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Sentinel Node Biopsy
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Sentinel Node Biopsy

› Forums › General Melanoma Community › Sentinel Node Biopsy

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    • January 30, 2018 at 10:40 pm
    pinky2001
    Participant

      Wide excision done and stage is pT1b.   I’ve been told that, since the wide excision has already been done, a sentinel node biopsy may prove a false negative. Has anyone had a sentinel node biopsy AFTER their wide excision?  

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        • January 31, 2018 at 12:31 am
        Janner
        Participant

          How deep was your lesion? 

          If you really want to do it, you can.  The odds are good that it would be negative for a stage 1b lesion anyway.  If you choose to do it, the surgery is only worthwhile if you have a positive node.  But if it is negative, you will never know if that is because you had no spread, or that the sentinel node drainage path was affected by the WLE and they found the wrong sentinel node.  It leaves such a big question if it is negative that it becomes unnecessary surgery.  That's why the guidelines say to do it before.  Some have done it but negative results don't necessarily ease the mind.  You might ask the doctor if you could do ultrasound followup of the lymph node basin instead?

            • January 31, 2018 at 11:26 am
            pinky2001
            Participant

              Initial punch biopsy showed .33 mm deep. At that point they didn’t think it was necessary to do a sentinel node biopsy.   After the wide excision was done, it came in at .90 mm, Clark’s level IV, no ulceration.

              • January 31, 2018 at 11:27 am
              pinky2001
              Participant

                Please share more info in the ultrasound test. 

                • January 31, 2018 at 2:47 pm
                Janner
                Participant

                  It used to be they didn't do SLNB for anything under 1mm.  My one primary was .88mm and I didn't have a SLNB for it.  So honestly, there are many who haven't had a SLNB with a depth of .9mm.  They've only recently changed guidelines to do it for a little less depth.

                  The ultrasound idea may not fly with the doctor but you can ask.  They have sometimes done if for individuals who had a single lymph node affected and removed with the SLNB, but the individual did not have all the lymph nodes removed.  They just do an ultrasound and monitor the size of the lymph nodes in the area.  That does depend a bit on where your primary was located, however, because the SLNB does identify the correct nodal basin.  If the lesion were on an arm/leg/head, it's pretty straightforward knowing the right lymph node basin.  Not as much if it is on your trunk somewhere.

                • January 31, 2018 at 3:36 pm
                Bubbles
                Participant

                  I think Janner makes some very good points and ultrasound is certainly one tool with which to keep an eye on things…esp in the nodal basin.  Ironically, I just posted a report on a study that looked at ultrasound follow-up in StageI/II melanoma peeps.  Here's a link if you are interested:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2018/01/ultrasound-based-follow-up-does-not.html  

                  Melanoma is not easy.  Hang in there.  Celeste

                    • January 31, 2018 at 4:15 pm
                    Janner
                    Participant

                      Interesting, Celeste.  I wish they would have broken it down better.  As you said, Stage II could be a fairly deep lesion and comparing that with a reliatively thin stage 1a lesion seems at best a jumble.  Maybe the clinical folks think that way but as a stage I person, I see stage II as a different beast.  Possibly since my Dad was originally diagnosed as stage II and that metastasized.

                      • January 31, 2018 at 5:43 pm
                      Bubbles
                      Participant

                        Yes, to all your points!!  I also think Stage I and II are very different and combining them leaves many points unanswered.   And…yes…this abstract lacks a great deal in defining many things…perhaps the actual article does better.  Oh, well…  We do what we can.  Hope you have a great day!  c

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