Awaiting snob and wle

Hi 46 male, welcome to the online community I’m sorry to hear about your diagnosis. I know you’d like to have your surgery ASAP, and I don’t know if I can say anything to make that wait any better, or to ease the uncertainty. I have this feeling, and I may be wrong, that your asking about the outcome down the line to either ease your mind that it’s ok to wait, or to find out something scary so you can reach a point where you acknowledge the scariness but then put some resolve in to say I’m going to beat these I’m an individual not a statistic. 

I like to think that down the line I’m doing ok, but then again, I haven’t had a primary melanoma removed. My diagnosis was when it had already spread to many lymph nodes but nearly 5 years later I’m still smiling and on lockdown with everyone else, but I’ve had my moments of wallowing in the sadness and nearly 5 years of dealing with uncertainty, and I think with a bit of help from here every now and then I’m doing ok. I hope you reach your ok moment.

Hi Andrew,

I can understand your worry regarding this delay. I can't find any literature in the UK that explains the ramifications of postponing further surgery. However, Australia are also postponing WLE & SLNB procedures due to Covid-19 so I'm attaching an excerpt of a letter sent by the Melanoma Institute of Australia to their clinicians today (this was shared to an advocate friend of mine) - hopefully this will help calm your fears a little.

'It is important to understand that excision biopsy with 2-3mm clinical margins (that can typically be performed using local anaesthesia in the primary care setting) immediately provides satisfactory urgent treatment of primary melanoma of all thicknesses. Very importantly, at this time we wish to emphasise that all forms of partial biopsy (punch, shave and incisional biopsies) do not achieve that benefit for the patient. Wider excisions (following a simple 2-3mm margin biopsy) do not alter overall survival but do influence local recurrence rates particularly in thicker tumours. Nonetheless, wider re-excisions are not urgent and can reasonably be deferred for a number of months. Sentinel node evaluation for appropriate higher risk melanomas is also a procedure that can, in circumstances such as we currently face, be deferred because accurate lymphatic mapping will still be possible in the future if only an excision-biopsy has been performed'.

From personal experience, I left my dodgy mole a year before getting it checked. I wasn't offered a SLNB (just under the 0.8mm depth) and I didn't have a WLE as the surgeon thought he'd got wide enough margins first time around. Sadly it returned in my lymph nodes many years later, however I was first diagnosed 24 years ago & I'm still here, fighting fit & with no evidence of melanoma so take heart that all your melanoma has been removed & these postponed procedures are just the 'belt & braces'. 

Good luck, I hope you aren't waiting too long x

Hi Grendo, 

ive been having a wobble day  what with cancellation of WLE&SLNB and the current situation with C-19, but this information has really left me feeling so much less anxious. You have to wonder why we as patients we  aren’t armed automatically with kind of communications or that it’s publicly available in U.K. Thank You very much for this, it’s so greatly appreciate. 

Hi Andrew, I can’t offer anything further in terms of prognosis vs wait times. I would add though that I spoke with my specialist nurse a few days ago and this was the first time anyone had fully discussed the report from my original excision. This did infact did show really positive results in terms of mitosis, margins etc so in addition to Grendos post I’m now not quite so anxious and fearful.  It might help to contact your nurse in the hope they can offer some element that’s helps.

I guess through out all this I feel I’ve been totally abandoned by at least my surgeon. I want to say NHS but of course know just how difficult things are there and having nothing but admiration for those on the front line, however no one from plastics contacted me only after chasing some poor girl in the department advised that both surgeon and his secretary had left ( not working)  with instruction that his list was cancelled. Even now I’ve not officially been advised of cancellation!!! She is now trying to figure out what’s going on. 

The news seems to be full of people who are in much dire situations to myself with some very scary cases for seemingly urgent ops and treatments being cancelled. I wonder just what impact this decision will have on future prognosis of cancer patients and therefore further impact on NHS well after Covid goes away. 

So Andrew I hope you get some comfort from Grendo post. Keep busy and stay safe. XX