sentinel node biopsy
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sentinel node biopsy

› Forums › General Melanoma Community › sentinel node biopsy

  • Post
    • August 2, 2015 at 8:57 pm
    akamo
    Participant

    Hi. My husband was just diagnosed with stage 1A melanoma, .33mm.  Dermatoligist scheduled him for wide excision and sentinel node biopsy. I have done a ton of research and everthing I have read recommends not to have the sentinel node biopsy surgery (.33 not in the guidelines). The biopsy of the melanoma came back with clean margins. Please can anyone help with this decision?

Viewing 8 reply threads
  • Replies
      • August 3, 2015 at 1:11 am
      Janner
      Participant

      It is not recommended for stage 1A because the risks of the surgery outweigh the benefits.  The likelihood that a stage 1A 0.33mm lesion would have positive nodes is pretty minimal – less than the accuracy rates for SNB.  Personally, I wouldn't do it.  But if it makes your husband feel better, then go for it.  There are risks to the surgery.  If he just has the WLE (wide local excision), he can have a local anesthetic.  If he does the SNB, it is general anesthetic.  The SNB provides no clinical benefit, only staging.

      Just my opinion – let your husband do whatever makes him the most comfortable.

      Best wishes,

      Janner

        • August 3, 2015 at 1:33 am
        Millykamp
        Participant

        So at what mm is rhe border line for it to be quilled for SLNB???  I am 1.33mm and have to get one done. But from what I look up I am stage  1b as well..  Does it also depend on the mitisco rates as well?

        • August 3, 2015 at 2:06 am
        stars
        Participant

        Hi Melissa

        In Australia it is 1mm. My impression is that the USA is more likely to do SLNB at shallower depths if there are features like high mitotic rate. But in Australia, 1mm is the cutoff.

        • August 3, 2015 at 2:06 am
        stars
        Participant

        Hi Melissa

        In Australia it is 1mm. My impression is that the USA is more likely to do SLNB at shallower depths if there are features like high mitotic rate. But in Australia, 1mm is the cutoff.

        • August 3, 2015 at 2:06 am
        stars
        Participant

        Hi Melissa

        In Australia it is 1mm. My impression is that the USA is more likely to do SLNB at shallower depths if there are features like high mitotic rate. But in Australia, 1mm is the cutoff.

        • August 3, 2015 at 2:13 am
        Janner
        Participant

        Stage 1a has <1 mitosis and is considered very low risk.  In the U.S., most use 1mm as the cutoff but some docs are using 1a versus 1b as the deciding factor which seems very aggressive.  Ulceration or a high mitotic rate for lesions less than 1mm might be considered higher risk, but there is really nothing high risk about a shallow stage 1a lesion of the original poster.

        • August 3, 2015 at 2:30 am
        Millykamp
        Participant

        Ok still learning . My mitoioc rate is an 8. But to me that seems low compare to some that is reading high

        • August 4, 2015 at 3:10 pm
        DianaD
        Participant

        Melissa, from what I've read, a mitotic rate of 8 is high.  I believe that best case scenario is for it to be less than 1. 

        • August 4, 2015 at 3:10 pm
        DianaD
        Participant

        Melissa, from what I've read, a mitotic rate of 8 is high.  I believe that best case scenario is for it to be less than 1. 

        • August 4, 2015 at 3:10 pm
        DianaD
        Participant

        Melissa, from what I've read, a mitotic rate of 8 is high.  I believe that best case scenario is for it to be less than 1. 

        • August 3, 2015 at 2:30 am
        Millykamp
        Participant

        Ok still learning . My mitoioc rate is an 8. But to me that seems low compare to some that is reading high

        • August 3, 2015 at 2:30 am
        Millykamp
        Participant

        Ok still learning . My mitoioc rate is an 8. But to me that seems low compare to some that is reading high

        • August 3, 2015 at 2:13 am
        Janner
        Participant

        Stage 1a has <1 mitosis and is considered very low risk.  In the U.S., most use 1mm as the cutoff but some docs are using 1a versus 1b as the deciding factor which seems very aggressive.  Ulceration or a high mitotic rate for lesions less than 1mm might be considered higher risk, but there is really nothing high risk about a shallow stage 1a lesion of the original poster.

