Just got diagnosed with Melanoma

Clear margins cannot guarantee lymph nodes are not affected.  Your lesion is considered low risk but not no risk.  There are a small percentage of people who will have positive nodes.  However, a negative SLNB cannot guarantee you won't have further spread either.  There are again a small percentage of people who progress with a negative SLNB.  SLNB are not recommended for lesions with your depth because statistically the number of people with positive nodes doesn't justify the risk in performing the procedure.

I would have thought that mitosis 1/mm would make you a stage 1b. As for SLNB, in Australia it's 1mm or 0.75mm if any concerning features, and you don't meet either criteria so no. It is a little close to the line so you could do it for peace of mind, but keep in mind SLNB is a staging tool only, not any kind of 'cure'. It's simply a more in-depth staging method than the usual wide level excision (WLE). In your shoes, I would not opt for an SLNB as your melanoma does not meet the fairly stringent criteria for one.

Staging update:  Staging changed in 2018 and stage 1a is defined as tumors < 0.8mm without ulceration.  Mitotic rate is no longer used as a staging criteria.

Your risk of a recurrence (depending on where you read) is generally less than 10%.  Probably lower but just generalizing.  Your risk of another primary lesion is about 10%. 

Ask your derm to tell you how to palpate the most likely lymph node basin to check for regional metastasis.  Then do a monthly skin and lymph node exam.  Continue to watch your skin for the ugly duckling or new and changing.  Recent studies show melanoma arises on new lesions 75% of the time, 25% on existing lesions.  Be sun safe and live life!

I asked the same exact questions as you are asking now.  It is difficult to do nothing, so better to feel like we are doing something. Do everything Janner already mentioned, and keep your dialogue going with your doctor so you always feel like you have a team. My melanoma was on my right arm and I was told to check my right underarm lymph nodes on an ongoing basis.  Ask your doctor which area to check. Others on this site have said that their doctors agreed to do ultrasounds of the potentially impacted lymph node region periodically.  My doctor declined unfortunately, as that is not their protocol.  I do weekly self-checks, on a weekday so if there is enlargement I can get right in to my doctor for a second look.  (At first I was doing them daily and driving myself insane.)  In addition to my 3-month dermatology skin checks, my primary doctor says I should come in every 6 months and she will feel for enlargement. Most importantly, I see a therapist who is trying to help me move forward mentally while still being vigilant (a tough balancing act).  Again, all the best to you and please keep us posted.  

I asked the same exact questions as you are asking now. It is difficult to do nothing, so better to feel like we are doing something. Do everything Janner already mentioned, and keep your dialogue going with your doctor so you always feel like you have a team. My melanoma was on my right upper arm and I was told to check my right underarm lymph nodes on an ongoing basis.  Ask your doctor which area to check.  Others on this site have said that their doctors agreed to do ultrasounds of the potentially impacted lymph node region periodically.  My doctor declined unfortunately, as that is not their protocol.  I do wekkly self-checks, on a weekday so if there is enlargement I can get right to my doctor for a second look.  (At first I was doing them daily and driving myself insane.)   In addition to my 3-month dermatology skin and lymph node checks, my primary doctor says I should come in every 6 months and she will feel for enlargement.  Most importantly, I now see a therapist who is trying to help me move forward mentally while still being vigilant (a tough balancing act).  In reality, there is nothing we can do but wait and see, but that is so, so tough.  Again, all the best to you and please keep us posted.  

Doctors discuss a new lesion because the odds are higher for you to have a new primary than they are for you to have a metastasis of your stage 1a lesion.  Since your original biopsy had clean margins, the WLE will not change your staging.  The WLE is done to try and make sure that any rogue cells are removed that might have escaped the original biopsy.  Surgery is still the best option and most likely all of your melanoma has been removed.  And as I said before, the odds are so low of having a positive SNB that the benefit is not there.  You make 98% of the people have unnecessary surgery for the 2% who may have a positive lymph node.  That's why it isn't offered.  But that's why palpating your lymph node basin makes sense at your 3 month visits (as well as home exams).  The vast majority of stage 1a folks never deal with melanoma again.  Beside the newly diagnosed, people who end up on this site are the "exceptions" who end up having melanoma return.  This site is NOT representative of the real world.

Ask your doctor which basins to check – but most likely the left armpit, left clavicle and left neck.  Neck nodes swell more than other nodes from any type of trauma/infection so you need to be a bit more forgiving and patient when checking those nodes.  In addition, any trauma (including your surgeries) can cause these nodes to swell.  Swollen nodes don't have to be melanoma but nodes that stay swollen for several months should be checked.  It can take at least a month for neck nodes to go back to normal after a cold.  In addition, some nodes may never return to their normal size – they are called reactive nodes.  Enlarge and stay that way and are totally benign.  You can always compare left side to right side.  But again, specifically ask your doctor for their guidance in how to check and where to check.