When melanoma is on the skin, it can be effectively and permanently removed in most cases. Sometimes, however, it spreads (metastasizes) to other areas of the body, usually traveling first to the nearest lymph nodes in your armpit, neck, or groin. If your healthcare provider suspects that this has happened, a test called a sentinel node biopsy will be performed to identify and remove the lymph node to which the cancer is likely to have spread from the primary tumor.
If your sentinel node biopsy is positive (contains cancerous cells), then it’s decision time. Should you have all the other lymph nodes in this area removed, in a surgical procedure called completion lymph node dissection (CLND, or lymphadenectomy)? The idea is that a CLND ensures that the melanoma cells in all the other lymph nodes are removed, which then may prevent the disease from spreading farther.
Unfortunately, the evidence is inconclusive, so this decision is not straightforward, even for healthcare providers. Here are some pros and cons to consider.
Pros of Lymph Node Dissection
A CLND helps to accurately determine the stage of the melanoma, which assists the healthcare provider in making recommendations for post-surgery (adjuvant) treatment.
The overall number of nodes containing melanoma cells is a predictor of survival for patients who have stage III disease, and only a CLND can provide this information.
By stopping the spread of melanoma at the lymph nodes, a CLND optimizes the chance for a cure. Even microscopic amounts of melanoma in lymph nodes can eventually progress over time to be significant and dangerous.
Cons of Lymph Node Dissection
- Complications of a CLND are significant and occur in approximately 40% of patients, especially in those that had inguinal lympadenectomy for whom the complications were approximately 48%. These include:
Build-up of fluid at the site of surgery (seroma) Infection Swelling of a limb affected by the removal of the lymph nodes (lymphedema) Numbness, tingling, or pain in the surgical area Breakdown (sloughing) of skin over the area
Although swelling after surgery can be prevented or controlled by use of antibiotics, elastic stockings, massage, and diuretics, it can be a debilitating complication.
- The effectiveness of a CLND may depend on the size of the melanoma tumor. Small tumors ( less than 0.1 mm in diameter) in the sentinel lymph node may not ever lead to metastasis at all, so performing a CLND may not be necessary. A 2009 study showed that the survival and relapse rates of patients with these small tumors were the same as those who had no melanoma in their sentinel lymph node. Thus, these “low-risk” patients may be able to avoid a CLND and have the same outcome.
The Bottom Line
Electing to undergo a major surgical procedure such as a CLND is not a decision you should take lightly, especially if your biopsy shows only a small amount of melanoma in your lymph nodes. Many factors are involved, including the size and location of your primary melanoma, the results of the sentinel lymph node biopsy and other tests, and your age. You may find it helpful to seek out a second opinion.