        • August 3, 2015 at 2:13 am
        Janner
        Participant

        Stage 1a has <1 mitosis and is considered very low risk.  In the U.S., most use 1mm as the cutoff but some docs are using 1a versus 1b as the deciding factor which seems very aggressive.  Ulceration or a high mitotic rate for lesions less than 1mm might be considered higher risk, but there is really nothing high risk about a shallow stage 1a lesion of the original poster.

        • August 3, 2015 at 1:33 am
        Millykamp
        Participant

        So at what mm is rhe border line for it to be quilled for SLNB???  I am 1.33mm and have to get one done. But from what I look up I am stage  1b as well..  Does it also depend on the mitisco rates as well?

        • August 3, 2015 at 1:33 am
        Millykamp
        Participant

        So at what mm is rhe border line for it to be quilled for SLNB???  I am 1.33mm and have to get one done. But from what I look up I am stage  1b as well..  Does it also depend on the mitisco rates as well?

        • August 3, 2015 at 2:27 am
        akamo
        Participant

        Janner,

        Thank you for your reply and opinion. We feel the same way. I just don't understand why a doctor would tell us he needs a SNB, putting the fear in us that "if he doesn't have it done…..?". At the time we got his results and talked to the doctor, we had no clue what is was and now that we have done the reseach, I believe he will opt out of the SNB. The dermatologist that told him he was getting the SNB is from a large, well-known office in our area. He ordered full blood work, chest x-ray, and SNB with a wide local excision. We trusted it was all necessary and now wondering what to do next. Monday when the office opens, I am going to try and sort this out,

        THANKS again!

        Robin

        • August 3, 2015 at 2:31 am
        Millykamp
        Participant

        Robin.. 

         

        Prayers r to you and your husband 

        • August 3, 2015 at 2:31 am
        Millykamp
        Participant

        Robin.. 

         

        Prayers r to you and your husband 

        • August 3, 2015 at 2:31 am
        Millykamp
        Participant

        Robin.. 

         

        Prayers r to you and your husband 

        • August 3, 2015 at 2:27 am
        akamo
        Participant

        Janner,

        Thank you for your reply and opinion. We feel the same way. I just don't understand why a doctor would tell us he needs a SNB, putting the fear in us that "if he doesn't have it done…..?". At the time we got his results and talked to the doctor, we had no clue what is was and now that we have done the reseach, I believe he will opt out of the SNB. The dermatologist that told him he was getting the SNB is from a large, well-known office in our area. He ordered full blood work, chest x-ray, and SNB with a wide local excision. We trusted it was all necessary and now wondering what to do next. Monday when the office opens, I am going to try and sort this out,

        THANKS again!

        Robin

        • August 3, 2015 at 2:27 am
        akamo
        Participant

        Janner,

        Thank you for your reply and opinion. We feel the same way. I just don't understand why a doctor would tell us he needs a SNB, putting the fear in us that "if he doesn't have it done…..?". At the time we got his results and talked to the doctor, we had no clue what is was and now that we have done the reseach, I believe he will opt out of the SNB. The dermatologist that told him he was getting the SNB is from a large, well-known office in our area. He ordered full blood work, chest x-ray, and SNB with a wide local excision. We trusted it was all necessary and now wondering what to do next. Monday when the office opens, I am going to try and sort this out,

        THANKS again!

        Robin

      • August 3, 2015 at 1:11 am
      Janner
      Participant

      It is not recommended for stage 1A because the risks of the surgery outweigh the benefits.  The likelihood that a stage 1A 0.33mm lesion would have positive nodes is pretty minimal – less than the accuracy rates for SNB.  Personally, I wouldn't do it.  But if it makes your husband feel better, then go for it.  There are risks to the surgery.  If he just has the WLE (wide local excision), he can have a local anesthetic.  If he does the SNB, it is general anesthetic.  The SNB provides no clinical benefit, only staging.

