biosample or at least their images, but Dr refused. He even got irritated that I am questioning his report or followup plan (or the lack of it, I'd say). And yes, I am inclining to have the SLNB done. First removal was Nov 10th, and now is almost mid Jan….
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- January 7, 2017 at 6:54 am
Thank you for responding. Yes, I asked for the slides with biosample or at least their images, but Dr refused. He even got irritated that I am questioning his report or followup plan (or the lack of it, I'd say). And yes, I am inclining to have the SLNB done. First removal was Nov 10th, and now is almost mid Jan….
-
- January 7, 2017 at 6:10 am
Let me make sure I understand. The melanoma was 1.5mm deep and you had 5mm margins?
Typically the SNB isn't done after margins are taken because they can disrupt the lymph flow to the sentinel node. Since your margins were quite small, doing it now means that the results could not guarantee the right sentinel node but "probably" the right one. You should have been offered the SNB prior to the 5mm margins being taken because, at 1.5mm, the lesion was deep enough to indicate having it.
I would also send the slides to a dermatopathologist and get a good pathology report that states all the characteristics. Then you know for certain what you are dealing with. I would do that regardless of what you decide to do with the SNB.
As for whether or not to go there, it's a tough call. You should definitely have additional margins taken – 5mm is not considered adequate for a lesion as deep as yours. I would probably have the SNB as well if your depth was truly 1.5mm with the knowledge that there is some probability of an inaccurate result based on the previous excision.
-
- January 7, 2017 at 6:10 am
Let me make sure I understand. The melanoma was 1.5mm deep and you had 5mm margins?
Typically the SNB isn't done after margins are taken because they can disrupt the lymph flow to the sentinel node. Since your margins were quite small, doing it now means that the results could not guarantee the right sentinel node but "probably" the right one. You should have been offered the SNB prior to the 5mm margins being taken because, at 1.5mm, the lesion was deep enough to indicate having it.
I would also send the slides to a dermatopathologist and get a good pathology report that states all the characteristics. Then you know for certain what you are dealing with. I would do that regardless of what you decide to do with the SNB.
As for whether or not to go there, it's a tough call. You should definitely have additional margins taken – 5mm is not considered adequate for a lesion as deep as yours. I would probably have the SNB as well if your depth was truly 1.5mm with the knowledge that there is some probability of an inaccurate result based on the previous excision.
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- January 7, 2017 at 3:57 pm
Hi George, just wanted to add to what Janner has given you to this point. I have two videos, one an overview with Dr.Jason Luke which covers a lot of the materials early stage folks deal with and a second that is more the early pathology stuff. Best Wishes!!!Ed https://www.youtube.com/watch?v=eofW8d4J6sI https://www.youtube.com/watch?v=2wmeyNjFKQw
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- January 7, 2017 at 3:57 pm
Hi George, just wanted to add to what Janner has given you to this point. I have two videos, one an overview with Dr.Jason Luke which covers a lot of the materials early stage folks deal with and a second that is more the early pathology stuff. Best Wishes!!!Ed https://www.youtube.com/watch?v=eofW8d4J6sI https://www.youtube.com/watch?v=2wmeyNjFKQw
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- January 7, 2017 at 3:57 pm
Hi George, just wanted to add to what Janner has given you to this point. I have two videos, one an overview with Dr.Jason Luke which covers a lot of the materials early stage folks deal with and a second that is more the early pathology stuff. Best Wishes!!!Ed https://www.youtube.com/watch?v=eofW8d4J6sI https://www.youtube.com/watch?v=2wmeyNjFKQw
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- January 7, 2017 at 5:55 pm
At 1.5mm I would definitely consider the SLNB. That is half again as deep as the point at which most melanoma specialists would recommend an SLNB. By the way, I may be wrong, but those slides and medical information are yours to,direct as you see fit. I don't believe your doctor can legally withhold those slides or prevent you from forwarding to another physician. Good luck!
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- January 7, 2017 at 5:55 pm
At 1.5mm I would definitely consider the SLNB. That is half again as deep as the point at which most melanoma specialists would recommend an SLNB. By the way, I may be wrong, but those slides and medical information are yours to,direct as you see fit. I don't believe your doctor can legally withhold those slides or prevent you from forwarding to another physician. Good luck!
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- January 7, 2017 at 5:55 pm
At 1.5mm I would definitely consider the SLNB. That is half again as deep as the point at which most melanoma specialists would recommend an SLNB. By the way, I may be wrong, but those slides and medical information are yours to,direct as you see fit. I don't believe your doctor can legally withhold those slides or prevent you from forwarding to another physician. Good luck!
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Tagged: cutaneous melanoma
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