SNB ... what to Expect?

Posted By
7/20/2014 5:19pm
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Replies: 7

Hello everyone,

My fiance and I will be meeting with a new surgeon/oncologist in two weeks to discuss him getting a SNB.  Unfortunately, this is happening after his WLE, which was done in April.  We are still hoping that this will give us some extra piece of mind and that it will come back negative.

I was wondering, what questions should we be asking at the consultation?

Are there any other tests we should be requesting at this point?

Also, how invasive is this type of surgery? His original lesion was on his jawline, so I am assuming the nodes will be taken from his neck... Is this correct?  How much time will he need to recover and return back to work?

Thank you so much, I dont know what I would do without this website. 

 

 

Anonymous - (7/20/2014 - 6:21pm)

Here' s a very good source for you to explain everything:  http://melanomainternational.org/melanoma-facts/sentinel-node-biopsy

 

Anonymous - (7/20/2014 - 6:22pm)

That has great list of questions to ask too.  Good luck!

5dives - (7/21/2014 - 10:02am)

Hell, ScaredV

I am chiming in because I feel this board has been so helpful to me, and I finally have something I can contribute to someone looking for information! 

I had my SLNB on July 9th. I was TERRIFIED as I headed into that because I had read so much about how the SLNB was the worst part of so many different peoples' surgery experience. I was really scared of the dye injections. 

It's true, the dye injections are a little unpleasant, but far more manageable than what I had expected. The doctor told me that they are using a much less caustic dye than was used in the past, and that helps the injections be less awful.  Tell your husband to expect the "normal" poke of a shot and then about 10 seconds of burn for each of the four to six injections. I think the whole thing for me was about 60 seconds of discomfort. Definitely not worth the fear I had built up for it, or the crying I did while waiting for it. What a silly goose that doctor must have thought I was, lol. 

Anyway, this whole melanoma thing is terrifying, to be sure, but each time I've come to this group they have calmed me down with good advice and straightforward information. 

Good luck to you in this journey. 

Best,

Elaine

Thandster - (7/21/2014 - 3:15pm)

The snb itself is not that big of a deal. I really think your questions need to be geared more towards the wisdom of doing it at this point. There are hundreds of nodes in your neck and you are looking for 1-5 nodes that the primary may have drained to. Since he already had the WLE, the original tissue is gone, existing tissue is stretched and there is scar tissue. The drain pattern for where his primary was will be a totally different landscape now. I think at this point he is probably better off to have his nodes regularly monitored with ultrasound. If they do the surgery and everything comes back clean, instead of peace of mind, I would just be wondering if they actually got the right nodes.

Make sure your doctors specialize in melanoma.

Good luck with your decision.

Thandster

(1 Peter 5:7 NLT). Give all your worries and cares to God, for he cares about you

vlmd1986 - (7/21/2014 - 10:20pm)

Hi there,

I'm going to have to pleasantly disagree with you, Thandster :) I do not believe the drainage pattern is going to be all that different this far out from the WLE, and the surgical oncologist should have a pretty good idea of the most likely locations for that location to drain to (and thus would be able to compare his pre-test ideas to the results of the radiologic testing to ensure the accuracy/efficacy of the radiologic mapping). I've read on this message board that many people with head/neck lesions actually have SLNB done from two separate lymph node basins, so don't let that surprise you if that ends up being the case, ScaredV.

I just had my SLNB done on 7/11 (left groin), and it came back positive for microscopic mets. The dye before the procedure was the worst part, in my opinion, but I think Elaine did a SUPERB job of explaining it above! The 10 seconds or so of burning (per injection) was EXCRUCIATING, and it was bizarre how the pain just *disappeared* after the 10 seconds!!

My incision site is still pretty tender, and my left thigh is really sore/tender in random places. The SLNB requires a lot of careful dissection, retraction, and manipulation, so it's no wonder I'm still sore this far out. But also, the lymph nodes tend to be somewhat superficial in the head/neck area, so I don't think it's TOO major of a surgery. My pain gets better every day, and I was back to work on Monday after I had mine done on a Friday! I was pretty motivated to get back to work, because I had just started a new job on July 1st, but I think it's definitely doable for him to get back to work within a few days as long as he gets up and walks and tries to be active in the days following the surgery. I would definitely recommend having the surgery on a Friday, recovering over the weekend, and then trying to get back to work on Monday or Tuesday. In my opinion, sick days are going to be better used for other future endeavors :) Also, it's going to take a few days (maybe even a week) for the path result to come back from the SLNB, so don't think that if you had the surgery on a day other than Friday that you would get the results sooner. 

I would imagine the imaging (PET/CT, MRI, etc) would come after the SLNB for further staging if the node is positive--at least that's how it's going for me right now.

I would highly recommend using an ice pack for pain relief for up to 48 hours after surgery (IF your doctor approves!), because I took Aleeve and Norco (hydrocodone) after surgery, and they didn't really do much at all for the pain :/ But the ice was AMAZING, and even at the 48 hour mark, I was like, please can I keep using the ice?? It feels sooo good...lol.

Anyhow, I'm sure y'all are both pretty terrified, but stay strong and try to focus on one thing at a time--get through the SLNB, get the results, and THEN worry about what's next!

I hope this has been helpful, and please feel free to email me if you have any other questions/concerns!!

Love,

Val

ScaredV - (7/22/2014 - 12:03am)

Thank you everyone for your opinions and advice. I really appreciate it all. 

So weird your name is Val, That's my name too.

This had been a hard decision for us as his original surgeon did not want to do it but his dermatologist does want it Done and  he has now set us up with a melanoma specialist team at a very good hospital so we both feel this will give us some piece of mind that 'wait and see' won't. I wish we had got it done at the same time as the WLE but when he went in for that, they believed the depth was only .34 which wasn't the case after they removed it all. 

My fiancé is only 27 years old, before all this we were planing  our wedding and now we are planning surgeries and follow up tests and it's just all been very hard to deal with. I just hope we can get some piece of mind from this test - or if for some horrible reason it comes back positive at least we can start fighting back.

 

Thandster - (7/22/2014 - 3:32pm)

A pleasant response to Val's pleasant disagreement.

The drainage pattern may not be all that different, but ANY different makes the procedure not that accurate of a way to determine if ANY cells have gone to one or a couple lymph nodes. The surgeon may have a pretty good idea of where it should drain, but the point of the snb is to determine EXACTLY which 1, 2 or several lymph nodes the primary might have drained to. Remember, there are hundreds of nodes in the neck. The point is not to take a few random nodes from the general area, but the specific nodes where the dye is going. 

I'm not telling them he shouldn't do the surgery, just that this is the direction my questions would be geared. Looking for even a single cancer cell in an area with hundreds of nodes is a needle in a haystack search that may have been compromised by having the wle done before the snb.

Standard practice is certainly to do the snb at the same surgery as the wle and this is standard practice for a reason.

Good luck! 

Thandster

(1 Peter 5:7 NLT). Give all your worries and cares to God, for he cares about you