SHOULD I GET A SENTINEL LYMPH BIOPSY

Hi there are a few on this board who will give you some very good advice about this, especially someone like Janner. I too think personally that I would have the SLB for piece of mind.

Hoping all goes well.

Nahmi from Melbourne

Hi there are a few on this board who will give you some very good advice about this, especially someone like Janner. I too think personally that I would have the SLB for piece of mind.

Hoping all goes well.

Nahmi from Melbourne

Hi there are a few on this board who will give you some very good advice about this, especially someone like Janner. I too think personally that I would have the SLB for piece of mind.

Hoping all goes well.

Nahmi from Melbourne

Dear Janner !

      I know what SNB and Wider Excision should be done at the same day at one go. But I really do not undersatnd why so ,and Why Wider exsicion results will not be valuable if done later???

I understand if it is some melanoma cells in Lymth nodes already , it can be diagnosed and found any time even after tumor removel or wide cut out.

 Please ,could you explain us this .

 Thank you very much ,Janner , for all you help and support.

Natasha

It's the SNB that is compromised if the WLE is done first. 

Think about what a SNB does.  You inject dye/tracer into the center of the biopsy.  The tracer goes through the lymph vessels to the sentinel node — the first lymph node in the drainage basin.  If you do the SNB after just a biopsy, minimal skin was removed and most likely, the lymph vessels were not disturbed at all.  So basically the SNB is saying that if any melanoma cells escaped, they would be seen here first. 

When you do the WLE, you cut out a big chunk of skin down to the muscle fascia.  This severs both blood and lymph vessels.  The blood vessels may be cauterized (sealed) and everything is just sewn back together as best as the surgeon can.   Now, if you inject some type of tracer into the center of the WLE scar, it might go to lymph vessels that weren't that close to the center before — basically, the lymph vessels are different ones that they were previous to the WLE.  So now your sentinel node (first in the drainage path) is JUST A sentinel node.  It's the first node in the NEW pathway, but it may not have been parth of original pathway prior to the WLE.  You'd still get results, but you can never know if they are the correct results.

Hope this helps a little.

Janner

Thanks , Janner! I got it !! Yes , you are right .

Natasha

Thanks , Janner! I got it !! Yes , you are right .

Natasha

Thanks , Janner! I got it !! Yes , you are right .

Natasha

It's the SNB that is compromised if the WLE is done first. 

Think about what a SNB does.  You inject dye/tracer into the center of the biopsy.  The tracer goes through the lymph vessels to the sentinel node — the first lymph node in the drainage basin.  If you do the SNB after just a biopsy, minimal skin was removed and most likely, the lymph vessels were not disturbed at all.  So basically the SNB is saying that if any melanoma cells escaped, they would be seen here first. 

When you do the WLE, you cut out a big chunk of skin down to the muscle fascia.  This severs both blood and lymph vessels.  The blood vessels may be cauterized (sealed) and everything is just sewn back together as best as the surgeon can.   Now, if you inject some type of tracer into the center of the WLE scar, it might go to lymph vessels that weren't that close to the center before — basically, the lymph vessels are different ones that they were previous to the WLE.  So now your sentinel node (first in the drainage path) is JUST A sentinel node.  It's the first node in the NEW pathway, but it may not have been parth of original pathway prior to the WLE.  You'd still get results, but you can never know if they are the correct results.

Hope this helps a little.

Janner

It's the SNB that is compromised if the WLE is done first. 

Think about what a SNB does.  You inject dye/tracer into the center of the biopsy.  The tracer goes through the lymph vessels to the sentinel node — the first lymph node in the drainage basin.  If you do the SNB after just a biopsy, minimal skin was removed and most likely, the lymph vessels were not disturbed at all.  So basically the SNB is saying that if any melanoma cells escaped, they would be seen here first. 

