Will I be offered the SLNB along with the WLE?

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Hi all, I recently got the results back from an excision I had done at the start of the year. It came back as stage 1B melanoma, Breslow depth of 1.0mm, no ulceration, no lymphovascular invasion, mitotic rate of 1/mm. I’ve read the NICE guidelines that say for melanomas 0.8mm - 1.0mm deep you have to have another concerning feature such as ulceration, lymphovascular invasion or a mitotic rate of 2/mm or more before the SLNB is considered. Is this correct? Has anyone else been in a similar situation where it was/wasn’t offered? I’m still waiting on my consultation so haven’t been able to ask anyone yet, so thought I would post here in the meantime. 

  • Hi Mysticdaisy, many thanks for your update and congratulations on your pregnancy. When I first met with the plastic surgeon, I was told they would do the WLE and SLNB, although they said that the decision to do the SLNB was marginal in my case. Following an MDT meeting, I was subsequently told that I didn’t need the SLNB because the 1mm maximum thickness was marginal and the mitotic index was zero. I took a cancellation slot for the WLE on 15th Feb.

    I have a follow up appointment on 26th March and following that, I may have a slight extension of the WLE because of the precancerous mole removed with the first WLE - where they would prefer a 5mm clearance rather than the current 2.5mm. The incision has healed up very nicely - it seems a shame to open it up again.

    A complicating factor in my case is that I’m also waiting for surgery to repair a leaky heart (mitral) valve. The melanoma was removed from my chest near to the bottom of where the sternotomy will be - so I was very fortunate that the melanoma was found and removed.

  • Thank you very much Tony250. I was open to having the SLNB but they can’t delay the WLE incase there’s anything at all left over from the initial excision so it’s better to have the WLE sooner rather than later. The plastic surgeon said very similar to me, if I was 0.99mm I wouldn’t be offered it at all, I’m just on the cusp and only because they have capacity to do it for people who really want it, eventually they will follow the new guidelines where I wouldn’t be offered it. They said my mitotic rate of 1 is low like 0 so that’s reassuring. Just waiting for an appointment now. My initial excision wasn’t too sore, just tight because of the location so I can imagine it’ll be like that again. Yes thankfully it was found and removed, good luck with any future heart surgeries too. Did you find the melanoma yourself or did someone else point it out? 

  • Hi Mysticdaisy, I’ve always had lots of moles, including atypical ones, and a history of outdoor activities and sun exposure - I was a keen runner and enjoy hill walking and cycling, and more so since retiring.

    I’ve had moles removed in the past but they haven’t been of concern. I went to my GP to have some moles checked and they referred me to dermatology at one of our local hospitals (RVI in Newcastle). I was given a head to toe examination and the dermatologist kept returning to the one on my chest. I had it removed on that day, plus one on my back - the one on my back was fine.

  • I don’t have a lot of moles but I do have very fair skin that burns very easily in the sun. I noticed the one I had a while ago but it originally looked very innocent, just stood out in a strange way, changed very slowly over time and I never felt comfortable with it so I opted to have it removed and thank god I did. I’ve since had another one removed, just waiting on the results, this one was much smaller, hasn’t changed since I noticed it but just looked darker so we thought it’s best for it to go. 

  • My skin is fair and I do go a bit red to start with but then I go brown. I rarely used sunscreen - only in hot climates - and never wore hats. This all changes from now on. I have short hair which is thin on the crown - so I’ll wear hats or caps from now on. I won’t sit in the sun or sunbathe in future and I’ll slap on factor 30 when I’m out and about.