Find out about the importance of removing the lymph nodes and how it relates to melanoma diagnosis and treatment strategies.
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Lymph node removal and treatment options
Many people with early melanoma will not need to have any lymph nodes removed. But if lymph nodes do need to be removed, these are a few ways it can be done:
Sentinel lymph node
If the melanoma is thicker than 1 mm or has high-risk features, you may have a sentinel lymph node biopsy at the same time as the wide local excision.
Further scans and treatment
If a sentinel lymph node biopsy shows melanoma 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.
Lymph node dissection
If your lymph nodes feel or look swollen, and a fine needle biopsy confirms that a lymph node contains melanoma, you may need to have all the lymph nodes in that area removed under a general anaesthetic. This operation is called a lymph node dissection or lymphadenectomy, and may mean a longer stay in hospital.
Side effects of lymph node removal
Having your lymph nodes removed can cause side effects. These can be milder if you have a sentinel lymph node biopsy compared with having all of the lymph nodes from an area removed (lymph node dissection).
| Wound pain | Most people will have some pain after the operation, which usually improves as the wound heals. Sometimes, the pain may last longer or be ongoing. Talk to your treatment team about how to manage any 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 treatment team to refer you to a physiotherapist. |
| Seroma/lymphocele | This is a collection of fluid in the area where the lymph nodes have been removed. It is a common side effect and usually appears 7–10 days after surgery. It usually gets better after a few weeks, but sometimes fluid may need draining with a needle. |
| Lymphoedema | This is a swelling of the neck, arm or leg that may appear after the lymph nodes are removed. Lymphoedema happens when lymph fluid builds up in the affected part of the body because the treatment has damaged or blocked the lymphatic system. |
Managing lymphoedema
Your risk of developing lymphoedema depends on the extent of the surgery and whether you’ve had radiation therapy.
Lymphoedema can start a few weeks after treatment. Sometimes it develops several years later. Although it 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 trained practitioner, visit 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. Keeping the skin healthy can help reduce the risk of infection.
Learn more about managing lymphoedema.
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A/Prof Rachel Roberts-Thomson, Medical Oncologist, The Queen Elizabeth Hospital, SA; A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, Royal Prince Alfred Hospital and The University of Sydney, NSW; Alison Button-Sloan, Consumer; Dr Marcus Cheng, Radiation Oncologist Registrar, Alfred Health, VIC; Prof Anne Cust, Deputy Director, The Daffodil Centre, The University of Sydney and Cancer Council NSW, Chair, National Skin Cancer Committee, Cancer Council, and faculty member, Melanoma Institute Australia; Prof David Gyorki, Surgical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr Rhonda Harvey, Mohs Surgeon, Dermatologist, Green Square Dermatology, The Skin Hospital, Darlinghurst and Sydney Melanoma Diagnostic Centre, RPA, NSW; David Hoffman, Consumer; A/Prof Jeremy Hudson, Southern Cross University, James Cook University, Chair of Dermatology RACGP, Clinical Director, North Queensland Skin Cancer, QLD; Dr Damien Kee, Medical Oncologist, Austin Health and Peter MacCallum Cancer Centre and Clinical Research Fellow, Walter & Eliza Hall Institute, VIC; Angelica Miller, Melanoma Community Support Nurse, Melanoma Institute Australia, WA; Romy Pham, 13 11 20 Consultant, QLD; A/Prof Sasha Senthi, Radiation Oncologist, Alfred Health, and Clinical Research Fellow, Victorian Cancer Agency, VIC; Dr Chistoph Sinz, Dermatologist, Melanoma Institute Australia, NSW; Dr Amelia Smit, Research Fellow, Melanoma and Skin Cancer, The Daffodil Centre, The University of Sydney and Cancer Council NSW; Nicole Taylor, Clinical Nurse Consultant, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW.
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