Doc says no SNB if FISH test comes back negative

› Forums › General Melanoma Community › Doc says no SNB if FISH test comes back negative

  • Post
    • October 31, 2014 at 5:07 pm
    SMGY1978
    Participant

      To date, my 8yo son has only had the mole on his scalp removed by the dermatoloist.  (Initial pathology yielded "spitzoid melanoma" – Clark IV, Breslow 2.1 mm, 3/mm mitotic rate).

       

      Next, we're discussing the plan of action with Oncology/Plastic Surgery/Pathology.   They're tentatively scheduling surgery for Nov 7th.  Today, the Oncologist said if the FISH (fluorescence in situ hybridization) test comes back negative, they'll only do a re-excision.  If it's positive, they'll do the wide excision AND SNB.  They have a concensus that the tissue is "borderline" melanoma.  

       

      Thoughts?   Anyone have negative FISH results, but had problems down the road?

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    • Replies
        • October 31, 2014 at 6:45 pm
        Janner
        Participant

          Negative FISH test basically says it is benign.  So if it were benign, what advantage would there be checking the lymph nodes?  Sptiz Nevi are common in kids and if it is determined to be a Spitz and not melanoma, I guess I don't see any advantage to additional surgery.

          In all my years on the board, I've never heard of anyone who has done the FISH test and later has metastatic melanoma at a later date.  The FISH test isn't always conclusive, but if there were any question on the results, I'm sure they'd do the SNB.

          • October 31, 2014 at 6:45 pm
          Janner
          Participant

            Negative FISH test basically says it is benign.  So if it were benign, what advantage would there be checking the lymph nodes?  Sptiz Nevi are common in kids and if it is determined to be a Spitz and not melanoma, I guess I don't see any advantage to additional surgery.

            In all my years on the board, I've never heard of anyone who has done the FISH test and later has metastatic melanoma at a later date.  The FISH test isn't always conclusive, but if there were any question on the results, I'm sure they'd do the SNB.

            • October 31, 2014 at 6:45 pm
            Janner
            Participant

              Negative FISH test basically says it is benign.  So if it were benign, what advantage would there be checking the lymph nodes?  Sptiz Nevi are common in kids and if it is determined to be a Spitz and not melanoma, I guess I don't see any advantage to additional surgery.

              In all my years on the board, I've never heard of anyone who has done the FISH test and later has metastatic melanoma at a later date.  The FISH test isn't always conclusive, but if there were any question on the results, I'm sure they'd do the SNB.

                • October 31, 2014 at 8:13 pm
                Becky
                Participant

                  To me the plan sounds good. Something else to consider is that benign spitz nevus can sometimes spread to the lymph nodes (still beign but can be confusing to pathologists) so I would use the FISH test as the definitive answer and only do the WLE  if its is neganitve.

                  • October 31, 2014 at 8:13 pm
                  Becky
                  Participant

                    To me the plan sounds good. Something else to consider is that benign spitz nevus can sometimes spread to the lymph nodes (still beign but can be confusing to pathologists) so I would use the FISH test as the definitive answer and only do the WLE  if its is neganitve.

                    • October 31, 2014 at 8:13 pm
                    Becky
                    Participant

                      To me the plan sounds good. Something else to consider is that benign spitz nevus can sometimes spread to the lymph nodes (still beign but can be confusing to pathologists) so I would use the FISH test as the definitive answer and only do the WLE  if its is neganitve.

                      • October 31, 2014 at 9:14 pm
                      Becky
                      Participant

                        Also, I cam across this article a few years back when I was researching my sons dx. I thought it was pretty informative, although long. You may want to take a look. It addresses some of the questions you have

                        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/

                         

                         

                         

                         

                        • October 31, 2014 at 9:14 pm
                        Becky
                        Participant

                          Also, I cam across this article a few years back when I was researching my sons dx. I thought it was pretty informative, although long. You may want to take a look. It addresses some of the questions you have

                          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/

                           

                           

                           

                           

                          • October 31, 2014 at 9:14 pm
                          Becky
                          Participant

                            Also, I cam across this article a few years back when I was researching my sons dx. I thought it was pretty informative, although long. You may want to take a look. It addresses some of the questions you have

                            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/

                             

                             

                             

                             

                          • October 31, 2014 at 9:55 pm
                          Lil0909
                          Participant

                            Sooo…. the "rules" could definitely be different for a child v. an adult, and I am by no means a dr, and I would have no idea what to do in your situation… but my pathology report says "FISH studies were performed which were negative for copy number aberrations in 6, 11, and 9", I had SNB done, and came back with micro metastasis in 1 of 3 sentinel nodes.  Now Stage 3a.

                            • October 31, 2014 at 9:55 pm
                            Lil0909
                            Participant

                              Sooo…. the "rules" could definitely be different for a child v. an adult, and I am by no means a dr, and I would have no idea what to do in your situation… but my pathology report says "FISH studies were performed which were negative for copy number aberrations in 6, 11, and 9", I had SNB done, and came back with micro metastasis in 1 of 3 sentinel nodes.  Now Stage 3a.

                              • October 31, 2014 at 9:55 pm
                              Lil0909
                              Participant

                                Sooo…. the "rules" could definitely be different for a child v. an adult, and I am by no means a dr, and I would have no idea what to do in your situation… but my pathology report says "FISH studies were performed which were negative for copy number aberrations in 6, 11, and 9", I had SNB done, and came back with micro metastasis in 1 of 3 sentinel nodes.  Now Stage 3a.

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