Melanoma Follow Up

I am an oncology nurse, but I still feel I am not getting straight answers about my cancer. Recently diagnosed with superficial spreading melanoma. Depth 0.74; stage Ia. Wide local excision complete; SNB negative; 5 nodes removed; 2 sentinel; 3 palpable. 7 additional moles removed; 5 negative; 2 results pending. My problem is every MD I see has a different idea of which of my dysplastic nevi should still be removed???? Would I benefit from either a PET scan or TA-90 testing?

Wouldn't byopsies show which moles to remove? I am trying to figure out the best way to check lymph nodes and elsewhere for invasive melanoma. The original spot was on my left neck.Looking for experienced help or guidance.

Actually, after a diagnosis of melanoma, I don't think there is complete agreement in the medical community about what to do about dysplastic (abnormal) nevi (moles). If you only have a few moles, they can biopsy them and decide what to do. However I have probably about 300 moles, some normal some dysplastic. I've been to 4 different specialists and all disagree about which ones looks suspicious; that makes me nervous because I don't know myself which ones have changed over the years. So far 7 biopies done, but a PET scan will show subcutaneous activity (activity under the skin) because melanoma is a very active metabolic process. I've talked to my oncologist and he agrees I should have a PET scan to be sure I'm clear of disease. I'm still not sure myself the best way to go??? But I think we have the right to ask for the lasted technology available to us.

It depends on the depth and stage of the original cancer > 0.75 a sentinal node biopsy is recommended some say >1.0. If it hasn't gone very deep the chance of spread is very minimal. What stage and depth is your cancer?

Gen. question. What is a sentinel node biopsy? Is that the first or can or should it be done during my wide excision?
thanks.
MN wondering

A sentinal node biopsy is a test to check for lymph node spread of disease. It is used in melanoma and i think it was originally developed for staging breast cancer. It is done at the same time as the wide excision or at least mine was done then. Basically, they take you to nuclear medicine, inject a radioisotope around the mole and then they put you under a scanning device to see where the uptake of the isotope goes. If it goes to an area where they can take lymph nodes out (such as under the arm) they inject another dye during surgery (which is very blue... like smurf blue) and the nodes that the melanoma would drain to first turn blue. They remove that node or nodes and check them for cancer. If those nodes are negative then the chance of spread is minimal like less then 5%. If wide excision is already done, then I don't think you can do it cause they need to inject around the original mole. It is indicated for depth of 0.75 or greater. How deep is your melanoma?

The invasive cells were removed. The measurement was .18. 3mm of clean tissue was taken. Now since I asked the derm. if I should have a sentinel node biopsy - he and the path. feel I don't need a wide excision. What do you think?

I think it sounds like you were lucky and your melanoma was caught very early. Superficial spreading melanoma has 2 growth phases. First the radial growth phase where it spreads on the skin and then the invasive or vertical growth phase where it starts to invade surrounding tissue. In the second phase, the deeper it is at presentation, the greater chance of spread to other parts of the body. Melanoma less then 0.75 or less then 1.00 (depending on who you talk too) do not need a SNB. 3 mm sounds like a safe margin. Continue to watch that area for any signs of regrowh. Appropriate follow up would be see derm every 4 to 6 mo at least for the next couple of years especially if you still have other moles. Also it is a good idea to get your eyes checked by an opthamologist not an optomistrist. Keep your follow up apppointments it is very important.

Thank you for your information. I had an opthamologist appt. in the back of my mind. You reminded me again. Thanks. I do appreciate your advice and experience. Take care.
Keep in touch.
Kathy S.
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