When you do the WLE, you cut out a big chunk of skin down to the muscle fascia.  This severs both blood and lymph vessels.  The blood vessels may be cauterized (sealed) and everything is just sewn back together as best as the surgeon can.   Now, if you inject some type of tracer into the center of the WLE scar, it might go to lymph vessels that weren't that close to the center before — basically, the lymph vessels are different ones that they were previous to the WLE.  So now your sentinel node (first in the drainage path) is JUST A sentinel node.  It's the first node in the NEW pathway, but it may not have been parth of original pathway prior to the WLE.  You'd still get results, but you can never know if they are the correct results.

Hope this helps a little.

Janner

Dear Janner !

      I know what SNB and Wider Excision should be done at the same day at one go. But I really do not undersatnd why so ,and Why Wider exsicion results will not be valuable if done later???

I understand if it is some melanoma cells in Lymth nodes already , it can be diagnosed and found any time even after tumor removel or wide cut out.

 Please ,could you explain us this .

 Thank you very much ,Janner , for all you help and support.

Natasha

Dear Janner !

      I know what SNB and Wider Excision should be done at the same day at one go. But I really do not undersatnd why so ,and Why Wider exsicion results will not be valuable if done later???

I understand if it is some melanoma cells in Lymth nodes already , it can be diagnosed and found any time even after tumor removel or wide cut out.

 Please ,could you explain us this .

 Thank you very much ,Janner , for all you help and support.

Natasha

A mitotic rate of 1 makes it stage IB – just like I am.  However, the margins are correct.  You only get 2cm margins when the lesion is deeper than 2cm.  Your margins are fine.  Almost every institution would NOT do a SNB on you given the depth of .65mm.  It's not considered a high risk lesion.   So you didn't get the incorrect treatment despite you thinking you could have the SNB later.  You're in the same boat I am in – except I've been there for 20 years.  There wasn't even a SNB back then – it didn't exist.  So even though things might not have worked out exactly like you wanted, they worked out to exactly the standard of care for your lesion.  You might not like it, but had it been me (and most people in the same boat), we would have just had the WLE without the SNB and that's it.   The SNB is surgery and can have its own complications – and it is NOT a guarantee against future spread.  It's diagnostic only.

Best wishes,

Janner

Correction.  2cm margins are done when a lesion is deeper than 2mm (not 2cm).  I'm not sure what articles you are reading with regards to margins, but the margin size has been static for some time (used to be larger) and I haven't seen or read anything that says doctors are adopting new larger margins.

Correction.  2cm margins are done when a lesion is deeper than 2mm (not 2cm).  I'm not sure what articles you are reading with regards to margins, but the margin size has been static for some time (used to be larger) and I haven't seen or read anything that says doctors are adopting new larger margins.

Correction.  2cm margins are done when a lesion is deeper than 2mm (not 2cm).  I'm not sure what articles you are reading with regards to margins, but the margin size has been static for some time (used to be larger) and I haven't seen or read anything that says doctors are adopting new larger margins.

First off, I don't think your doctor is reckless and negligent.  You had what the standard of care suggests.  What most people in your same position would have had done.  How is that reckless or negligent?  It would be hard to prove any type of negligence when you have had nothing done wrong.  Certainly, if the doctor said you could do the SNB later, she may not understand the full ramifications.  Some docs will do the SNB even after the WLE then and claim it will be fine – but it seems misleading to me.  The odds of you having a positive SNB are very small – certainly not the 10-15% claimed by the doctor who would still do the SNB.  To me, THAT doctor is more misleading than your derm.

If you would have been diagnosed before 2011, you would have been stage IA.  New staging guidelines came out then, and I went from 1a to 1b.  Tell me this:  if you would have had a SNB with negative results, would you really have been more relieved?  Somehow, I think you'd still be dealing with the anxiety of the newly diagnosed.  The hardest thing to learn after having a cancer diagnosis is that there is little you can do to influence whether or not melanoma returns.  You have no control.  The loss of that sense of control is what most people struggle with.  The only things I did is become more sun aware and learn to watch my moles.  I've not seen anything that shows diet influences anything – and I'd probably be an example of the opposite.  My diet leaves something to be desired if you were touting it for its health benefits.  However, some people change their diet because it gives them a sense of control – something they can do.  I, personally, think that if that helps your anxiety, go for it.  But I don't believe it is going to make an ultimate difference in the outcome of melanoma – just general health.  My mantra would be more along the lines of "moderation in all things".

