Lymph nodes are located throughout the body, including in the neck, underarm, groin, elbows, and knees. Melanoma, Merkel cell carcinoma, or other skin cancer that invades deeper layers of skin can spread to the lymph nodes. For this reason, your doctor may check your lymph nodes for signs of cancer. During the physical exam, your doctor will feel your lymph nodes. Hard, swollen, or enlarged lymph nodes are a sign that cancer may have spread. A biopsy can be done to get a sample of lymph node tissue and look for cancer cells.
When skin cancer is found in the lymph nodes, it is considered at an advanced stage . Your doctor may suggest surgery to remove the affected lymph nodes.1,2 Other terms for lymph node removal surgery are lymph node dissection or lymphadenectomy.3,4
How is lymph node dissection performed?
Lymph node dissection is done in a hospital under general anesthesia.4 Your surgeon will make a cut (incision) where the affected lymph nodes are.5 The surgeon will remove the section of fat tissue that contains the lymph nodes. Between 8 and 30 lymph nodes may be removed. They will be sent to a pathologist to be studied under a microscope.5 Your surgeon will place a drain in the spot where the lymph nodes were. Lymph fluid will leak from the area for a while.5 The drain is usually left in place for 1 to 3 weeks after surgery.4 You may go home the same day or stay in the hospital overnight.4,5
Will this surgery cure cancer that has spread to the lymph nodes?
Melanoma returns in the lymph nodes in about 20% of people who have lymph node dissection.4 Possible benefits of having the surgery include longer survival and less pain due to cancer in the lymph nodes.3 However, lymph node dissection has some risks. The biggest risk is lymphedema, which is when fluid builds up in the limbs. It can lead to permanent swelling.
You should discuss the possible benefits and risks of surgery with your doctor. Two important questions are below. The answers likely depend on your particular situation.
- The cancer in my lymph nodes was found with sentinel lymph node biopsy. I currently have no lymph node symptoms. What are the benefits of removing my lymph nodes? Will removing my lymph nodes help me to live longer? How do the benefits compare with the risks?
- The cancer has spread to my lymph nodes, making them swollen and hard. Is the cancer contained in the lymph nodes or has it spread farther? If it has already spread beyond the lymph nodes, is there a good reason to remove the lymph nodes? Will I need other treatments after you remove my lymph nodes? What is the ultimate goal or expected outcome of these treatments?
Your doctor may recommend imaging tests. These tests are done to see whether the cancer has spread beyond the lymph nodes. This information may help you and your doctor plan treatment.
Will I need additional treatment after lymph node dissection?
If the risk of cancer recurrence is high, your doctor may recommend additional (adjuvant) treatments.4 Radiation therapy is one adjuvant treatment. The radiation kills any cancer cells that remain after the lymph nodes are removed. Other treatment options for melanoma can include chemotherapy, targeted therapy, and immunotherapy.2,4
What are the risks of lymph node dissection?
Complications are common after lymph node dissection. One expert estimated complication rates after surgery in different locations:4
- Neck lymph nodes: 10%
- Underarm lymph nodes: 23%
- Groin lymph nodes: 50%
Lymphedema is a long-term, troublesome complication of lymph node removal.3 One job of the lymph nodes is to drain fluid from the arms and legs. Once the lymph nodes are removed, fluid may build up in your limbs. This causes swelling, which can be permanent. You may feel heaviness, aching, numbness or tingling in your limbs. It may be tiring to use the limb.6 Severe lymphedema can lead to skin problems and infection.
Estimates of how often lymphedema occurs range from 5% to 20%.4,7 It is not possible to prevent lymphedema. It is possible to lessen the severity. It helps to wear elastic stockings or compression sleeves.3 Avoid injury or trauma to your limb. For example, wear hard-sole shoes outside and gloves while gardening. Take care of your nails and skin to avoid infection or cracking.6 Your doctor will give you more instructions on how to minimize swelling. You should follow your doctor’s instructions and talk to your doctor if you have any questions.
Other possible complications of lymph node dissection are:
- Nerve damage, leading to loss of function or sensation in the arms or legs
- Pockets of fluid (seroma) or blood (hematoma) at the surgery site
- Infection of the incision
- Problems with the repair (incision or skin flap)
- Blood clot in the legs (deep vein thrombosis)4
What questions should I ask before lymph node surgery?
- What is the reason for doing this surgery?
- Has the cancer spread to my lymph nodes?
- Has it spread further than my lymph nodes? If yes, what are the possible benefits of removing my lymph nodes?
- What can I expect during my recovery? When will I be able to resume normal activities, such as showering, work, or driving?
- How do I care for the wound?
- How do I care for the drain?
- What can I do to reduce or manage lymphedema?
- How often should I have follow-up exams with my dermatologist to check for cancer recurrence or a second skin cancer?