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Paediatric melanoma - awaiting WLE

Posted by

Hi Ellen,

We're waiting for my almost 4 yo to get a date for her WLE. Consultant derm today said she wants it done asap - within 4 weeks ideally. We are meeting her again along with plastic surgeon in two weeks.

She examined the mole in question today, took some photos, family history and an inventory of other moles and freckles. Happily I found two photos from 6months ago where you could see the mole was quite different to how it presented today in size, texture and colour.

I'm really concerned about the general anesthetic - not because i don't think it's safe just because she's my baby. I've no idea if skipping biopsy in favour of WLE is a good thing or a bad thing or just common with children. Do you have any info? I wish I hadn't been so shocked at the appointment as I would have asked that.

My other query is regarding a sentinel node biopsy. Dr hasn't actually said it's a melanoma - only that she can't tell how deep it is or what we're dealing with until surgery but alarm bells are ringing for me. I wonder is it wise to ask for the biopsy to be done now - when she's on the table anyway, as opposed to 4/6 weeks down the line if we do get bad news following WLE.

Thanks for your time.

Ellen M-Macmillan
Posted by

Hi scaredmum90,

Thanks for getting in touch with us.

It’s natural to feel lots of different emotions when you’re waiting for your daughter to have tests. And to feel concerned about a general anaesthetic is understandable, as you rightly say she is your baby. You wouldn’t be human if you didn’t worry and have lots of questions.

It’s important to remember that the doctors will not put your daughter under any unnecessary risk. A group of doctors called a MDT will have decided what the best operation would be in your daughter’s situation.

Melanoma’s in children are unusual and rarely diagnosed before puberty. I can’t be sure why they have decided to do a WLE in the first instance rather than an excision biopsy. Only the team looking after her will know the reason for this.

It could be to do with the size, position and the appearance of the mole. But if this is not melanoma (which we hope is the case) the doctors may have recommended this as they want to remove it no matter what it is. So rather than put your daughter through a biopsy for a diagnosis, they may have decided that it’s better that she has one operation, which means one anaesthetic.

The doctors will want to make sure they remove all the mole as well as a healthy piece of tissue around the area. This decreases the chance of it returning in the future.

It’s not uncommon to involve a plastic surgeon as they will want to make sure that the wound can be closed. At the same time, they will want your daughter to have a good cosmetic outcome.

Doctors wouldn’t do a sentinel node biopsy at this point. This would not be recommended without a diagnosis of melanoma. If this is not a melanoma they would be performing an unnecessary operation with potential side effects.

We would suggest that you go back and speak to the dermatologist again about their decision not to do an excision biopsy first. This will help you to fully understand why this has been recommended, and it can also help to reassure you.

Waiting for tests and investigations can be an anxious time for any parent to go through. If you feel that this is getting on top of you and that you are struggling to cope we would suggest that you talk to your GP in the first instance. They should be able to offer you support during this difficult time.

However, in reality, the one thing that will help is for your daughter to have her surgery and for you to get the results. Callers to our Support Line often tell us no matter what the results are “good or bad” it’s easier once they know what they are dealing with. It’s the uncertainty that makes the anxiety more difficult to deal with.

You can also look at this self help guide about things that you can do to help you to manage your anxiety.

Best wishes and take care.

I hope all goes well with your daughter’s surgery and that you don’t have to wait too long for the results.

Ellen-Macmillan Online Digital Nurse Specialist.


Posted by

Would be interested in your outcome as my 9 yr old is going through the same thing.x