› Forums › General Melanoma Community › question about SLNB with thin tumor <.75 mm
- This topic has 24 replies, 7 voices, and was last updated 8 years, 8 months ago by
JC.
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- August 12, 2015 at 6:56 pm
Hello,
I'm recently diagnosed with melanoma on my ankle, 41 years old. T1a, superficial spreading, 0.58mm, Clark's level 3, no ulceration, dermal mitoses <1/mm2, no regression.
I'm scheduled for a wide excision surgery and the surgeon also recommended sentinel lymph node biopsy, though optional. He did reassure me that the chance of finding anything in the nodes was about 5% or less, but he thought I might want to have that extra reassurance and he assured me that other than mild pain at incision site, it would be very unlikely that I would suffer side effects from the biopsy. I agreed to the biopsy with the surgery. I WOULD like to have that more certain assurance that we are in the clear.
Anyone here with thoughts on this? From all that I've read online, SLNB is NOT recommeded for lesions under (about) 0.7mm, at least those without any other features present such as ulceration, faster mitoses, etc. So is there some reason I shouldn't have the SLNB done? I'm not ooking forward to having any surgery, and certainly not anything "extra", but I'm willing to go through it if in fact it will give me more certainty of being free of future effects of this tumor.
Any helpful comments appreciated.
Thank you!
Louise
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- August 13, 2015 at 12:14 am
Louise,
To do, or not to do, sentinel node biopsy is a contentious issue with patients as well as researchers. I had mine done….twice…along with a complete lymph node disection…twice. Right axilla in 2003 after my first primary on my back…with one positive node. Left axilla in 2007 after a second primary on my left forearm, no positive nodes. It wasn't fun…but I've been through worse. I have never developed lymphadema. Unfortunately, I did progress to Stage IV with brain and lung mets in 2010. However, after surg, SRS and Nivo…I have been NED ever since. I am still glad that I did have the SNB and complete lymphadenectomies. I think it bought me time, though I cannot prove it. You have to do what you think is best for you and simply move forward from there. Here is some research data from related blog posts if you are interested:
I wish you my best in whatever path you choose. Celeste
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- August 13, 2015 at 12:14 am
Louise,
To do, or not to do, sentinel node biopsy is a contentious issue with patients as well as researchers. I had mine done….twice…along with a complete lymph node disection…twice. Right axilla in 2003 after my first primary on my back…with one positive node. Left axilla in 2007 after a second primary on my left forearm, no positive nodes. It wasn't fun…but I've been through worse. I have never developed lymphadema. Unfortunately, I did progress to Stage IV with brain and lung mets in 2010. However, after surg, SRS and Nivo…I have been NED ever since. I am still glad that I did have the SNB and complete lymphadenectomies. I think it bought me time, though I cannot prove it. You have to do what you think is best for you and simply move forward from there. Here is some research data from related blog posts if you are interested:
I wish you my best in whatever path you choose. Celeste
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- August 13, 2015 at 12:14 am
Louise,
To do, or not to do, sentinel node biopsy is a contentious issue with patients as well as researchers. I had mine done….twice…along with a complete lymph node disection…twice. Right axilla in 2003 after my first primary on my back…with one positive node. Left axilla in 2007 after a second primary on my left forearm, no positive nodes. It wasn't fun…but I've been through worse. I have never developed lymphadema. Unfortunately, I did progress to Stage IV with brain and lung mets in 2010. However, after surg, SRS and Nivo…I have been NED ever since. I am still glad that I did have the SNB and complete lymphadenectomies. I think it bought me time, though I cannot prove it. You have to do what you think is best for you and simply move forward from there. Here is some research data from related blog posts if you are interested:
I wish you my best in whatever path you choose. Celeste
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- August 13, 2015 at 2:20 am
In Australia I don't think you would be offered a SLNB by any GP who is following the official guidelines – here the cutoff for SLNB is 1mm thick, and yours is a long way under that. I know in the States things are different – drs seem more likely to offer/do SLNB on thinner melanomas. But I thought that was only if the mel had negative indicators like really high mitosis etc. It's a bit of a dilemma… I personally wouldn't, but then again it's hard to say no with the dr providing such a good argument for doing it.
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- August 13, 2015 at 2:20 am
In Australia I don't think you would be offered a SLNB by any GP who is following the official guidelines – here the cutoff for SLNB is 1mm thick, and yours is a long way under that. I know in the States things are different – drs seem more likely to offer/do SLNB on thinner melanomas. But I thought that was only if the mel had negative indicators like really high mitosis etc. It's a bit of a dilemma… I personally wouldn't, but then again it's hard to say no with the dr providing such a good argument for doing it.
