Removing lymph nodes
Many people with early melanoma will not need to have any lymph nodes removed.
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In some cases, you may have a sentinel lymph node biopsy at the same time as the wide local excision. This removes the first lymph node that melanoma may have spread to. If melanoma is found in the removed node, you will need to have regular imaging scans to check that the melanoma has not come back or spread. You may also be offered drug therapy to reduce the risk of the melanoma returning.
Occasionally, melanoma may spread to lymph nodes and cause lumps that your doctor can feel during a physical examination. If a fine needle biopsy confirms that a lymph node contains melanoma, that group of lymph nodes may be removed in an operation called a lymph node dissection or lymphadenectomy. This is performed under a general anaesthetic and requires a longer stay in hospital.
Having your lymph nodes removed can cause side effects. These are likely to be milder if you have only a few lymph nodes removed.
Most people will have some pain after the operation, which usually improves as the wound heals. For some people, the pain may be ongoing, especially if lymph nodes were removed from the neck. Talk to your medical team about how to manage your pain.
Neck/shoulder/hip stiffness and pain
These are the most common problems if lymph nodes in your neck, armpit or groin were removed. You may find that you cannot move the affected area as freely as you could before the surgery. It may help to do gentle exercises or ask your GP or cancer care team to refer you to a physiotherapist.
This is a collection of fluid in the area where the lymph nodes have been removed. It is a common side effect and appears straight after surgery. It usually gets better after a few weeks, but sometimes your surgeon may drain the fluid with a needle.
This is a swelling of the neck, arm or leg that may appear after lymph node removal (see below).
If treatment for melanoma removes or damages lymph nodes, your neck, arm or leg may later become swollen. This is called lymphoedema. It happens when lymph fluid builds up in the affected part of the body because the lymphatic system is not working as it should.
Your risk of developing lymphoedema following melanoma treatment depends on the extent of the surgery and whether you’ve had radiation therapy that has damaged the lymphatic system.
Lymphoedema can develop a few weeks, or even several years, after treatment. Although this condition may be permanent, it can usually be managed, especially if treated at the earliest sign of swelling or heaviness.
A lymphoedema practitioner can help you manage lymphoedema. To find a practitioner, visit the Australasian Lymphology Association or ask your doctor for a referral.
You may need to wear a professionally fitted compression garment. Massage and regular exercise, such as swimming, cycling or yoga, can help the lymph fluid flow. It is also important to keep the skin healthy and unbroken to reduce the risk of infection.
For more on this, see our general section on Lymphoedema.
Podcast: Making Treatment Decisions
A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA.
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