New here, pathology report questions

i'm not sure what all of it means but good luck.  make sure you see a very good cutaneous surgeon/oncologist.  these are the ones that specialize in melanoma.  best wishes

My understanding is that SNB is warranted when Breslow is 1.0 mm or greater.  At 1.6 (at least) I would expect your surgeon to offer it without you even needing to advocate for it.  As for the question about skipping the SNB and just doing a full lymph node dissection on the assumption there will be positive nodes, I don't know.  You should ask the surgeon that very question.

Good luck~let us know how things shake out.

KatyWI

I would expect the idea of a sentinel node biopsy would be raised with you.  I doubt a surgeon would be willing to strip the entire section of lymph nodes without some evidence of disease in the lymph system.  The issue with shave biopsy is, as you noted, it can cut through the tumor.  This can make staging very difficult.  Really depends on the tumor and the surgeon.  You will probably know more after your next appointment, but in any event you may want to get a couple of opinions.  You have a couple of very good melanoma docs at Yale, and a very strong team at Sloan Kettering should you decide to take a drive into the city.

Tim

Yes, I would definitely want an SNB with a depth of 1.6mm, ulceration, and a significant mitotic rate. Having said that, I want you to know that my husband's mel was nodular and at least 2.22mm with involved deep margins from a shave biopsy. His mitotic rate was 6/mm2. He had a WLE which found no additional mel cells and an SNB that was negative. He is now more than 3 1/2 years out and is NED (no evidence of disease). He is perfectly healthy and doing great. For the first two years or so, I was holding my breath just waiting for the other shoe to drop. But eventually you learn to deal with the uncertainty and get on with living. When I think about his "negative" factors (mitotic rate, nodular, etc.) it can still freak me out a bit–but I feel so much more prepared to deal with whatever happens after educating myself.

I would insist on an SNB and then take it from there. Hopefully it will be negative and you will eventually learn how to live a normal life again.

Best wishes,

Niki (Wife of Joe, Stage IIA and 3 1/2 years NED)

Everyone has already pretty much covered what I would say but I wanted to add that there is plenty of room for hope even if more melanoma is removed during the wide excision and/or your sentinel node is positive. I also had a shave biopsy because miy nodular melanoma looked like it could be a blood blister. Mine was very deep (at least 6.9 mm breslow) and my sentinel node was positive. I also had an addition 2.8 mm removed during the wide excision. I am saying all of this because I haven't had any recurrences since my lymph node dissection in March of 2005. Hopefully you won't have any positive nodes but either way there is a lot of room for hope. I wouldn't read anything into there being more views than responses. People often read the posts but don't comment if they don't have any experience with the specifics of some situations.  Best of luck, Carver

Hello IntoTheWild, and welcome to the board.  Don't worry about the difference in views vs replies. Many people will red and decide they have nothing to offer in terms of advice, they might not have answers…or their answers might agree with others.

In your case, most will agree that yes, you are likely to be looking at a sentinal node biopsy, and a WLE ..wide local excision. They'll do both procedures on the same day. They'll inject you with the dye for the snb..put you under, do the snb and then the WLE then wake you up, and you'll have a much bigger scar.

The further LND (lymph node dissection) would depend on what the SNB shows, and who your doctor is. I've seen people here who ~automatically~ have a total dissection of the lymph node basin..and indeed that seems to be favored by most surgeons. I've known others though, who had selected lymph node removals. Where maybe a cluster of 10 or so nodes were removed, leaving others intact.

I am not sure about any evidence showing that one method is more effective than the other, but perhaps someone else here does and will offer up that info. You should definately ask your doctors about their feellings on this matter, and also ask about the consequences of total LND.

Also, you might be looking at scans, anything from xrays to PET/CT scans, especially if your SNB is positive.

There are a lot of knowledgable people here who have gone through all of these exact procedures. Good luck, and hang in there!

dian

I will confirm what the others are saying.  You'll probably have a wide local excision (WLE) since it looks like you had a shave biopsy.  You have 4 risk factor which will lead the surgeon to recommend a sentinel node biopsy(SNB).  Those are Breslow Depth > 1mm, Clark level of III or greater, high mitotic rate and ulceration.  This is a time to stay calm and learn about the condition.  Understand that only about 20% of patients who have a sentinel node biopsy will show melanoma in the regional lymph node.  That means you have an 80% chance of having clear nodes.  That is what I hope for you.  The morbidity (adverse side effects) of a complete lymph node dissection is significant.  Patients can sometimes suffer from lymphedema afterwards.  It is controversial even if the SNB is positive whether to have a complete lymph node excision of the regional nodes.

Stay strong.  Stay calm.  Hopefully things will not go beyond the SNB. It is a simple outpatient surgery that has very few complications

Kevin