Further treatment post mole removal

Hi R

Most melanomas are detected at a very early stage where they are very shallow (I think this called is stage 1a). Even so, extra skin around the original site is removed to give what they call 'clear margins' - this operation is called a wide local incision (WLE). Depending where the mole is, closing the incision nicely can be easy or a bit tricky, which is why the plastic surgeon is needed.

In a few cases the melanoma is deeper. In those cases the consultant will talk to you about tests to check whether there has been any spreading.

Most of us who have been diagnosed with melanoma are careful of our skin in the sun. I am very pale so I have always worn a hat and I now use factor 50+ sunscreen that has a five star rating. My brand of choice is Ultrasun but Altruist (available on Amazon) is also meant to be very good.

Enjoy your holiday!

All the best

Hi and a second welcome to the online community

It's difficult to say what you should expect at this meeting with your consultant dermatologist and a plastic surgeon as you haven't had a diagnosis yet. However, you should be told what the results of the biopsy were and, as you've been told you need further treatment, they may wish to discuss a wide local excision (WLE) and a possible sentinel lymph node biopsy (SLNB). The latter is optional and usually only offered to people who are Stage 1b and above.

I have had both of these procedures so if you want to know the ins and outs please just ask.

I think for your holiday it's safer to presume that you have been diagnosed with melanoma and you might find the following advice that I was given when first diagnosed helpful:

1. Stay out of the sun during the strongest time of the day (11am to 3pm) between April and October inclusive in the UK and in all months of the year in any other part of the world
2. When going outside wear long sleeved tops and trousers/skirts made from natural fibres like cotton
3. Wear a broad brimmed hat (brim should be at least 3 inches) and sun glasses
4. Sit in the shade and never sunbathe 
5. Any part of your body that is not covered, ie face, neck, back of hands should have a sun protection cream of SPF 50 that is effective against both UVA and UVB rays
6. Re-apply the sunscreen every two hours or more frequently if directed on the bottle
7. Never use sunbeds
8. Don't use sunscreen instead of covering up

The first summer after I was diagnosed was particularly hard as I used to enjoy sitting in the sun. However, I quickly got used to the new regime and have a selection of hats to choose from when I go out. I also decided that I now needed a whole new wardrobe so went on a shopping spree. So, every cloud has a silver lining!

Last year I went to Australia to visit my sister and I still went on the beach and swam in the sea. However, instead of sitting in the sun, I stayed in the shade and I only went in the sea for a short time. Ironically it's easier going on holiday somewhere like that because nearly everyone covers up as they're so aware of the damage the sun can do so I didn't feel a freak in long trousers and a hat!

My friends know that I need to sit in the shade so if we're going to be sitting outside we try to look for a table which means that I can sit in the shade while they can sit in the sun if they want to. If I'm with people who don't know why I need to be in the shade I don't necessarily tell them but will just say something along the lines of "I prefer to sit in the shade" or "it's too hot for me in the sun".

I hope you have a lovely holiday!

x

Hi

How did your meeting with the consultant dermatologist and plastic surgeon go on Monday?

x

Thank you so much for asking. I have stage1b melanoma. I need a further procedure to take more tissue away. I wasn’t offered a lymph biopsy. I have asked my contact nurse why but am yet to hear. Can you shed any light on this? 

With 1b it appears to be mixed as to who gets this or not? Any ideas on the deciding factors?

Btw, I used Ultrasun on holiday, it was very good; too recommendation! 

Kind regards,

Rachel

Hi Rachel

I'm sorry to hear that it did turn out to be melanoma. The procedure to take more tissue away is called a wide local excision (WLE) and the lymph biopsy is a sentinel lymph node biopsy (SLNB). I've had both of these so if you want to ask any further questions just fire away.

According to NICE guidelines anyone with a Stage 1b or above melanoma can be offered a SLNB. The guidelines also give you the advantages and disadvantages of having a SLNB. If it is something that you want to have it has to be done at the same time as the WLE so it's important that you find out why you haven't been offered it. 

One thing to remember though is that a SLNB isn't a treatment but a staging tool which shows if your melanoma has spread to the nearest lymph nodes.

On a nicer topic I hope you had a lovey holiday and I'm glad you got on with the Ultrasun!

x

Hey Rachel

I was just checking in to see how you were and to ask if your SCNS was able to tell you why you haven't been offered a SLNB. Do you have the date for the WLE yet?

x

Hi there!

I am typing with one hand, as I had the WLE today. SLNB was not offered due to the depth of my melanoma, 0.5mm. I assume that is normal procedure based on what I have been told.

I avoided a skin graft today too, which is good news.

Thank you for your follow-up...you have a sixth sense!!!

Kind regards,

Rachel

Hey Rachel

I'm probably more nosey than gifted, lol! However, I'm glad that you've avoided having a skin graft. 

Looking back through your posts you said that you were Stage 1b and at this stage you can be offered a SLNB. However, I think it's only offered if the thickness is 0.8mm or more.

I'm guessing that your melanoma was on your arm if you're typing with one hand. Mine was on my upper left arm and if yours is on your arm then you should be up and about again fairly quickly. I didn't do any lifting with that arm for a week but I could have started sooner. However, it was nice having my meals cooked for me and sitting with my feet up while my husband did the housework! If yours isn't on your arm then disregard this last paragraph!

Take care

x

Hi Rachel

Just wondering if you'd had the results back from your WLE yet? I hope it's all healed nicely by now and you no longer have to type one handed!

x

Hi there. I went back to hospital yesterday for a further check and review and no further cells were found. Wonderful news...I had presumed they’d have called me if they’d found any. 

So, as I understand it all, it’s visible checks from here on in. They checked my lymph’s areas for swellings and said to keep an eye on any mole changes or lumps in lymph areas. I’m back every 3 months now for 5 years, as they said with melanoma it’s visible checks only. Great news but are there really no further checks I can have done? 

Life has resumed and is more cherished!!!

rachel x