Melanoma Surgery to Remove Lymph Nodes
You might have surgery to remove the lymph nodes close to the melanoma if cancer has spread there. This operation is called a lymph node dissection.
Deciding about surgery
There are different ways to see whether the melanoma has spread to the lymph nodes. This is important because it may affect the decision about whether you have the operation to remove all the lymph nodes.
The doctor might diagnose that melanoma has spread to your lymph nodes after:
- a physical examination shows your lymph nodes feel abnormally large or hard
- a scan shows that lymph nodes appear abnormal
- a sentinel node biopsy finds melanoma cells in your lymph nodes – this is when the surgeon removes lymph nodes closest to the melanoma to see if they contain cancer
If your lymph nodes look or feel abnormal
The doctors usually take a sample of tissue (biopsy) from lymph nodes that feel enlarged or abnormal, or appear abnormal on a scan. If the biopsy shows melanoma in a node or nodes, the doctors usually offer you an operation to remove all of the lymph nodes in that area.
If a sentinel node biopsy shows melanoma in your lymph nodes
This is called a positive sentinel node biopsy. At the moment, it is still unclear how useful it is to remove all the remaining lymph nodes if the sentinel nodes contain cancer cells.
Advantages and disadvantages of lymph node removal after a positive sentinel node biopsy
The National Institute for Health and Care Excellence (NICE) has produced guidelines about the diagnosis and treatment of melanoma. They list some advantages and disadvantages of this operation for people with a positive sentinel node biopsy. You can talk to your doctor about the operation. They can help you decide what to do.
Possible advantages of removing the rest of the lymph nodes are:
- it is less likely that melanoma will come back in the lymph nodes close to the melanoma in the future
- it is safer and less complicated than waiting and removing them if melanoma develops in the rest of the lymph nodes
- after you have this operation you might be able to take part in clinical trials looking at new treatments (you might not be able to take part in these trials if you have not had these lymph nodes removed)
Possible disadvantages of removing the rest of the lymph nodes are:
- you might develop long term swelling called lymphoedema – this is more likely if the lymph nodes are in your groin than in other parts of the body
- melanoma may not develop in the remaining lymph nodes, so there is a chance that it has been unnecessary to remove them – we know that melanoma develops in the remaining lymph nodes in 1 out of every 5 people who don’t have them removed
- any operation can cause complications
The operation to remove all the lymph nodes close to your melanoma can be a big operation. You usually have a general anaesthetic.
The surgery you have depends on which part of the body the lymph nodes are in. For example, if a melanoma on the arm spreads to nearby lymph nodes, those lymph nodes are in the armpit. So surgery involves removing the lymph nodes in the armpit.
Your specialist will tell you more about the operation and how long you might be in hospital. They will also tell you about the possible risks.
The risks will depend on which lymph nodes the surgeon removes.
Having all the lymph nodes removed can cause some long term side effects. Lymph nodes drain fluid from your arms and legs. If the surgeon removes the lymph nodes, fluid can build up and cause swelling in your arms or legs. This is called lymphoedema. Your doctor and nurses will tell you how you can reduce your chance of getting lymphoedema.
At your first follow up appointment, your doctor:
- gives you the results of the surgery
- examines you
- asks how you are and if you’ve had any problems
This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.
How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have check ups and what they will involve.