Melanoma sentinel lymph node biopsy recovery: Caring for Yourself After Your Sentinel Lymph Node Biopsy
Caring for Yourself After Your Sentinel Lymph Node Biopsy
This information will help you care for yourself after your sentinel lymph node biopsy at Memorial Sloan Kettering (MSK).
You may have had a sentinel lymph node biopsy if you have breast cancer or melanoma. It allows your doctor to see if the cancer cells have spread to your lymph nodes.
Back to top
After Your Procedure
Your incision (surgical cut) will be closed with Steri-Strips™ (thin strips of paper tape) or Dermabond® (surgical glue) and covered with a bandage.
- If your incision is covered with Steri-Strips, leave them on until they fall off on their own. If they haven’t fallen off after 14 days, you may gently remove them.
- If your incision is covered with Dermabond, don’t remove the glue. The Dermabond will peel off on its own.
Your incision may feel tender and sore. You may also notice numbness and tingling along your incision as it heals. This can come and go. It can last from a week to more than several months. These sensations happen as your nerves heal. They’re normal and will go away with time.
You may feel scar tissue along your incision as you continue to heal. It will feel hard. This is common and will soften over the next several months.
You may have a bluish-green stain near your incision from the blue dye that was used to find your sentinel node(s). The color will fade over time. Some people may have a faint stain for up to 12 months after their biopsy.
Your urine and stool may also be a bluish-green color. This will go away in 1 to 2 days, when the dye is out of your body.
Back to top
You will have some soreness or pain in the area near your incision. Take acetaminophen (Tylenol®) or ibuprofen (Advil®) to help.
Your doctor may give you a prescription for stronger pain medication. If so, take the medication as instructed by your doctor or nurse. Don’t drink alcohol or drive while you are taking prescription pain medication.
You can shower 24 hours after your biopsy.
Before showering, remove the bandage that was on your incision. You don’t need to put another bandage on after your shower.
If you had breast surgery, we recommend that you wear a supportive bra (such as a sports bra) or a wrap for 72 hours after your biopsy. It will support and compress the area near the incision and make you more comfortable.
We suggest wearing the bra or wrap even while sleeping. You may remove your bra or wrap when you bathe or shower.
After your biopsy, you may have some stiffness or pain, in your arm or leg on your affected side (the side where your lymph nodes were removed). If you still have stiffness or pain 6 weeks after your procedure, call your doctor.
If you had breast surgery, your nurse will give you the resource titled Exercises After Your Sentinel Lymph Node Biopsy or Lumpectomy. These exercises will help with the stiffness.
You may return to most normal activities the day after your biopsy. However, speak with your doctor or nurse before resuming heavy exercises, such as:
- Lifting weights
Back to top
Cancer diagnosis and treatment can be a very stressful and overwhelming event. You may feel depressed, anxious, confused, afraid, or angry. You may have strong feelings about any permanent changes. These changes can have an impact on your emotional well-being. Help is available for you at any time. If you would like counseling, your nurse can refer you to see a social worker, psychiatrist, or counselor.
The MSK Resources for Life After Cancer (RLAC) Program provides support services after your treatment is finished. To learn more about these services, call 646-888-8106.
You may also find it comforting to speak with a former patient or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, you have a chance to speak with former patients and caregivers. To learn more about this service, call 212-639-5007.
Back to top
Call Your Doctor or Nurse if You Have:
- Increased redness around your incision
- New or increased swelling around your incision
- Drainage from the incision line
- Warmer than normal skin around your incision
- A temperature above 101 °F (38.3 °C)
Back to top
Sentinel lymph node biopsy | Melanoma skin cancer
A sentinel lymph node biopsy (SLNB) is a test to find the first lymph node or nodes that a melanoma may spread to. The doctor then checks to see if this lymph node contains cancer cells.
If your doctor thinks you need a sentinel lymph node biopsy, you have it at the same time as your operation to remove tissue around the melanoma (wide local excision).
What is a lymph node?
