› Forums › General Melanoma Community › 1mm excised, sent to a surgeon for another excision
- This topic has 6 replies, 2 voices, and was last updated 10 years, 5 months ago by
phr.
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- September 10, 2015 at 9:49 pm
Hi all, I was diagnosed with melanoma from a mole I spotted in the middle of my back last month. I had had a complete check (all clear) last October by my dermatologist. So it must not have been there in October. SHe removed it , stitched it up and sent it off for a biopsy. Here are the details:
It is 1mm deep, but only on part of it. They call this an “Intermediate” depth. It had an in situ component on the remainder. There were no ulcerations present. THere was no mitosis identified. Histology showed superficial spreading (i.e. spreading more on surface than internally).
All of the above are my notes from the followup visit to the derm. The derm referred me to a plastic surgeon at Yale New Haven who specializes in cancer surgery. They want him to cut more out, to make sure there werent any stray cells outside of the area (get a bigger "margin"). Not recommending adjuvant therapy now. The dermatologist is deferring to the surgeon on whether to do a sentinel node biopsy; they seem to think it is on the margin.
I guess one question from those who've been through it is, if I am on the margin of whether to do a sentinel node biopsy, should I push for it? The derm says no, trust the surgeon, he'e the best and if he thought i didnt need one, I don't need one. I have read many stories of recurrence, and so it seems to me that with a node biopsy, I could rest a little more compftably going forward. I have great insurance so cost wont be an issue.
I am surprised I am not more freaked out. I am a pretty calm person, and I realize that while this is cancer, it sounds like i got it early and (subject to what the surgeon says ) I am fortunate relative to many others. I feel grateful. And I'd like to hear any thoughts, particularly opinions on whether to push for a SLNB.
Thanks
- Replies
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- September 11, 2015 at 2:23 am
phr, you really are on the margin with your deepest level 1 mm with no ulceration and no mitosis. This is a tough call. There are some of us who would say do the SLNB: It will not only ease your mind if negative, but if positive, will stage you at higher risk (stage 3) so you can be followed more closely. I am on the fence with this. I tend to err on the side of conservative, but that doesn't mean it's the right way to do things!
On the down side, there are risks with any surgery and with SLNB in particular, there is always a risk of lymphedema. My own surgeon told me my risk of developing lymphedema with my lymph node biopsy was minimal because I was thin and fairly young (45) and in good health, but still I have developed a mild case of lymphedema in my right leg that comes and goes. It is painful when I have it. It is very hard to predict who will develop this. I had bilateral groin SLNB and it was negative, but I'm still glad I did the procedure. But I do have mucosal melanoma, which is more aggressive than cutaneous melanoma and carries a worse prognosis. As you can see, it comes down to personal choice.
With just a biopsy (as opposed to removal of all or most lymph nodes in a particular lymph bed location, which is called lymphadenectomy) your risk of lymphedema is decreased. But as I said, I have still developed a minor case of it. I hope this all helps you to determine where you fall in terms of trying to make this decision. I have been following melanoma forums for a few years now and I have seen people, even at stage 1, who swear by their SLNBs as the best thing they ever did, and others who say they are nontherapeutic and useless. I just tend to want to know as much as it is possible to know and do as much as it is possible to do. Even so, the lymphedema is no fun. It is manageable, however. There may be people with worse cases than me with a similar procedure, and people who had no problems at all.
I am sorry not to be of more help in a decisive way, but I hope this at least gives you a little overview of the situation, from one person's perspective anyway.
Good luck to you!
Cheri
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- September 11, 2015 at 11:19 pm
Thank you so much Cheri. You captured the dilemma well and understand completely what I'm weighing. I turned 52 yesterday and am in good physical shape so he may say something similar to me about being able to tolerate the intrusion. I was unaware of he risk of lymphadema. It sounds like you manage it well but it must be uncomfortable as hell. I'm glad you mentioned it and it points to the vale if this forum. I will wait and see what the surgeon says. Your knowledge and care in responding helps me so very much.
Thanks again
Rich
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- September 11, 2015 at 11:19 pm
Thank you so much Cheri. You captured the dilemma well and understand completely what I'm weighing. I turned 52 yesterday and am in good physical shape so he may say something similar to me about being able to tolerate the intrusion. I was unaware of he risk of lymphadema. It sounds like you manage it well but it must be uncomfortable as hell. I'm glad you mentioned it and it points to the vale if this forum. I will wait and see what the surgeon says. Your knowledge and care in responding helps me so very much.