It's time to move on and not research or agonize over what is done and what can't be changed.  If you feel you can no longer trust your derm, maybe it is time to look elsewhere.    But my take is the SNB was not necessary in your case (in other words, it would have been negative) and it's time to move forward.

Best wishes,

Janner

First off, I don't think your doctor is reckless and negligent.  You had what the standard of care suggests.  What most people in your same position would have had done.  How is that reckless or negligent?  It would be hard to prove any type of negligence when you have had nothing done wrong.  Certainly, if the doctor said you could do the SNB later, she may not understand the full ramifications.  Some docs will do the SNB even after the WLE then and claim it will be fine – but it seems misleading to me.  The odds of you having a positive SNB are very small – certainly not the 10-15% claimed by the doctor who would still do the SNB.  To me, THAT doctor is more misleading than your derm.

If you would have been diagnosed before 2011, you would have been stage IA.  New staging guidelines came out then, and I went from 1a to 1b.  Tell me this:  if you would have had a SNB with negative results, would you really have been more relieved?  Somehow, I think you'd still be dealing with the anxiety of the newly diagnosed.  The hardest thing to learn after having a cancer diagnosis is that there is little you can do to influence whether or not melanoma returns.  You have no control.  The loss of that sense of control is what most people struggle with.  The only things I did is become more sun aware and learn to watch my moles.  I've not seen anything that shows diet influences anything – and I'd probably be an example of the opposite.  My diet leaves something to be desired if you were touting it for its health benefits.  However, some people change their diet because it gives them a sense of control – something they can do.  I, personally, think that if that helps your anxiety, go for it.  But I don't believe it is going to make an ultimate difference in the outcome of melanoma – just general health.  My mantra would be more along the lines of "moderation in all things".

It's time to move on and not research or agonize over what is done and what can't be changed.  If you feel you can no longer trust your derm, maybe it is time to look elsewhere.    But my take is the SNB was not necessary in your case (in other words, it would have been negative) and it's time to move forward.

Best wishes,

Janner

Have a doctor show you how to palpate your nearest lymph node basin.  In the very unlikely scenario that you have spread, the lymph nodes are typically the first area they go to.  So if your melanoma was on your arm, you'd learn to check under your armpit.  Compare against the other side.  If your lesion was on your trunk somewhere, the closest lymph basin becomes a bit more difficult to know.  Talk to your doctor about this.  The key is learning what "normal" is for you so you can recognize something "not normal".  Lymph nodes swell for many reasons (illness/trauma/bug bites) so swollen nodes most often don't mean cancer, they just rate closer evaluation.

Have a doctor show you how to palpate your nearest lymph node basin.  In the very unlikely scenario that you have spread, the lymph nodes are typically the first area they go to.  So if your melanoma was on your arm, you'd learn to check under your armpit.  Compare against the other side.  If your lesion was on your trunk somewhere, the closest lymph basin becomes a bit more difficult to know.  Talk to your doctor about this.  The key is learning what "normal" is for you so you can recognize something "not normal".  Lymph nodes swell for many reasons (illness/trauma/bug bites) so swollen nodes most often don't mean cancer, they just rate closer evaluation.

Have a doctor show you how to palpate your nearest lymph node basin.  In the very unlikely scenario that you have spread, the lymph nodes are typically the first area they go to.  So if your melanoma was on your arm, you'd learn to check under your armpit.  Compare against the other side.  If your lesion was on your trunk somewhere, the closest lymph basin becomes a bit more difficult to know.  Talk to your doctor about this.  The key is learning what "normal" is for you so you can recognize something "not normal".  Lymph nodes swell for many reasons (illness/trauma/bug bites) so swollen nodes most often don't mean cancer, they just rate closer evaluation.