A lymph node is part of the lymphatic system. This is a network of thin tubes (vessels) and nodes that carry a clear fluid called lymph around the body. This is an important part of the immune system. It plays a role in fighting infection and destroying old or abnormal cells.
The nodes are bean shaped structures that filter the lymph fluid and trap bacteria and viruses, and cancer cells.
Why you might have this test
The most common place that melanoma skin cancer spreads to is the nearby lymph nodes. You might have a sentinel lymph node biopsy (SLNB) if your doctor wants to check whether your nearby lymph nodes contain cancer cells.
You don’t always need to have a SLNB – it depends on the stage of your melanoma.
Your specialist might offer you a SLNB if your melanoma is deeper than 1mm (stage IB to IIC) or if you have other risk factors. You have it at the same time as your operation to remove tissue around the melanoma (wide local excision).
Before your sentinel lymph node biopsy
The day before or morning of your wide local excision, you have a scan to show where the sentinel nodes are. You have the scan in the nuclear medicine department of the hospital.
You lie down on the treatment couch. You have small injections of a radioactive liquid into the area where your melanoma was.
About 15 minutes later, you have a scan. This picks up the radioactive liquid and traces it as it moves through the lymphatic vessels and into the lymph nodes. The first nodes that the tracer drains into are the sentinel nodes. The radiographer marks where these nodes are on your skin.
The scan takes about 90 minutes or more, depending on where the melanoma is and where the sentinel nodes are.
You have the sentinel lymph node biopsy under general anaesthetic. While you are asleep, the surgeon injects a blue dye into the area around the site of the melanoma. The dye will gradually drain into the sentinel nodes.
Your surgeon uses a handheld scanner to pick up the radioactivity in the sentinel lymph nodes. They make a cut into your skin over the area. They can see the blue dye, which also helps them identify the sentinel nodes. They remove these nodes and send them to the laboratory to see if they contain cancer cells.
The surgeon then continues with the operation to remove more tissue around the site of the melanoma (wide local excision).
They stitch the wounds closed and cover with a small dressing. They may leave a thin tube where they took out the lymph nodes. This is to drain fluid that may collect there.
After your sentinel lymph node biopsy
You can usually go home later the same day, if you don’t have a drain. Going home will also depend on the type of operation you had for the wide local excision.
As you have had a general anaesthetic, you will need someone to take you home and stay with you for 24 hours after the operation.
If you have a drain, your nurse will normally remove it the next day unless it is still draining a lot of fluid. Once they have taken this out, they will check your wounds and then you can go home.
The blue dye will make your urine look blue or green for the next couple of days. This is harmless.
About a week later, you have an appointment at the clinic or your GP surgery to have your stitches taken out, if needed.
Possible risks of a sentinel lymph node biopsy
A sentinel lymph node biopsy is normally a safe procedure but your nurse will tell you who to contact if you have any problems afterwards. Your doctors will make sure the benefits of having this test outweigh these possible risks.
You may have pain around the site of the sentinel lymph nodes. This might last up to 2 weeks. Taking mild painkillers can help. You might also feel stiff or tight around the area. It usually gets better over 6 weeks.
Contact your GP or the hospital if you have a high temperature or feel unwell. Or if your wound looks red, swollen or is leaking fluid (discharge). You might need antibiotics.
Fluid collecting near the wound can cause swelling and pain. It also increases the risk of infection. The fluid normally goes away on its own within a few weeks. Your nurse may need to drain it with a needle and syringe.
Occasionally blood collects in the tissues around the wound. This can cause pain and swelling, and the area may feel hard.
It normally goes away on its own, but can take a few months. If necessary, your doctor or nurse can drain the swelling.
Some people may develop scar tissue in their arm or leg, depending on where the lymph nodes were taken from. It can cause tightness and feel uncomfortable.
It is usually temporary and will settle over the first few months.
There is a small risk of developing lymphoedema. This is caused by lymph fluid that cannot drain away.
If your surgeon removes sentinel nodes from under your armpit, you may develop swelling in your hand or arm. If they take lymph nodes from your groin, you may develop swelling in your leg.
This is usually temporary, but in a small number of people it can be permanent.