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- August 13, 2015 at 2:20 am
In Australia I don't think you would be offered a SLNB by any GP who is following the official guidelines – here the cutoff for SLNB is 1mm thick, and yours is a long way under that. I know in the States things are different – drs seem more likely to offer/do SLNB on thinner melanomas. But I thought that was only if the mel had negative indicators like really high mitosis etc. It's a bit of a dilemma… I personally wouldn't, but then again it's hard to say no with the dr providing such a good argument for doing it.
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- August 13, 2015 at 3:03 am
Louise, I have to say I am one of the rare few who had the SLNB and have had issues with lymphedema, though mild, and some chronic referred pain from the biopsy site on one side. In my case, the SLNB was warranted with mucosal melanoma, 1 mm thickness, and regression being factors, but the doc really felt I was at low risk for side effects because I was thin, fairly young, and very healthy. Even so, I have had a bit of trouble on one side (mine were bilateral groin biopsies). I have mixed feelings about doing this if not truly necessary. It is not therapeutic of course, just helps, as your doctor said, to provide some reassurance if the nodes are clear. But reassurance is also valuable, I definitely agree. Is it worthwhile to do it for that reason alone? Maybe so. I don't regret having the procedures done, and mine came back clear, in spite of the side effects. But with a thinner melanoma and fewer risk factors, it might not be worth the potential hassle. As others have said, it just comes down to individual choice. Some doctors don't even offer it for thinner melanomas, some do.
Just my 2 cents.
Good luck, whatever you decide is best for you! : )
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- August 13, 2015 at 3:03 am
Louise, I have to say I am one of the rare few who had the SLNB and have had issues with lymphedema, though mild, and some chronic referred pain from the biopsy site on one side. In my case, the SLNB was warranted with mucosal melanoma, 1 mm thickness, and regression being factors, but the doc really felt I was at low risk for side effects because I was thin, fairly young, and very healthy. Even so, I have had a bit of trouble on one side (mine were bilateral groin biopsies). I have mixed feelings about doing this if not truly necessary. It is not therapeutic of course, just helps, as your doctor said, to provide some reassurance if the nodes are clear. But reassurance is also valuable, I definitely agree. Is it worthwhile to do it for that reason alone? Maybe so. I don't regret having the procedures done, and mine came back clear, in spite of the side effects. But with a thinner melanoma and fewer risk factors, it might not be worth the potential hassle. As others have said, it just comes down to individual choice. Some doctors don't even offer it for thinner melanomas, some do.
Just my 2 cents.
Good luck, whatever you decide is best for you! : )
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- August 13, 2015 at 3:03 am
Louise, I have to say I am one of the rare few who had the SLNB and have had issues with lymphedema, though mild, and some chronic referred pain from the biopsy site on one side. In my case, the SLNB was warranted with mucosal melanoma, 1 mm thickness, and regression being factors, but the doc really felt I was at low risk for side effects because I was thin, fairly young, and very healthy. Even so, I have had a bit of trouble on one side (mine were bilateral groin biopsies). I have mixed feelings about doing this if not truly necessary. It is not therapeutic of course, just helps, as your doctor said, to provide some reassurance if the nodes are clear. But reassurance is also valuable, I definitely agree. Is it worthwhile to do it for that reason alone? Maybe so. I don't regret having the procedures done, and mine came back clear, in spite of the side effects. But with a thinner melanoma and fewer risk factors, it might not be worth the potential hassle. As others have said, it just comes down to individual choice. Some doctors don't even offer it for thinner melanomas, some do.
Just my 2 cents.
Good luck, whatever you decide is best for you! : )
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- August 14, 2015 at 2:53 am
This is really a reply to all those who responded to me, above. I thank you all for your replies.
This is giving me some pause to think about this and whether in fact I want to go ahead with the SLNB or not. I do fear the potential side effects (unlikely as they may be).
My surgery is scheduled for Sept 16th (is this too long to wait? the surgeon thought there is no rush as "all of the tumor is out, we just need to get good margins"…does that sound right?) so I guess I have some time to think about things (aka worry about and not come to any conclusive decision), over the next few weeks.
I wish that this disease did not exist, that it had not affected any of you, or me, but I guess that goes without saying.
Again thanks all, and wishing you all the best.
Louise
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- August 14, 2015 at 2:53 am
This is really a reply to all those who responded to me, above. I thank you all for your replies.
This is giving me some pause to think about this and whether in fact I want to go ahead with the SLNB or not. I do fear the potential side effects (unlikely as they may be).
My surgery is scheduled for Sept 16th (is this too long to wait? the surgeon thought there is no rush as "all of the tumor is out, we just need to get good margins"…does that sound right?) so I guess I have some time to think about things (aka worry about and not come to any conclusive decision), over the next few weeks.