      Just my opinion – let your husband do whatever makes him the most comfortable.

      Best wishes,

      Janner

      • August 3, 2015 at 1:11 am
      Janner
      Participant

      It is not recommended for stage 1A because the risks of the surgery outweigh the benefits.  The likelihood that a stage 1A 0.33mm lesion would have positive nodes is pretty minimal – less than the accuracy rates for SNB.  Personally, I wouldn't do it.  But if it makes your husband feel better, then go for it.  There are risks to the surgery.  If he just has the WLE (wide local excision), he can have a local anesthetic.  If he does the SNB, it is general anesthetic.  The SNB provides no clinical benefit, only staging.

      Just my opinion – let your husband do whatever makes him the most comfortable.

      Best wishes,

      Janner

      • August 3, 2015 at 5:14 pm
      CHD
      Participant

      My only thoughts were to wonder whether this was a melanoma on a mucosal surface, in which case they are sometimes treated more aggressively, or if possibly the melanoma showed signs of regression, which can call the actual depth of the lesion into question and sometimes they will be treated like deeper melanomas just to be on the safe side.  Anyway, hopefully you will have some answers today.  Best wishes!

      • August 3, 2015 at 5:14 pm
      CHD
      Participant

      My only thoughts were to wonder whether this was a melanoma on a mucosal surface, in which case they are sometimes treated more aggressively, or if possibly the melanoma showed signs of regression, which can call the actual depth of the lesion into question and sometimes they will be treated like deeper melanomas just to be on the safe side.  Anyway, hopefully you will have some answers today.  Best wishes!

      • August 3, 2015 at 5:14 pm
      CHD
      Participant

      My only thoughts were to wonder whether this was a melanoma on a mucosal surface, in which case they are sometimes treated more aggressively, or if possibly the melanoma showed signs of regression, which can call the actual depth of the lesion into question and sometimes they will be treated like deeper melanomas just to be on the safe side.  Anyway, hopefully you will have some answers today.  Best wishes!

      • August 5, 2015 at 2:34 am
      jvictoria
      Participant

      My suggestion is to get a second even third opinion from a center(s) that have lots of melanoma exposure… My initial melanoma was 1mm at biopsy and 5mm when completely removed with positive SNB.

      Good thoughts and prayers are with you…

        • August 8, 2015 at 4:30 pm
        akamo
        Participant

        Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been identified:Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been
         

        Greatest thickness 0.33 mm

        Level of Invasion Clark Level II

        Growth phase vertical

        Host response Non-brisk

        Regression not identified

        Mitosis Absent

        Satelitosis Absent

        Angiolymphatic Invasion Not identified

        Perineural Invasion Not identified

        Ulceration Not identified

        Precursor lesion Not identified

        Surgical Margins FREE

        • August 8, 2015 at 4:30 pm
        akamo
        Participant

        Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been identified:Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been
         

        Greatest thickness 0.33 mm

        Level of Invasion Clark Level II

        Growth phase vertical

        Host response Non-brisk

        Regression not identified

        Mitosis Absent

        Satelitosis Absent

        Angiolymphatic Invasion Not identified

        Perineural Invasion Not identified

        Ulceration Not identified

        Precursor lesion Not identified

        Surgical Margins FREE

        • August 9, 2015 at 3:01 am
        stars
        Participant

        I think you've made the right decision. None of that pathology suggests a deep and/or aggressive mel. With the money you saved not getting the SLNB done, go out and have dinner! A melanoma diagnosis really makes you appreciate life and go for the nice things.

        • August 9, 2015 at 3:01 am
        stars
        Participant

        I think you've made the right decision. None of that pathology suggests a deep and/or aggressive mel. With the money you saved not getting the SLNB done, go out and have dinner! A melanoma diagnosis really makes you appreciate life and go for the nice things.

        • August 9, 2015 at 3:01 am
        stars
        Participant

        I think you've made the right decision. None of that pathology suggests a deep and/or aggressive mel. With the money you saved not getting the SLNB done, go out and have dinner! A melanoma diagnosis really makes you appreciate life and go for the nice things.