First off, I don't think your doctor is reckless and negligent.  You had what the standard of care suggests.  What most people in your same position would have had done.  How is that reckless or negligent?  It would be hard to prove any type of negligence when you have had nothing done wrong.  Certainly, if the doctor said you could do the SNB later, she may not understand the full ramifications.  Some docs will do the SNB even after the WLE then and claim it will be fine – but it seems misleading to me.  The odds of you having a positive SNB are very small – certainly not the 10-15% claimed by the doctor who would still do the SNB.  To me, THAT doctor is more misleading than your derm.

If you would have been diagnosed before 2011, you would have been stage IA.  New staging guidelines came out then, and I went from 1a to 1b.  Tell me this:  if you would have had a SNB with negative results, would you really have been more relieved?  Somehow, I think you'd still be dealing with the anxiety of the newly diagnosed.  The hardest thing to learn after having a cancer diagnosis is that there is little you can do to influence whether or not melanoma returns.  You have no control.  The loss of that sense of control is what most people struggle with.  The only things I did is become more sun aware and learn to watch my moles.  I've not seen anything that shows diet influences anything – and I'd probably be an example of the opposite.  My diet leaves something to be desired if you were touting it for its health benefits.  However, some people change their diet because it gives them a sense of control – something they can do.  I, personally, think that if that helps your anxiety, go for it.  But I don't believe it is going to make an ultimate difference in the outcome of melanoma – just general health.  My mantra would be more along the lines of "moderation in all things".

It's time to move on and not research or agonize over what is done and what can't be changed.  If you feel you can no longer trust your derm, maybe it is time to look elsewhere.    But my take is the SNB was not necessary in your case (in other words, it would have been negative) and it's time to move forward.

Best wishes,

Janner

A mitotic rate of 1 makes it stage IB – just like I am.  However, the margins are correct.  You only get 2cm margins when the lesion is deeper than 2cm.  Your margins are fine.  Almost every institution would NOT do a SNB on you given the depth of .65mm.  It's not considered a high risk lesion.   So you didn't get the incorrect treatment despite you thinking you could have the SNB later.  You're in the same boat I am in – except I've been there for 20 years.  There wasn't even a SNB back then – it didn't exist.  So even though things might not have worked out exactly like you wanted, they worked out to exactly the standard of care for your lesion.  You might not like it, but had it been me (and most people in the same boat), we would have just had the WLE without the SNB and that's it.   The SNB is surgery and can have its own complications – and it is NOT a guarantee against future spread.  It's diagnostic only.

Best wishes,

Janner

A mitotic rate of 1 makes it stage IB – just like I am.  However, the margins are correct.  You only get 2cm margins when the lesion is deeper than 2cm.  Your margins are fine.  Almost every institution would NOT do a SNB on you given the depth of .65mm.  It's not considered a high risk lesion.   So you didn't get the incorrect treatment despite you thinking you could have the SNB later.  You're in the same boat I am in – except I've been there for 20 years.  There wasn't even a SNB back then – it didn't exist.  So even though things might not have worked out exactly like you wanted, they worked out to exactly the standard of care for your lesion.  You might not like it, but had it been me (and most people in the same boat), we would have just had the WLE without the SNB and that's it.   The SNB is surgery and can have its own complications – and it is NOT a guarantee against future spread.  It's diagnostic only.

Best wishes,

Janner

"residual intraepidermal melanoma" means melanoma was found in the WLE tissue in the epidermis only – the top most layer of skin.  "incidental excised intradermal melanocytic nevus" means there was another mole in the WLE with no relationship to the melanoma lesion.  Subcutaneous tissue refers to the fat layer removed in every WLE.  WLE's take the skin and subcutaneous tissue down to the muscle fascia. 

"residual intraepidermal melanoma" means melanoma was found in the WLE tissue in the epidermis only – the top most layer of skin.  "incidental excised intradermal melanocytic nevus" means there was another mole in the WLE with no relationship to the melanoma lesion.  Subcutaneous tissue refers to the fat layer removed in every WLE.  WLE's take the skin and subcutaneous tissue down to the muscle fascia. 

