Will I be offered the SLNB along with the WLE?

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.

Hi Tony250, how are you getting on now? Did you need to have a further WLE? I finally had my WLE done yesterday. It’s tender today and stings from time to time but it’s not terrible. They told me I should have the results within 6 weeks time. 

Hi MysticDaisy, I’m fine thanks. I will be having a slight extension to the WLE in order to get the 5mm margin for the precancerous cells in the other mole - the current margin is 2.5mm. However, I had my heart valve repair surgery on 29th April and although I’m recovering well, I would prefer to wait until I’m more fully healed as my sternotomy scar touches the end of my WLE. The plastic surgeon says there’s no rush to do the surgery. In all other respects I’m ok and hope that you are too.

Yes that’s fair enough, better to fully recover from one surgery rather than jump straight into another and have to recover from two. They’re probably very confident that nothing else will come up on your next WLE. Was you ever offered an ultrasound on your lymph nodes since you’re not having the SLNB? I’ve had an ultrasound on mine which came back normal and I’ll be having those along with my skin checks every few months for a couple of years. 

No I wasn’t offered an ultrasound scan of my lymph nodes - I was advised to examine them myself every couple of weeks to a month or so and they seem fine so far. I have a follow up appointment with the plastic surgeon in August by which time I may have had the extended WLE. I’m doing a check on my existing moles every month or so and will report any concerns to my skin cancer nurse.