        • August 9, 2015 at 3:54 am
        akamo
        Participant

        Extremely grateful for the reply! We have been back and forth on this trying to see if maybe we missed something or of course, not understand something. We are moving forward with no regrets. My husband is schedule for WLE on August 17th. THANKS AGAIN~Robin

        Btw, I have read so many topics posted on here, and you are an amazing person to take the time and respond to so many people in need of support and answers.

        • August 9, 2015 at 3:54 am
        akamo
        Participant

        Extremely grateful for the reply! We have been back and forth on this trying to see if maybe we missed something or of course, not understand something. We are moving forward with no regrets. My husband is schedule for WLE on August 17th. THANKS AGAIN~Robin

        Btw, I have read so many topics posted on here, and you are an amazing person to take the time and respond to so many people in need of support and answers.

        • August 9, 2015 at 3:54 am
        akamo
        Participant

        Extremely grateful for the reply! We have been back and forth on this trying to see if maybe we missed something or of course, not understand something. We are moving forward with no regrets. My husband is schedule for WLE on August 17th. THANKS AGAIN~Robin

        Btw, I have read so many topics posted on here, and you are an amazing person to take the time and respond to so many people in need of support and answers.

        • August 8, 2015 at 4:30 pm
        akamo
        Participant

        Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been identified:Thanks for all the replies! So nice to have some one to talk to that understands.We have decided against the SNB surgery. I called the dermatologist's office and talked to a nurse and asked for reasoning behind the SNB surgery. She asked the doctors in the office and the only response she got was because the doctor ordered it (owner of the facilily). It is soooo confusing! The dermatology office is a very reputable office so I just don't understand. Anyway, here is the pathology report so if anyone has any comments and sees any reason my husband should have the surgery, please reply. Thanks! Robin

         

         

        Skin, left abdomen, shave removal  –malignant melanoma, superficial spreading type,

        invasive to clark's level II, breslow thickness .33 mm, nonulcerated.

        COMMENT: The malignant melanoma is very close tho the lateral and deep edges of the biopsy. Further excison with appropriate surgical margins is recommended. Consultation may be indicated for Plastics or MOHS surgery. with or without frozen section technique.

        GROSS DESCRIPTION: Skin, left abdomen; Submitted to the laboratory in a formalin-containing bottle labeled with patient's name and the anatomic site is a superficial piece of skin measuring .8 cm at the largest surface dimension and black in color.

        MICROSCOPIC DESCRIPTION: Sections show skin with a poorly demarcated lesion composed of atypical melanocytes with large, hyperchromatic and pleomorphic nuclei and abundent cytoplasm. Single cells predominate over nests. Melaanocytic nests vary in size and shape and are haphazardly distributed at the dermal-epidermal junction. Single melanocytes are located throughout the epidermis, including the level of the granular layer, in a pagetoid pattern. Atypical melanocytes similar to those in the epidermis are present in the dermis. Melan-A and HMB45 stains highlight the melancytes. Ki-67 immunostain does not reveal increased proliferative activity in the lesional cells. A host mononuclear cell inflammatory response is present in the dermis. The following histologic variables pertaining to this tumor have also been
         

        Greatest thickness 0.33 mm

        Level of Invasion Clark Level II

        Growth phase vertical

        Host response Non-brisk

        Regression not identified

        Mitosis Absent

        Satelitosis Absent

        Angiolymphatic Invasion Not identified

        Perineural Invasion Not identified

        Ulceration Not identified

        Precursor lesion Not identified

        Surgical Margins FREE

      • August 5, 2015 at 2:34 am
      jvictoria
      Participant

      My suggestion is to get a second even third opinion from a center(s) that have lots of melanoma exposure… My initial melanoma was 1mm at biopsy and 5mm when completely removed with positive SNB.

      Good thoughts and prayers are with you…

      • August 5, 2015 at 2:34 am
      jvictoria
      Participant

      My suggestion is to get a second even third opinion from a center(s) that have lots of melanoma exposure… My initial melanoma was 1mm at biopsy and 5mm when completely removed with positive SNB.

      Good thoughts and prayers are with you…

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