MRF-Logo2019-Horizontal-RGB
Stage 1A and Sentinel Lymph Node Biopsy
REGISTER
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Content within the patient forum is user-generated and has not been reviewed by medical professionals. Other sections of the Melanoma Research Foundation website include information that has been reviewed by medical professionals as appropriate. All medical decisions should be made in consultation with your doctor or other qualified medical professional.

Stage 1A and Sentinel Lymph Node Biopsy

› Forums › Cutaneous Melanoma Community › Stage 1A and Sentinel Lymph Node Biopsy

  • Post
    • August 4, 2017 at 12:26 am
    papillion
    Participant

      Good evening all. I am new to this forum (and to melanoma) and I was hoping someone could ease my mind until my next doctor's appointment. I've been reading here and other sites but cannot find the specific information I am looking for.

      On 7/25 I had a shave biopsy done for a suspicious mole on my back shoulder. This week the doctor called me with the results and said that it had been identified as superficial spreading melanoma. It had a Breslow depth of 0.70, mitotic rate less than 1, no ulceration, Clark level 4, all margins negative. The pathologist classified it as pT1aNx. From my reading, it seems that this should be one of the less severe forms. However, the dermatologist is recommending me to a surgeon for further excision and the sentinel lymph node biopsy. The excision part I understand but I am a little concerned/confused with respect to the SLNB. Dermatologist said that while the Breslow level was shallower than the recommendation, she wants to have it because of my age (just turned 35).  

      Does anyone have any experiences with this or references they could point me towards? I know the doctors are much better informed than I am, but I would like to understand this better.

      Also is a Clark level 4 unusual for Breslow 0.70? I have read that the Clark level is out of favor, but might this explain why?

      I appreciate in advance any information. I am rather stressed at the moment. I haven't even been able to tell family yet as they are out of the country on vacation.

      I wish you all well in your treatments.

    Viewing 1 reply thread
    • Replies
        • August 4, 2017 at 2:01 am
        MTCowhand
        Participant

          Hello Papillion,

          I am guessing a bit about what might be going on with your case based on my own recent research (I was diagnosed Stage 2b a few months ago), but my understanding is that in January 2018 a number of new guidelines are being adopted by a number of cancer organisations that deal with the complex relationship between diagnosis, prognosis and treatment.  For melanoma specifically, I believe Clark level is essentially being disregarded as a significant prognostic factor for lesions that have a Breslow depth greater than 0.8 mm, but still being considered for lesions shallower than that.  As you seem to recognize, your Clark level is unusual given the depth of your lesion, but it is not unheard of either, and I am thinking your dermatologist is recommending the SLNB because of this and also in concordance with the 2018 guidelines.  While this may worry you, the other prognostic factors you mention (no ulceration, low mitotic rate, clear margins) are very good, so I think your doctor is being cautious here in a good way.  With melanoma nothing is sacred and we all recognize the intial terror of diagnosis, but at the same time there is huge progress being made in figuring out the best medical avenues for treating it.  Hope this helps and best wishes.   

            • August 4, 2017 at 3:37 am
            papillion
            Participant
              Thank you so much for your reply. I will definitely look into the new guidelines. Best of luck to you!
              • August 4, 2017 at 6:58 am
              ara82
              Participant

                Hi!

                I am also 35, live in Germany and got quite simillar diagnosis as you in March 2016. My melanoma was 0.6 mm deep, no ulceration, Clark level II BUT in my case mitotic rate = 1. So I also had one but different adverse factor. Doctors at the clinic here also recommended SLNB, because of the mitotic rate 1 and young age. The results came back negative – no melanoma Ella in the three indes they checken! Today I'm very happy that I did it! It gives me more security and faith, that it will not come back and spread.

                According to articles I read, younger people have higher probability of positive SLN, this is why, they want to make sure and check, if there are any adverse factors.

                Here is an online calculator, which can help to calculate the risk:

                http://www.lifemath.net/cancer/melanoma/nodal/index.php

                and this one calculates the possible outcome:

                http://www.lifemath.net/cancer/melanoma/outcome/index.php

                I wish you all the best!

                agata

                • August 4, 2017 at 3:48 pm
                papillion
                Participant
                  I am so glad that you got good news. Thank you for sharing your experience with me!
                  • August 4, 2017 at 6:08 pm
                  Jamie1960
                  Participant

                    If you might provide a link to a summary of the new guidelines I know many of us would be appreciative. Thank you !

                    • August 4, 2017 at 7:00 pm
                    MTCowhand
                    Participant

                      Hi…link is below for a summary article, and there are links within this article that you can follow as well.  Besides new mel staging guidelines, I understand the AJCC is also planning to update survival data and possibly present some of the first robust data on conditional survival like the Australians are doing…lots of good news in the new trends, I understand.  Best to you.

                       

                      http://www.mdedge.com/edermatologynews/article/131388/melanoma/new-ajcc-guidance-brings-melanoma-staging-changes

                      • August 5, 2017 at 3:51 am
                      papillion
                      Participant
                        Thank you for helping me be better informed.
                      • August 4, 2017 at 11:15 pm
                      Marksa2570
                      Participant

                        Hi,

                        My melanoma was .2mm and I was Clarks level III which suprised me.   I am guessing there isnt a correlation between depth and Clarks level due to thickness of skin or something.   Ive seen many thicker lesions only Clarks level II.  

                         

                           

                          • August 5, 2017 at 3:52 am
                          papillion
                          Participant
                            Thank you for sharing your experience. I hope you were able to make a good recovery.
                            • August 5, 2017 at 3:39 pm
                            becky15
                            Participant

                              I can't see anything about Clarks level in the referenced article or any other article I've read concerning the new guidelines…….

                        Viewing 1 reply thread

                        Tagged: 

                        • You must be logged in to reply to this topic.
                        About the MRF Patient Forum

                        The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

                        The information on the forum is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

                        Popular Topics