Stage 1 Superficial Spreading

Posted By
lindy303
12/6/2018 2:24pm
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Replies: 6

Hi,

Recently diagnosed with invasive superficial spreading melanoma. The Breslow depth is <0.8, but MR is 1.  Has anyone on here had a sentinel node biopsy with a thin melanoma?  I realize it's not normally indicated, as the risk of a positive SN is about 5%.  But still, that 5% makes me worry! 

 

Janner - (12/6/2018 - 2:44pm)

Certainly some with thin melanomas have had SNB's.  The cutoff used to be 1mm, not 0.8mm so many with thicker melanomas than yours haven't had a SNB.  The risk of the surgery / general anesthesia / side effects like infection and lymphedema, and low likelihood of a positive outcome is the reason it isn't typically done.  A negative SNB is not a guarantee against future spread.  There are people on this site in both categories.  Mitotic rate is no longer used in staging but 1 is good.  You can't have depth without some mitosis.  You don't say your actual depth as that would also add to the equation.  My gut feel might be different if your lesion were .2mm versus .8mm. 

I think you're thinking the wrong direction - 95% you'll never deal with melanoma again.  For cancer, that's pretty fantastic.  Just living has a couple % risk of dying!!!!  :)

My personal history - 3 primaries, 1 in situ and the other two .58mm and .88mm with no SNB.  Originally diagnosed in 1992, last primary in 2001 and I'm still stage 1.

Thank you! and you're right, I tend to focus on the negative!! My lesion was 0.5mm.  Hearing stories such as yours makes me feel better and a little less terrified.  I realize my diagnosis could be much worse, but just hearing "you have melanoma" is pretty life changing.

Happy Holidays to you!

 

AN8 - (12/7/2018 - 12:19am)

Hello, fellow Stage 1(1b to be exact due to focal ulceration).  Derm removed my melanoma stating no SLNB needed due to thin lesion (.44mm).  Due to my anxiety, I consulted an oncologist.  I just happened to be lucky enough to have my appointment with a member of the national board that sets the criteria for melanoma testing and treatment.  Talk about a blessing!  He explained, like Janner stated, .75mm is the standard used to determine the use of a SLNB.  EXCEPT when ulceration is involved.  The opinion then splits 50/50 and he sides with those that would perform a SLNB regardless of thin depth.  Therefore, he checks my lymph nodes behind my knee and in my groin every 3 months and he will do so for the next 3 years.  It gave me peace of mind to speak to someone who understood my anxieties and the unpredictability of melanoma.  I also felt like I was doing something to check the inside of my body and not just my skin.   My insurance covers the ultra sounds and it is a non invasive test. Why not??

 Do what brings you peace of mind and confidence that if ..IF..it does return you will be on top of it.  If you did not have ulceration, I do feel that a SLNB would be an invasive procedure for your depth.  Most drs won't do it and most insurances won't cover it.   Be your own advocate.  Best wishes to you!

 

 

 

Thanks for your reply! I'm finding it so helpful and reassuring to gain information on this site. Best wishes to you as well and happy holidays!

MMH - (12/7/2018 - 12:59pm)

Hello to you! You are not alone in your fear/anxiety. I had a .6mm removed in August. I have appointments every 3 months to feel lymph nodes and check for skin issues. As another post mentions, ultrasounds are a nice option. I asked for the ultrasound but was told that it was not protocol at my hospital (Johns Hopkins) but perhaps your doctor will do that to provide you with a non-invasive option. I have not yet found the solution to the worry, but trusting your doctor will help. Build a relationship and surround yourself with a group that makes you feel confident that no matter what happens, you will tackle it. The worry has become a part of my life, but I try to channel it in a positive direction. Remain vigilent, stay up to date on appointments, and trust your instincts. All the best to you.   

MMH

Thanks for your reply! Best to you and happy holidays!