Failed Sentinel Lymph Node Biopsy

Posted By
10/8/2018 2:25pm
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Replies: 10

Hi All,


I was diagnosed stage 1b a couple of months ago. I was 1.9mm non ulcerated with a Clark 3 and Mitiotic rate of 6. I went to the dermatologist who decided to do my WLE on the spot. Before I left he suggested I see an oncologist so I made an appointment. The oncologist said the results from the WLE came back clean however based on the stage and mitiotic rate a SLNB would be necessary to determine if it has spread. I got a surgeon recommended and booked the procedure. When I was coming around from anesthesia the surgeon told me nothing lit up and he wasn’t able to get a lymph node. I only write this because after making an appointment with my oncologist to see what happens now I went home and researched online why they couldn’t get one and what that means. I found nothing. I couldn’t believe it was only me that had this issue. After seeing my oncologist it seems that sometimes when they do the WLE first it can change the flow or mapping to the lymph node and make it so the radioactive dye doesn’t get there. Hope this helps someone. Next order for me is a PET scan which Im hoping will help me determine if I’m stage 3 or clean.


This is scary for me....I had a WLE in Aug. The Tumor Board at my  hospital and my doctor have decided while they got clean margins the first time around, they need another tissue sample in the same area due to how deep the surgeon had to go the first time (down to muscle) and because of the Clark Level (mine was 1.75mm, Clark Level 4, mitotic rate 3) they want to do a sentinel node biopsy at that time as well. I have heard recently because the WLE was done once already, it could change the mapping to the nodes. My doctor did say if the dye didn't reach the nodes, they inject another dye in the exact area the nodes should be....Please let me know what you find out. I am not scheduled for mine until November at this point....

I’m sorry to hear you are going through this. I have been referred to MD Anderson for any possible trials and based on my current situation a second opinion. My appointment is Oct 18th so I let you know what they tell me. 

Good luck with your appointment!!

The best results of a SLNB is before the WLE is done. Not sure why they would have done it in this order. The WLB can defiantly disrupt the flow of lymph nodes once it is done. I would make sure you are seeing a Melanoma specialist from this point on. Hopefully your PET will come back clear but I would still be inclined to at least talk with a melanoma oncologist about follow up scans for the future.

I am now going to be working with a melanoma specialist at MD Anderson so hopefully it all gets sorted out.

Hi Steve, no sense in kicking a horse when it is down but that derm of yours needs a update coarse on melanoma and fast. I don't think a Pet- scan would pick up micro mets in lymph nodes but being closely followed by oncologist in the future would be important, I would push for ultrasound of nodal basins to check for progression. what part of your anatomy was your original mole removed from???

This originated basically where that bone sticks out at the top of your spine on the back of the neck. Looking back at this I am also fairly surprised that the dermatologist didn’t slow down and follow the normal course of action. When my GP called to tell me the biopsy was melanoma she said it was in situ which made me feel better until a little research told me that couldn’t be true. It is possible the dermatologist didn’t really read it and just took her word for it. Either way I won’t me going back. My Oncologist said that the PET could be unreliable but he has referred me to MD Anderson to see about any trials and I will use that to get a second opinion on what’s next.

Anonymous - (10/9/2018 - 9:46am)

I would also get the pathology report and doctors notes on the surgery to take with me and keep in a file for myself.

WLE first is a no-no.  Even if you didn't have that done first, there are a small percentage of folks that have the same SLNB results although it is more common in areas where procedures have been done. 

PET scan - go for it but it likely won't show much in the way of helpful info unless you have "macro" nodes.  Microscopic won't show.  PET scans also have a high occurrence of false positives since they pick up metabolic activity like inflammation, arthritis, and other things which also have metabolic activity.  I agree with the poster who suggested periodic ultrasound checks.  But going to MD Anderson where they have a clue how to treat melanoma is a good move.

Hello Steve & welcome to MRF! your in good, warm & sometimes "shakey" hands (due to meds) ya well, little Hiccups with "protocols" will happen..
God dont get me started with Lymphnode mapping & that Devilish Dye Juice they inject to map! My first of two was TERRIBLE for me, just above my left knee and right into the Ulcerated tumor they where to take out that morning! They where to also biopsy my groins Lymphnodes emmiedatly after the surgery so they needed the mapping done beforehand..That dye FREAKIN BURNED LIKE HELL FIRE!..ill NEVER forget..thanx for reminding me Steve, good job :)

Im Melanoma and my host is Mike..