There is a reason they don't recommend doing a SNB for lesions under 1mm – the odds of having a positive node are very small.  If the odds were higher, they'd change the recommended criteria.  The SNB is surgery and can have its own complications.  Even if you have a negative SNB, that doesn't guarantee there won't be future spread.  The SNB shows the "current state of events" and is a diagnostic tool only.   Life goes on, and there is not a great way to check for spread.  Just pay attention to your body and for things that don't seem quite right.

As for additional biopsies, the odds aren't that high (about 8%) for having another melanoma.  I remove moles that CHANGE.  If they look the same as they always did, chances are they are fine.  I still do the activities I did prior to melanoma including playing tennis outside and gardening.  I just try to do them smarter.  That may include more clothes, more sunblock, choosing times outside that are not high UV times.  But I try not to let melanoma run my life.  Maybe something like a rash shirt would cover you up, but let you enjoy surfing.  It's just about rethinking things – not eliminating things.

I really got into researching melanoma after my third primary (obsessed might be a better description).  There were limited resources when I was original diagnosed and no internet.  I learned a little too much for my own good.  But then I figured out I had a knack for helping others – mainly the newly diagnosed – figure out what was going on.  So I decided to put my researching to good use.  I'm not a medical professional at all, just an interested party.

Best wishes,
Janner

Please let us know the results of pathology of the nodes removed. i would expect them to be clear. As Janner has said LIVE LIFE. As far as the possibility of changing your diet there are a couple of things that I would suggest. MDA has made a study that supports the likelihood that Curcumin (Tumeric Extract) reduces the growth of some cancers. For people not in treatment otherwise increased antioxidants may be beneficial. Ingredients in asparagus and broccoli have also been found to have a likely benefit against cancer. These changes in diet don’t have to be huge. I also urge moderation in all things (well, at least related to health). My well known Surgical Oncologist referred me to look at Dr Andrew Weils work which is in the field of integrative medicine. No one know just what with melanoma but I’ve been satisfied with my decisions at Stage IV and still (usually) enjoy life. As Janner said Vigilance, not paranoid, keeps one going and living. (P.S. it takes the clear report at the end of the first year to really start making one feel better!)

Please let us know the results of pathology of the nodes removed. i would expect them to be clear. As Janner has said LIVE LIFE. As far as the possibility of changing your diet there are a couple of things that I would suggest. MDA has made a study that supports the likelihood that Curcumin (Tumeric Extract) reduces the growth of some cancers. For people not in treatment otherwise increased antioxidants may be beneficial. Ingredients in asparagus and broccoli have also been found to have a likely benefit against cancer. These changes in diet don’t have to be huge. I also urge moderation in all things (well, at least related to health). My well known Surgical Oncologist referred me to look at Dr Andrew Weils work which is in the field of integrative medicine. No one know just what with melanoma but I’ve been satisfied with my decisions at Stage IV and still (usually) enjoy life. As Janner said Vigilance, not paranoid, keeps one going and living. (P.S. it takes the clear report at the end of the first year to really start making one feel better!)

Please let us know the results of pathology of the nodes removed. i would expect them to be clear. As Janner has said LIVE LIFE. As far as the possibility of changing your diet there are a couple of things that I would suggest. MDA has made a study that supports the likelihood that Curcumin (Tumeric Extract) reduces the growth of some cancers. For people not in treatment otherwise increased antioxidants may be beneficial. Ingredients in asparagus and broccoli have also been found to have a likely benefit against cancer. These changes in diet don’t have to be huge. I also urge moderation in all things (well, at least related to health). My well known Surgical Oncologist referred me to look at Dr Andrew Weils work which is in the field of integrative medicine. No one know just what with melanoma but I’ve been satisfied with my decisions at Stage IV and still (usually) enjoy life. As Janner said Vigilance, not paranoid, keeps one going and living. (P.S. it takes the clear report at the end of the first year to really start making one feel better!)

Green — Post when you get your results. I'm sure the nodes will be negative.

I hope others have been following this thread. The lesson here, which I have unfortunately seen many times in the almost 20 years I've been visiting this bulletin board, is this. When you are diganosed with melanoma, you need a melanoma specialist. Lose the derm immediately. Go to a melanoma clinic at a major medical center. This can save your life.

