› Forums › General Melanoma Community › On stage I/II prognoses
- This topic has 9 replies, 3 voices, and was last updated 9 years, 4 months ago by
Kim K.
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- October 31, 2016 at 7:29 pm
Wondering if anyone else has felt somewhat confused about the prognosis of the node-negative disease, i.e. stage I/II. It seems that many sources and practicioners nowadays give a highly optimistic outlook following a negative sentinel lymph node biopsy (SLNB), speaking of a cured disease or in similar terms. On the other hand, research papers available online indicate rather notable recurrence rates for node-negative patients–in the ballpark of, say, 15%.
Of course, patient databases used to estimate 10-15 year recurrence/survival rates automatically span a few decades back. The SLNB method has been routinely adopted starting mid-90s to my understanding. Since then, SLNB has been carried out apparently with varying protocols regarding the use of radioactive tracing, no. of sections taken from biopsied nodes, and the use of immunohistochemical staining to detect melanoma cells.
I would assume that a state-of-the-art SLNB today would encompass all of the above mentioned steps, where the entire biopsied nodes would be sectioned for immunohistochemical staining. Thus, I would further speculate that the procedures are on average more accurate today than over the course of the past few decades, leading to a lesser amount of false-negative findings.
Has anyone come across any educated guesses as to what the impact of this should be on the historical-based recurrence/survival rates? Or has anyone had their excellent prognosis explained to them, perhaps, citing these kinds of factors?
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- November 1, 2016 at 5:23 am
I can't answer your question but I do have an opinion on SLNB. My daughter was diagnosed with nodular melanoma and they did the WLE and SLNB with both lymph nodes taken and all surrounding tissue negative for melanoma. Stage II. The lymph nodes taken were below the site of the original mole. One month after surgery she detected an enlarged lymph node above the site of the original mole. Yep, melanoma present. Lymph node dissection of 26 lymph nodes with no others or any surrounding tissue showing positive for melanoma. Stage IIIb. Granted her melanoma was on her neck and lymph drainage is not one direction in that area so I don't fault the technology or the procedure but my point is that SLNB is a diagnostic tool not a definitive procedure. SLNB is not 100% accurate so that may be why node-negative patients show a recurrence rate of about 15%. By the way she is now 4 years NED.
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- November 1, 2016 at 5:23 am
I can't answer your question but I do have an opinion on SLNB. My daughter was diagnosed with nodular melanoma and they did the WLE and SLNB with both lymph nodes taken and all surrounding tissue negative for melanoma. Stage II. The lymph nodes taken were below the site of the original mole. One month after surgery she detected an enlarged lymph node above the site of the original mole. Yep, melanoma present. Lymph node dissection of 26 lymph nodes with no others or any surrounding tissue showing positive for melanoma. Stage IIIb. Granted her melanoma was on her neck and lymph drainage is not one direction in that area so I don't fault the technology or the procedure but my point is that SLNB is a diagnostic tool not a definitive procedure. SLNB is not 100% accurate so that may be why node-negative patients show a recurrence rate of about 15%. By the way she is now 4 years NED.
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- November 1, 2016 at 5:23 am
I can't answer your question but I do have an opinion on SLNB. My daughter was diagnosed with nodular melanoma and they did the WLE and SLNB with both lymph nodes taken and all surrounding tissue negative for melanoma. Stage II. The lymph nodes taken were below the site of the original mole. One month after surgery she detected an enlarged lymph node above the site of the original mole. Yep, melanoma present. Lymph node dissection of 26 lymph nodes with no others or any surrounding tissue showing positive for melanoma. Stage IIIb. Granted her melanoma was on her neck and lymph drainage is not one direction in that area so I don't fault the technology or the procedure but my point is that SLNB is a diagnostic tool not a definitive procedure. SLNB is not 100% accurate so that may be why node-negative patients show a recurrence rate of about 15%. By the way she is now 4 years NED.
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- November 2, 2016 at 1:23 am
You can have spread by the vascular system completely bypassing the lymph nodes all together, in addition, you can still miss a metastasis in a node because it just didn't show up on the section that happened to be stained.
I was stage IIA and went straight to IV several years later, my nodes were and still are clean. Now NED for 6.5 years.
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- November 2, 2016 at 1:23 am
You can have spread by the vascular system completely bypassing the lymph nodes all together, in addition, you can still miss a metastasis in a node because it just didn't show up on the section that happened to be stained.
I was stage IIA and went straight to IV several years later, my nodes were and still are clean. Now NED for 6.5 years.
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- November 2, 2016 at 1:23 am
You can have spread by the vascular system completely bypassing the lymph nodes all together, in addition, you can still miss a metastasis in a node because it just didn't show up on the section that happened to be stained.
I was stage IIA and went straight to IV several years later, my nodes were and still are clean. Now NED for 6.5 years.
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