I wish that this disease did not exist, that it had not affected any of you, or me, but I guess that goes without saying.
Again thanks all, and wishing you all the best.
Louise
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- August 14, 2015 at 2:53 am
This is really a reply to all those who responded to me, above. I thank you all for your replies.
This is giving me some pause to think about this and whether in fact I want to go ahead with the SLNB or not. I do fear the potential side effects (unlikely as they may be).
My surgery is scheduled for Sept 16th (is this too long to wait? the surgeon thought there is no rush as "all of the tumor is out, we just need to get good margins"…does that sound right?) so I guess I have some time to think about things (aka worry about and not come to any conclusive decision), over the next few weeks.
I wish that this disease did not exist, that it had not affected any of you, or me, but I guess that goes without saying.
Again thanks all, and wishing you all the best.
Louise
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- August 14, 2015 at 7:48 am
LOL 'worry about and not come to any decision'… too funny, Louise. I see your dilemma though, I really do. It is correct that once the mel is completely removed, there is not an immediate urgency to WLE – most have mine have been within two weeks or so of initial biopsy but I did read somewhere you could wait quite a few weeks before the WLE.
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- August 14, 2015 at 7:48 am
LOL 'worry about and not come to any decision'… too funny, Louise. I see your dilemma though, I really do. It is correct that once the mel is completely removed, there is not an immediate urgency to WLE – most have mine have been within two weeks or so of initial biopsy but I did read somewhere you could wait quite a few weeks before the WLE.
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- August 14, 2015 at 7:48 am
LOL 'worry about and not come to any decision'… too funny, Louise. I see your dilemma though, I really do. It is correct that once the mel is completely removed, there is not an immediate urgency to WLE – most have mine have been within two weeks or so of initial biopsy but I did read somewhere you could wait quite a few weeks before the WLE.
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- August 25, 2015 at 7:31 am
I have a very similar diagnosis to yours and just had the WLE a few days ago. My surgeon strongly urged me not to do the SLNB. Said to wait for pathology because if the margins are clear my lymph nodes would be too. I wanted it all done at the same time but my surgeon was pretty adamant about not testing lymph nodes. At 38 years old he said the risks of complications from not having those lymph nodes was far greater than the risks of a second surgery to remove them if necessary. I opted not to have them removed just yet and will find out tomorrow what the pathology report has to say. FYI be prepared if you're not already , my WLE was much larger than expected. I thought the standard was 2cm for rumors <1mm but my surgeon went 5!!! My scar is the full length of my forearm for a thin melanoma the size of a quarter. Not to frighten you or anything but I was horrified when I removed my bandages. Recover has not been as easy as expected so I am very glad I don't have a second wound site to deal with as well. But that's just me. Good luck with your surgery.
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- August 25, 2015 at 7:31 am
I have a very similar diagnosis to yours and just had the WLE a few days ago. My surgeon strongly urged me not to do the SLNB. Said to wait for pathology because if the margins are clear my lymph nodes would be too. I wanted it all done at the same time but my surgeon was pretty adamant about not testing lymph nodes. At 38 years old he said the risks of complications from not having those lymph nodes was far greater than the risks of a second surgery to remove them if necessary. I opted not to have them removed just yet and will find out tomorrow what the pathology report has to say. FYI be prepared if you're not already , my WLE was much larger than expected. I thought the standard was 2cm for rumors <1mm but my surgeon went 5!!! My scar is the full length of my forearm for a thin melanoma the size of a quarter. Not to frighten you or anything but I was horrified when I removed my bandages. Recover has not been as easy as expected so I am very glad I don't have a second wound site to deal with as well. But that's just me. Good luck with your surgery.
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- August 25, 2015 at 7:31 am
I have a very similar diagnosis to yours and just had the WLE a few days ago. My surgeon strongly urged me not to do the SLNB. Said to wait for pathology because if the margins are clear my lymph nodes would be too. I wanted it all done at the same time but my surgeon was pretty adamant about not testing lymph nodes. At 38 years old he said the risks of complications from not having those lymph nodes was far greater than the risks of a second surgery to remove them if necessary. I opted not to have them removed just yet and will find out tomorrow what the pathology report has to say. FYI be prepared if you're not already , my WLE was much larger than expected. I thought the standard was 2cm for rumors <1mm but my surgeon went 5!!! My scar is the full length of my forearm for a thin melanoma the size of a quarter. Not to frighten you or anything but I was horrified when I removed my bandages. Recover has not been as easy as expected so I am very glad I don't have a second wound site to deal with as well. But that's just me. Good luck with your surgery.
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