You will NEVER get two pathology reports that say the same thing.  Reading pathology is as much an art as a science.  Being off a few hundredths of a millimeter is not uncommon for two reads of pathology.  Breslow depth is the best predictor because it is also the most consistent thing read on a path report.  .65 and .73mm are very close.  Really.  .08mm difference makes no difference in your outcome.  It is always best to have your slides read by a dermatopathologist.  These are people who specialize in skin pathology.  But even with two dermatopathologists, reports will seldom be the same. 

You will NEVER get two pathology reports that say the same thing.  Reading pathology is as much an art as a science.  Being off a few hundredths of a millimeter is not uncommon for two reads of pathology.  Breslow depth is the best predictor because it is also the most consistent thing read on a path report.  .65 and .73mm are very close.  Really.  .08mm difference makes no difference in your outcome.  It is always best to have your slides read by a dermatopathologist.  These are people who specialize in skin pathology.  But even with two dermatopathologists, reports will seldom be the same. 

No, I really don't "think these people would be a bit more consistent".  It's the nature of the beast.  It all depends on a person's experience.  What looks like melanoma in situ to one pathologist is "severely atypical" to another.  Same with every other factor that goes into a diagnosis.  None of this has hard and fast rules – it is just a judgement call based on a bunch of different factors.  As I said before, you will rarely find two reports that are the same.  It just doesn't work that way.  Just so you know, the first report isn't necessarily wrong, it is just different. Does the first pathologist have more experience than the second?  Take them for what they're worth – 2 different opinions.  As for the SNB results, you know that is of limited value after the WLE and most likely negative anyway.

Regarding 1 mitosis vs. 2, they lump everyone above 0 in the same category.  2 isn't "high" but I've never seen any definition for a mitosis breakdown.  It is a newer prognostic factor and I just don't think there are a lot of studies other than showing 0 is best.  I've not seen any study that breaks out mitosis and shows survival statistics based on that factor alone when it is other than 0.  

No, I really don't "think these people would be a bit more consistent".  It's the nature of the beast.  It all depends on a person's experience.  What looks like melanoma in situ to one pathologist is "severely atypical" to another.  Same with every other factor that goes into a diagnosis.  None of this has hard and fast rules – it is just a judgement call based on a bunch of different factors.  As I said before, you will rarely find two reports that are the same.  It just doesn't work that way.  Just so you know, the first report isn't necessarily wrong, it is just different. Does the first pathologist have more experience than the second?  Take them for what they're worth – 2 different opinions.  As for the SNB results, you know that is of limited value after the WLE and most likely negative anyway.

Regarding 1 mitosis vs. 2, they lump everyone above 0 in the same category.  2 isn't "high" but I've never seen any definition for a mitosis breakdown.  It is a newer prognostic factor and I just don't think there are a lot of studies other than showing 0 is best.  I've not seen any study that breaks out mitosis and shows survival statistics based on that factor alone when it is other than 0.  

No, I really don't "think these people would be a bit more consistent".  It's the nature of the beast.  It all depends on a person's experience.  What looks like melanoma in situ to one pathologist is "severely atypical" to another.  Same with every other factor that goes into a diagnosis.  None of this has hard and fast rules – it is just a judgement call based on a bunch of different factors.  As I said before, you will rarely find two reports that are the same.  It just doesn't work that way.  Just so you know, the first report isn't necessarily wrong, it is just different. Does the first pathologist have more experience than the second?  Take them for what they're worth – 2 different opinions.  As for the SNB results, you know that is of limited value after the WLE and most likely negative anyway.

Regarding 1 mitosis vs. 2, they lump everyone above 0 in the same category.  2 isn't "high" but I've never seen any definition for a mitosis breakdown.  It is a newer prognostic factor and I just don't think there are a lot of studies other than showing 0 is best.  I've not seen any study that breaks out mitosis and shows survival statistics based on that factor alone when it is other than 0.  