Thanks again
Rich
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- September 11, 2015 at 11:19 pm
Thank you so much Cheri. You captured the dilemma well and understand completely what I'm weighing. I turned 52 yesterday and am in good physical shape so he may say something similar to me about being able to tolerate the intrusion. I was unaware of he risk of lymphadema. It sounds like you manage it well but it must be uncomfortable as hell. I'm glad you mentioned it and it points to the vale if this forum. I will wait and see what the surgeon says. Your knowledge and care in responding helps me so very much.
Thanks again
Rich
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- September 11, 2015 at 2:23 am
phr, you really are on the margin with your deepest level 1 mm with no ulceration and no mitosis. This is a tough call. There are some of us who would say do the SLNB: It will not only ease your mind if negative, but if positive, will stage you at higher risk (stage 3) so you can be followed more closely. I am on the fence with this. I tend to err on the side of conservative, but that doesn't mean it's the right way to do things!
On the down side, there are risks with any surgery and with SLNB in particular, there is always a risk of lymphedema. My own surgeon told me my risk of developing lymphedema with my lymph node biopsy was minimal because I was thin and fairly young (45) and in good health, but still I have developed a mild case of lymphedema in my right leg that comes and goes. It is painful when I have it. It is very hard to predict who will develop this. I had bilateral groin SLNB and it was negative, but I'm still glad I did the procedure. But I do have mucosal melanoma, which is more aggressive than cutaneous melanoma and carries a worse prognosis. As you can see, it comes down to personal choice.
With just a biopsy (as opposed to removal of all or most lymph nodes in a particular lymph bed location, which is called lymphadenectomy) your risk of lymphedema is decreased. But as I said, I have still developed a minor case of it. I hope this all helps you to determine where you fall in terms of trying to make this decision. I have been following melanoma forums for a few years now and I have seen people, even at stage 1, who swear by their SLNBs as the best thing they ever did, and others who say they are nontherapeutic and useless. I just tend to want to know as much as it is possible to know and do as much as it is possible to do. Even so, the lymphedema is no fun. It is manageable, however. There may be people with worse cases than me with a similar procedure, and people who had no problems at all.
I am sorry not to be of more help in a decisive way, but I hope this at least gives you a little overview of the situation, from one person's perspective anyway.
Good luck to you!
Cheri
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- September 11, 2015 at 2:23 am
phr, you really are on the margin with your deepest level 1 mm with no ulceration and no mitosis. This is a tough call. There are some of us who would say do the SLNB: It will not only ease your mind if negative, but if positive, will stage you at higher risk (stage 3) so you can be followed more closely. I am on the fence with this. I tend to err on the side of conservative, but that doesn't mean it's the right way to do things!
On the down side, there are risks with any surgery and with SLNB in particular, there is always a risk of lymphedema. My own surgeon told me my risk of developing lymphedema with my lymph node biopsy was minimal because I was thin and fairly young (45) and in good health, but still I have developed a mild case of lymphedema in my right leg that comes and goes. It is painful when I have it. It is very hard to predict who will develop this. I had bilateral groin SLNB and it was negative, but I'm still glad I did the procedure. But I do have mucosal melanoma, which is more aggressive than cutaneous melanoma and carries a worse prognosis. As you can see, it comes down to personal choice.
With just a biopsy (as opposed to removal of all or most lymph nodes in a particular lymph bed location, which is called lymphadenectomy) your risk of lymphedema is decreased. But as I said, I have still developed a minor case of it. I hope this all helps you to determine where you fall in terms of trying to make this decision. I have been following melanoma forums for a few years now and I have seen people, even at stage 1, who swear by their SLNBs as the best thing they ever did, and others who say they are nontherapeutic and useless. I just tend to want to know as much as it is possible to know and do as much as it is possible to do. Even so, the lymphedema is no fun. It is manageable, however. There may be people with worse cases than me with a similar procedure, and people who had no problems at all.
I am sorry not to be of more help in a decisive way, but I hope this at least gives you a little overview of the situation, from one person's perspective anyway.
Good luck to you!
Cheri
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Tagged: cutaneous melanoma
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