Tell your doctor or nurse as soon as possible if you get swelling, pain or tenderness in your arm, hand or leg.
Getting your results
It takes 1 or 2 weeks to get the results. Your doctor will usually discuss them with you at your next clinic appointment.
Waiting for test results can be worrying. You might have contact details for a specialist cancer nurse. You can get in touch with them for information and support if you need to. It may help to talk to a close friend or relative about how you feel.
You can also call the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
What happens next
A negative result means there are no cancer cells in the sentinel nodes. This means that the melanoma is unlikely to have spread to the other lymph nodes. So you won’t usually need any further tests or treatment.
A positive result means there are cancer cells in the sentinel nodes. This means the cancer has started to spread. Your doctor will talk to you about further treatment. You’ll also have scans to see if the cancer has spread anywhere else.
Advantages and disadvantages of sentinel lymph node biopsy
The National Institute for Health and Care Excellence (NICE) has produced guidelines about the diagnosis and treatment of melanoma. They list some advantages and disadvantages of this test. You can talk to your doctor about sentinel node biopsy. They can help you decide whether or not to have this test.
- It can help doctors find out whether melanoma has spread to nearby lymph nodes, so they can offer you treatment for this.
- It is better than an ultrasound scan at finding very small cancers.
- Doctors can use the results to give you more information about what might happen to you in the future.
- You may be able to take part in clinical trials looking at new treatments (you may not be able to take part in these trials if you haven’t had a sentinel lymph node biopsy).
- It isn’t a cure for your melanoma, and there is no good evidence that people who have a sentinel lymph node biopsy live longer than those who don’t have it.
- The results don’t always predict what might happen to you in the future.
- You need to have a general anaesthetic to have the operation.
- The operation has possible risks, such as infection or collection of fluid under the wound.
Lymphedema After Sentinel Lymph Node Biopsy for Cutaneous Melanoma: A Report of 5 Cases | Oncology | JAMA Dermatology
Sentinel lymph node (SLN) biopsy has rapidly become the procedure of choice for assessing the lymph node status of patients with 1992 American Joint Committee on Cancer stages I and II melanoma. The procedure was designed to be less invasive and, therefore, less likely to cause complications than a complete lymph node dissection. To our knowledge, this is the first report in the literature documenting extremity lymphedema following SLN biopsy.
We report 5 cases of lymphedema after SLN biopsy in patients being routinely followed up after melanoma surgery at the Massachusetts General Hospital Melanoma Center, Boston. Three cases were mild, and 2 were moderate. Potential contributing causes of lymphedema were present in 4 patients and included the transient formation of hematomas and seromas, obesity, the possibility of occult metastatic melanoma, and the proximal extremity location of the primary melanoma excision. Four of the patients underwent an SLN biopsy at our institution. We used the total number of SLN procedures (N=235) that we have performed to calculate a 1.7% baseline incidence of lymphedema after SLN biopsy.
Sentinel lymph node biopsy can be complicated by mild and moderate degrees of lymphedema, with an incidence of at least 1. 7%. Some patients may have contributing causes for lymphedema other than the SLN biopsy, but many of these causes are difficult to modify or avoid.
TRADITIONAL management of patients with 1992 American Joint Committee on Cancer stage II and some cases of stage I melanoma in many centers has included elective dissection of the draining lymph node basin(s).1(pp38-49) Beside the role of node dissection for accurate staging, a major reason given for performing a dissection was to improve the survival of patients with nodal disease. Such a benefit has been difficult to demonstrate. The most recent prospective randomized trial2 that evaluated the role of elective lymph node dissection failed to show an overall benefit. Reluctance to accept elective node dissection for questionable therapeutic gains may have been in the past due to the morbidity associated with the procedure. Its postoperative complications include seroma and hematoma formation, wound infections, wound separations, pain and nerve dysfunction, skin slough, flap necrosis, and lymphedema. 3-8
Morton et al9 developed a technique that would reduce the need for lymph node dissections and thus the associated morbidity for most patients. This technique, eventually referred to as sentinel lymph node (SLN) biopsy, identifies the initial draining lymph node(s) in a lymph basin.10 It was proposed, and later validated, that if the SLN shows no evidence of metastatic melanoma, then the remainder of the lymph nodes in the basin are also highly likely free of disease.10-12 Thus, patients with negative SLN biopsy results can be spared a complete lymph node dissection.