You will NEVER get two pathology reports that say the same thing.  Reading pathology is as much an art as a science.  Being off a few hundredths of a millimeter is not uncommon for two reads of pathology.  Breslow depth is the best predictor because it is also the most consistent thing read on a path report.  .65 and .73mm are very close.  Really.  .08mm difference makes no difference in your outcome.  It is always best to have your slides read by a dermatopathologist.  These are people who specialize in skin pathology.  But even with two dermatopathologists, reports will seldom be the same. 

Green — Post when you get your results. I'm sure the nodes will be negative.

I hope others have been following this thread. The lesson here, which I have unfortunately seen many times in the almost 20 years I've been visiting this bulletin board, is this. When you are diganosed with melanoma, you need a melanoma specialist. Lose the derm immediately. Go to a melanoma clinic at a major medical center. This can save your life.

Green — Post when you get your results. I'm sure the nodes will be negative.

I hope others have been following this thread. The lesson here, which I have unfortunately seen many times in the almost 20 years I've been visiting this bulletin board, is this. When you are diganosed with melanoma, you need a melanoma specialist. Lose the derm immediately. Go to a melanoma clinic at a major medical center. This can save your life.

There is a reason they don't recommend doing a SNB for lesions under 1mm – the odds of having a positive node are very small.  If the odds were higher, they'd change the recommended criteria.  The SNB is surgery and can have its own complications.  Even if you have a negative SNB, that doesn't guarantee there won't be future spread.  The SNB shows the "current state of events" and is a diagnostic tool only.   Life goes on, and there is not a great way to check for spread.  Just pay attention to your body and for things that don't seem quite right.

As for additional biopsies, the odds aren't that high (about 8%) for having another melanoma.  I remove moles that CHANGE.  If they look the same as they always did, chances are they are fine.  I still do the activities I did prior to melanoma including playing tennis outside and gardening.  I just try to do them smarter.  That may include more clothes, more sunblock, choosing times outside that are not high UV times.  But I try not to let melanoma run my life.  Maybe something like a rash shirt would cover you up, but let you enjoy surfing.  It's just about rethinking things – not eliminating things.

I really got into researching melanoma after my third primary (obsessed might be a better description).  There were limited resources when I was original diagnosed and no internet.  I learned a little too much for my own good.  But then I figured out I had a knack for helping others – mainly the newly diagnosed – figure out what was going on.  So I decided to put my researching to good use.  I'm not a medical professional at all, just an interested party.

Best wishes,
Janner

There is a reason they don't recommend doing a SNB for lesions under 1mm – the odds of having a positive node are very small.  If the odds were higher, they'd change the recommended criteria.  The SNB is surgery and can have its own complications.  Even if you have a negative SNB, that doesn't guarantee there won't be future spread.  The SNB shows the "current state of events" and is a diagnostic tool only.   Life goes on, and there is not a great way to check for spread.  Just pay attention to your body and for things that don't seem quite right.

As for additional biopsies, the odds aren't that high (about 8%) for having another melanoma.  I remove moles that CHANGE.  If they look the same as they always did, chances are they are fine.  I still do the activities I did prior to melanoma including playing tennis outside and gardening.  I just try to do them smarter.  That may include more clothes, more sunblock, choosing times outside that are not high UV times.  But I try not to let melanoma run my life.  Maybe something like a rash shirt would cover you up, but let you enjoy surfing.  It's just about rethinking things – not eliminating things.

I really got into researching melanoma after my third primary (obsessed might be a better description).  There were limited resources when I was original diagnosed and no internet.  I learned a little too much for my own good.  But then I figured out I had a knack for helping others – mainly the newly diagnosed – figure out what was going on.  So I decided to put my researching to good use.  I'm not a medical professional at all, just an interested party.

Best wishes,
Janner

"residual intraepidermal melanoma" means melanoma was found in the WLE tissue in the epidermis only – the top most layer of skin.  "incidental excised intradermal melanocytic nevus" means there was another mole in the WLE with no relationship to the melanoma lesion.  Subcutaneous tissue refers to the fat layer removed in every WLE.  WLE's take the skin and subcutaneous tissue down to the muscle fascia.