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  • Sentinel Node Biopsy after Wide Excision??

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    Old 10-04-2009, 06:15 AM   #1
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    Sentinel Node Biopsy after Wide Excision??

    Hi Everyone,

    I have been posting lately under another thread regarding my husband's recent melanoma diagnosis. To make a long story short, the dermatologist did a punch biopsy on a large, suspicious lesion on my husband's left calf. The biopsy results revealed a malignant melanoma, Breslow depth .7, Clark's Level II. The surgical oncologist had her own lab look at the slides and came back with the same diagnosis. This put him at a Stage 1A.

    My husband elected not to do a sentinel node biopsy and underwent a wide excision only on September 29th. Prior to surgery the surgeon had explained that once the wide excision was done, the chance for a future SNB would be gone as the lymphatic paths would be disrupted.

    We received the path reports from the surgeon on Friday, October 2nd. The surgeon said the margins were clear, however the remainder of the lesion came back thicker at 1.4 mm and Clark's Level IV with a mitotic rate of less than 1. The surgeon called us again later the same day and said she had been in contact with some colleagues at other hospitals, and they seem to agree that an SNB can still be done after a wide excision with reliable results.

    Does anyone have any experience with SNB after a wide excision? The internet research I have done seems to be split down the middle. Any input would be greatly appreciated. Thanks so much!

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    Old 10-04-2009, 09:59 AM   #2
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    Re: Sentinel Node Biopsy after Wide Excision??

    If the cancer is in the lymphnodes it will be there no matter what or when. Have they talked about a CT scan ?

    Personally, I think it would be a good idea to have it done.

    I watched my father have 6 melonomas and my brother had one. I was taught if it is a Clark's level 1 or 2 no problem......but beyond that have more testing. That is just my experience. I think you need to be proactive.

    I am sure more people will step in here with experiences. It is alot to think about. Good luck to you.


    Old 10-05-2009, 06:53 AM   #3
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    Re: Sentinel Node Biopsy after Wide Excision??

    Hi Oleander,

    You are absolutely right, it is a lot to think about. The doctor hasn't mentioned a CT scan as of yet, just the possibility of doing an ultrasound on the lymph nodes starting with the first three month check up.

    Again you are correct when you say if the cancer is there it will be there no matter what or when. My husband is not inclined to go through another procedure at this point but said that if I could find a convincing argument for him to do so he would reconsider. So far I haven't been able to come up with anything that I think will change his mind.

    Thank you for your input and for sharing the experiences of your father and brother. Take care!

    Old 10-05-2009, 09:02 AM   #4
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    Re: Sentinel Node Biopsy after Wide Excision??

    I believe I have heard of an SNB being done after a WLE, though it isn't done very often. I really can't tell you much more than that, really.

    In the beginning, when you and your husband believed his melanoma was less than 1.0mm, I was really on your husband's side. Why undergo additional surgery when it might not be necessary? However, now that the final pathology is in, and the melanoma is far greater than 1.0mm, I'm opting for the addtional SNB.

    I can understand your husband does not want to undergo addtional surgery - who would? And 5% - 10% doesn't seem like good returns, I admit. But, what about the alternative? I know you stated in your previous thread that your husband is "treatment adverse." While I can totally respect that, I must first ask: does your husband understand, fully, the consequences of melanoma and potentially leaving it untreated?

    Now, I am NOT meaning to scare you, but let's just say that your husband falls into the 5% - 10%, and he chooses not to get an SNB. That means melanoma has already located to his lymph nodes. Even though his mitosis rate is less than 1 (that's the growth rate, btw), it will not take long before the lymph nodes will attempt to fight off this predator. Your husband will notice a large swelling in those lymph nodes, which will probably be in his groin area. You will too, most likely.

    Once he gets to the doctor, surgery may or may not be an option, after all, melanoma by now has probably spread through the lymph system. (this is an intensely aggressive cancer!) Course of treatment, if he elects this, is massive doses of Interferon. This will make him feel as though he has an intense case of the flu for several months. If his lucky, he will be one of the ones whose body responds. In addition, he will need to begin scans to assure the melanoma hasn't spread to any other organs.

    If the Interferon doesn't work, or if the melanoma spreads to another organ (normally the lungs, liver, or brain), normally doctors begin IL 2. This is taken intraveniously, with doctors attempting to get a patient to take 14 bags over several days. Most can only handle between 7 to 10. This stuff will literally kill you - it causes your blood pressure to drop, heart rate to drop, and some one HAS to be there with you in case you stop responding so hospital staff can stop treatment. Yeah, scary stuff. But, you see, chemo has no effect on melanoma. If there is no response to IL 2, a patient may be eligible for clinical trials. Other than that? Well, doctors will try to make you comfortable. How long to live? 6 - 9 months, but I've seen people last a year, or just over. Some pass sooner.

    Is this what your husband wants? That's the roulette wheel he's willing to spin at this point. This isn't "just skin cancer" he's got, where they "cut it out" and he goes on with his life. Now, once he learns the facts - all of them - about melanoma and he wants to be "treatment adverse," fine. It's his life, and it's his choice. However, he has a wife, a son, and that should give anyone reason to pause. It's easy to die, it's torture to watch it in some one you love. And for a child as young as your son? To me personally, that's worth fighting for.

    Granted, SNB surgery might be a bit uncomfortable. Who LIKES surgery? YUK! And he's going to have deal with drains and stitches and being laid up and just....everything. But he just may be in that 95% - 90% who won't have to worry. He can then look at his wife, his son and know he'll be there next year, the year after. He just may be there to see his son graduate, marry - and to sit on the porch and grow old with his wife.

    Is this surgery really all that bothersome to ask for all of this? But then, that's my opinion.

    Good luck!

    Old 10-06-2009, 06:01 AM   #5
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    Re: Sentinel Node Biopsy after Wide Excision??

    Hi Chele,

    You are preaching to the choir on this one. The points you have brought up are thoughts that have crossed my mind many times over the last few days and have also kept me awake at night.

    I, too, have to wonder if he understands the potential consequences of his decision here, but I honestly feel that in the end he will do what is best for his health as well as for our son and me.

    We have an appointment with the surgeon next week for a follow up on his wide excision, so the three of us will have a chance to talk further then. I'll let you know how it goes. Thank you for this post. I hope it will be beneficial to others as well. Take care!

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