Since the SLN biopsy offers an effective means of identifying metastatic melanoma in regional lymph nodes, it has become the staging procedure of choice for patients with stage II and higher-risk stage I melanoma.13 Staging is important for considerations of giving adjuvant therapy, for enrollment in investigational protocols, and for its prognostic value. 13,14
The SLN biopsy should have a lower rate of complications than complete dissections, because it is a less invasive procedure. The experience at our center supports this belief, but SLN biopsy does carry some risk. We describe 5 patients with lymphedema. To our knowledge, this is the first report in the literature of clearly documented extremity lymphedema after SLN biopsy. One SLN biopsy review15 mentions a case of “transient postoperative lymphedema of the extremities” in the “Results” section of its “abstract,” but no further comments about lymphedema are made in the article.
We identified clinically significant lymphedema after SLN biopsy in patients being routinely followed up after melanoma surgery at the Massachusetts General Hospital Melanoma Center, Boston. This report is not necessarily a complete listing of patients with lymphedema or other complications. The center is a multidisciplinary tertiary referral unit that includes surgeons, dermatopathologists, dermatologists, and medical oncologists. We have performed 235 SLN biopsies through November 1, 1998. Most, but not necessarily all, of these patients have been seen in follow-up. The patient base is diverse and includes a significant number of patients who have had the definitive primary surgery, including SLN biopsy, performed elsewhere. We categorized the severity of edema as mild, moderate, or severe. Mild edema was usually noted only by the physician and did not affect the patient clinically. The physician and patient identified moderate edema. It was associated with at least some discomfort. Severe edema was defined as clinically obvious disabling edema that made activities of daily living difficult.
We report 5 cases of lymphedema after SLN biopsy. Lymphedema was found in 2 women and 3 men (average age, 51 years; range, 37-59 years). The results of the primary biopsy showed 4 superficial spreading melanomas and 1 nodular melanoma or a possible metastatic nodule (primary site unknown). Patients 2 and 5 had primary melanomas and excisions on their backs. Patient 1 had a primary melanoma on his right shoulder. Patients 3 and 4 had distal lower extremity primary melanomas. The average Breslow tumor thickness was 2.16 mm (range, 0.80-4.00 mm). Three axillary and 2 inguinal SLN biopsies were performed. The average number of lymph nodes removed was 2.4 (range, 1-7). The average incision size was 3.5 cm (range, 2.2-5.0 cm). Four patients had normal lymph nodes, as determined by histopathologic examination. One lymph node showed microscopic metastatic disease; this patient (patient 3) chose not to undergo a complete lymph node dissection. She had no clinical adenopathy at her last examination 6 months following SLN biopsy. The postoperative course in all 5 patients, other than lymphedema, was without major problems. Patient 3 had a 2.5-cm hematoma after the SLN biopsy. It resolved spontaneously within 4 weeks. Patient 2 had a seroma that was successfully drained with needle aspiration. Patient 5 had mild paresthesias in an ulnar distribution after his right axillary SLN biopsy. The paresthesias were still present at his last examination, 3 months after the procedure. Potentially relevant comorbid histories were present in 3 patients. Patient 4 had a resected invasive breast carcinoma treated with tamoxifen citrate. The lymphedema being reported was in the left lower extremity following SLN biopsy of the left groin. Patient 1 had a long history of fibromyalgia. Of the 5 patients, 4 were described as being of normal weight. However, 1 patient (patient 3) was moderately overweight. He weighed 98 kg and was 1.8 m tall. No patient had a recent or distant history of keloidal scarring, wound healing problems, cellulitis, or significant antecedent trauma to the edematous limb.
