Disruption to the nerve supply in the area.Poor cosmetic results or discomfort due to tight scarring.Delayed wound healing from bleeding, infection, or dehiscence.The risks of any lymph node surgery include: What are the risks/disadvantages of lymph node surgery?Ĭomplication rates for sentinel lymph node biopsy occur in 6–14% of patients. Ĭompletion dissection offers immediate control of nodal metastatic melanoma. The results of sentinel lymph node biopsy may enable access to adjuvant immunotherapy, radiotherapy, or clinical trials.However, a patient with negative sentinel lymph node biopsy may later develop lymph node metastases in that nodal basin.Negative sentinel lymph node biopsy is reassuring.Sentinel lymph node biopsy provides prognostic information. What are the benefits of lymph node surgery? A scoring system to predict non-sentinel lymph node involvement may help select patients who would benefit from immediate completion lymphadenectomy.Immediate lymph node dissection offers disease control in the nodal basin, but patients are at risk of surgical complications unlike patients under observation.There was no difference in survival between patients who underwent immediate completion lymph node dissection compared with those had undergone regular clinical and ultrasound surveillance of their lymph node basin with dissection if recurrence was detected.Prior to the publication of the results of two studies, ‘DeCOG-SLT’ and ‘MSLT-II’, completion lymph node dissection was recommended for patients with a positive sentinel lymph node biopsy. Compared to those who underwent regular observation, those who underwent sentinel lymph node biopsy had no difference in 10-year melanoma-specific survival. Ī positive sentinel lymph node biopsy gives prognostic information for risk stratification and staging it does not have therapeutic benefit. When there is biopsy-proven lymphadenopathy for metastatic melanoma (ie, the lymph nodes are grossly enlarged).If a positive sentinel lymph node involves a large microscopic metastatic melanoma deposit or there are multiple positive lymph nodes.Lymph node dissection is currently considered in two settings: Melanomas that are greater than 1 mm in Breslow thickness without other adverse prognostic factors.Cutaneous melanomas that are greater than 0.8 mm in Breslow thickness with an additional adverse prognostic factor (eg, high mitotic rate or ulceration).Opinions vary in which patients it should be performed the key influence was the publication of the ‘MSLT-1’ study. Whether sentinel lymph node biopsy is performed depends on a melanoma patient’s risk for nodal metastasis. Which patients should be considered for lymph node surgery in melanoma? Sentinel lymph node biopsy The pathologist examines all the excised lymph nodes for metastatic melanoma. This is performed under general anaesthetic. Lymph node dissection or completion lymphadenectomy is the removal of all lymph nodes in the nodal basin (eg, axilla, inguinal region, or head and neck). The sentinel lymph nodes are excised for examination by a pathologist who measures the dimensions of any melanoma found within the lymph nodes and whether it extends beyond the lymph node (which confers poorer prognosis). Lymphoscintigraphy is also used to map the sentinel lymph nodes, using a specialised scanner to detect radiation from a radiotracer combined with the blue dye. Lymphatic drainage in the head and neck is unpredictable, with multiple possible locations for sentinel lymph nodes including involvement of multiple basins.A truncal melanoma can have a sentinel lymph node in the axilla, the inguinal region, or both.In-transit sentinel lymph nodes located closer to the melanoma site than the regional nodes have been detected in 10%.For the lower limb, it is typically found in the inguinal region.For the upper limb, the sentinel lymph node basin is usually located in the axilla.This dye is carried by lymphatic channels to the sentinel lymph node or nodes. Ī blue dye is injected into the initial biopsy scar prior to the wide local excision. Sentinel lymph node biopsy is performed in people who do not have swollen lymph nodes at the time of re- excision of the biopsy site - known as wide local excision - and is usually under general anaesthetic. Ī sentinel lymph node biopsy is used to identify and sample the ‘sentinel’ or first lymph node (or nodes) that potential metastatic melanoma would encounter if present in lymphatic vessels draining the site of the primary melanoma. Lymph node dissection or completion lymphadenectomy (CLND).There are two types of lymph node surgery for cutaneous melanoma:
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