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SLNB after being diagnosed with stage 1b melanoma

Caroline7124
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Hi, 

I have been diagnosed with stage 1B melanoma and attended my outpatient clinic yesterday to discuss the procedure, alongside a wider local excision of two mones which were removed.  Only one of them needs the SLNB procedure, and is in my upper arm.

I have decided that I definitely want to go ahead with the procedure, because I want to know whether it has spread to the lymph nodes, so that I can then have any treatment that is necessary.  I had read all around it, Using the very helpful leaflets that were given to me after my initial diagnosis and had definitely reached the conclusion that I wanted to have an SLNB.  

However, , the consultant has posed another dilemma for me now. Apparently, at the hospital I’m going to attend, they also offer a SLNB using a fluorescent die rather than the radio active isotope that is used as gold standard. This alternative procedure he explained,  has not been scientifically proven to be as effective, but due to problems and delays using the radiology equipment, in their opinion, it offers an effective and equally successful result.

The main advantage is that it would enable me to have the procedure done sooner. We’re currently talking a 6 to 8 week wait (excluding Christmas) for the gold standard treatment and maybe a couple of weeks earlier than that for the alternative.

So I  have to decide - time versus standard, tried and tested procedure.  Obviously I don’t want to end up with a false negative result, but I really want to find out as soon as possible whether it has spread!


Has anyone else faced this dilemma? I’d love to know how  and what you decided to do.

  • Hello and thanks for posting,

    I can appreciate your thoughts. Just to say if you did want other users feedback as well, you would need to post in the general section of Cancer Chat and not just in the Ask the Nurses section.

    There is a global radio isotopes supply issue affecting many countries. The UK Government are trying to address this by developing our own isotope manufacturing capability.

    This means that there are ongoing issues with supplies to hospitals. Prior to using isotopes in recent years, dye was used in many medical procedures, and still remains a reliable method of enhancing imaging. The specialist would not have mentioned it, if they thought that it was not of a high enough standard. So, please be reassured by this. I am sure that they will keep you informed of your situation moving forward.

    I hope this helps,

    Best wishes,

    Vanda

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    SLNB isn't entirely reliable even with the radioisotope. My partner was staged according to it coming back negative and we dropped our guard until it became apparent that it had spread to other local nodes and a transit area. It can give you some reassurance but keep up the physical exams whichever SLNB method you opt for. After a melanoma diagnosis I'd be careful to keep an eye for a number of years after it. My partner has been incredibly unlucky but our complacency did not help.

  • Offline in reply to Lyns21

    Thank you for your response Lyns21.  I really appreciate that..

    Oh that’s good. We had one all along.
     I suppose no diagnostic procedure is entirely foolproof.  There could be an error at path lab level.  No-one is infallible, including pathologists!  I just have to hope for the best in terms of the accuracy of the SLNB.

    I have already experienced one error in diagnosis, when the dermatologist diagnosed my colourless, perfectly symmetrical melanoma as a basal cell carcinoma.  I went along with three suspicious looking moles, and ironically that was the one he didn’t think was a melanoma( the other two weren’t).  

    i will get monitored with 3 monthly  check- ups for the next 3 years, followed by 6 monthly checkups for another two years, which ever path I choose to take in terms of the SLNB,  but obviously I would prefer to know if it has spread before it gets picked up in a physical examination.

    My dilemma really is, do I trade time for a less proven diagnostic technique?

  • Offline in reply to Caroline7124

    . Sorry Lyns 21.  Please ignore the second sentence above. I was dictating my answer and my husband came in at that point and I inadvertently managed to dictate part of my conversation with him. It has absolutely no relevant whatsoever to what I was trying to say!

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