Edema developed on average 6 weeks after SLN biopsy (range, 2-10 weeks). Its severity was mild in patients 1, 2, and 3 and did not interfere with their daily activities. Patient 2 initially had moderate edema, but severity decreased over 6 months to a mild level. Two patients have moderate edema. Patient 5 felt impaired by his hand edema, stating that it is difficult for him to grasp objects such as a tennis racket. His moderate swelling is noted in Figure 1. Patient 4 complains that by the end of the day discomfort forces her to elevate her leg. The swelling makes her right shoe feel uncomfortably tight. A recent trial of support hose dramatically reduced her symptoms.
Patient 5. The prominent edema on his right hand obscured his superficial dorsal veins. He had moderate edema, as determined by physical examination and medical history. We could not identify contributing factors other than sentinel lymph node biopsy as a cause for this patient’s lymphedema.
The baseline incidence of lymphedema seen after SLN biopsy at our institution is 1.7%. We calculate the incidence using the number of cases of lymphedema (n=4) divided by the total number of SLN biopsies performed at the center (N=235). We excluded patient 3 from the calculation because she had surgery at another institution.
Sentinel lymph node biopsy can be associated with mild and moderate degrees of lymphedema. The procedure appears to be a major cause of the lymphedema in the patients in this study, but contributing factors do exist for 4 of the 5 patients described. Lack of surgical experience with the technique is unlikely to explain the edema in all of our patients. In their classic study, Morton et al9 used only vital blue dye to isolate the initial draining lymph node(s). Finding this SLN was challenging. They suggested that a learning experience of at least 60 patients was needed to gain proficiency with the technique.9 The addition of radiocolloid along with vital blue dye to isolate the SLN has made the procedure simpler and has reduced the extent of exploratory surgical dissection.10 Patients 1, 2, 4, and 5 underwent the procedure at our institution, and the procedure was performed by experienced surgeons using radiocolloid and vital blue dye. The SLN biopsy of patient 3 was performed at another institution. This patient’s procedure used radiocolloid and vital blue dye.
Underlying medical conditions may contribute to the lymphedema seen in 3 of our patients. Patient 4 had breast cancer, but lymphedema of her left leg cannot be explained by breast cancer surgery or chemotherapy. The SLN of patient 3 had a small focus of microscopic melanoma, and the remaining lymph nodes were not resected. The results of a clinical examination 6 months after the SLN biopsy revealed no evidence of metastatic melanoma, but she may have microscopic nodal disease. She is the only patient with stage III cancer in our study and thus has the highest chance of disease advancement, particularly during the first postoperative year.1(pp11-35) If her remaining lymph nodes develop microscopic metastatic melanoma, they may contribute to lymphedema. Patient 1 had fibromyalgia. An examination of patients with fibromyalgia typically shows no abnormalities other than tenderness at points on the body. 16,17 Fibromyalgia may be associated with alterations in immune function, but lymphedema has not been reported.18 Thus, the localized lymphedema in patient 1 is in all likelihood unrelated to fibromyalgia. These case reports are insufficient to draw conclusions about risk factors for lymphedema. A previous study8 suggested that age and obesity were risk factors for edema after traditional nodal dissection. Four of the patients were in their 50s. One patient (patient 3) was moderately obese. He weighed 98 kg and was 1.8 m tall.
The primary surgical excision may have contributed to the lymphedema in 1 patient. Patient 1 had an 8.5 × 3.5-cm elliptical excision of his right shoulder melanoma. The resulting scar was vertical and was centered on the skin at the midpoint of his right clavicle. This excision alone may explain the edema on his right arm. It is less likely that the primary excision contributed to lymphedema in the other 4 patients. Patient 4 had a 4.4-cm-diameter circular excision to fascia of her primary melanoma centered on the skin over her tendo calcaneus. The defect was repaired with a split-thickness skin graft. The patient noted no edema after the surgery. Seven weeks later, she underwent an SLN biopsy and developed edema on her dorsal foot. The SLN biopsy temporally correlates with her lymphedema. The excisions on patients 2 and 5 were on the back. Patient 4 had edema of her right ankle, but the primary melanoma was distal to this site on her right dorsal foot.
The postoperative course in 2 patients may have contributed to their lymphedema. Patients 2 and 3 developed a seroma and a hematoma, respectively. The seroma resolved with needle aspiration, while the hematoma spontaneously resolved. Both collections were less than 3 cm in diameter, but they may have induced fibrosis or other changes to the lymph node basin. Both patients followed their surgeons’ suggestions to limit movement of their affected limb for several weeks after the SLN biopsy.
Lymphedema is seen in at least 1.7% of patients who undergo SLN biopsy at our institution. The incidence may be greater, because we may not have complete follow-up data on all patients. However, it is probably lower than the incidence of lymphedema after complete lymph node dissection. After a traditional lymph node dissection, lymphedema is considerable and varies markedly by site. Lymphedema after axillary dissection ranges from 1% to 12%.6,8 Inguinal dissections carry a higher rate of lymphedema, ranging from 22% to 41%.3-5,8 Unfortunately, previous studies3-6,8 on lymphedema do not include information on the severity of edema observed. It is our experience that the incidence and severity of lymphedema after SLN biopsy is much lower than that following complete lymph node dissection.
Developments in medical oncology may reduce the need for SLN biopsies. Recently, a randomized trial19 has shown a benefit of interferon alfa-2b in patients with stage II melanoma. If the validity of this trial can be confirmed, especially in surgically staged patients, some patients may be treated with interferon therapy regardless of the presence of microscopic metastatic lymph node disease. However, the SLN biopsy procedure may still retain value for its prognostic abilities.1(pp11-35) Also, a recent study20 has suggested that patients with occult metastatic lymph node disease may benefit from a complete lymph node dissection. The SLN biopsy could be used to identify this subgroup of patients.
In summary, SLN biopsy was a major cause of the lymphedema in the 5 patients described. It occurs with an incidence of at least 1.7%. Some patients may have contributing causes for lymphedema other than the SLN biopsy, but these causes are difficult to modify or avoid. Reduction of seroma or hematoma formation may reduce the likelihood of lymphedema formation in some patients. Weight reduction in obese patients may decrease the likelihood of lymphedema formation, but the time from diagnosis of melanoma to the time of SLN biopsy is frequently short.
Accepted for publication August 28, 1999.
This study was supported in part by the Marion Gardner Jackson Trust, Bank of Boston, Boston, Mass.
Corresponding author: Arthur J. Sober, MD, Department of Dermatology, Massachusetts General Hospital, Bartlett 622, Boston, MA 02114 (e-mail: [email protected]).
S-Jed Cutaneous Melanoma. 3rd ed St Louis, Mo Quality Medical Publishing Inc1998;
et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg. 1996;224255- 263Google ScholarCrossref 3.Karakousis
U Groin dissection in malignant melanoma. Am J Surg. 1986;152491- 495Google ScholarCrossref 4.Dasmahapatra
CP Therapeutic groin dissection in malignant melanoma. Surg Gynecol Obstet. 1983;15621- 24Google Scholar5.Harris
RW Ilioinguinal lymph node dissection for melanoma. Surg Gynecol Obstet. 1973;13633- 39Google Scholar6.Harris
H Axillary lymph node dissection for melanoma. Surg Gynecol Obstet. 1972;135936- 940Google Scholar7.Bland
CO Isolated regional lymph node dissection: morbidity, mortality and economic considerations. Ann Surg. 1981;193372- 376Google ScholarCrossref 8.Urist
CM Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients. Cancer. 1983;512152- 2156Google ScholarCrossref 9.Morton
et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127392- 399Google ScholarCrossref 10.Krag
et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg. 1995;130654- 658Google ScholarCrossref 11.Reintgen
et al. The orderly progression of melanoma nodal metastases. Ann Surg. 1994;220759- 767Google ScholarCrossref 12.Ross
CM Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol. 1993;9219- 223Google Scholar13.Tanabe
D The role of sentinel lymph node mapping for melanoma. Adv Surg. 1997;3179- 103Google Scholar14.Kirkwood
et al. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996;147- 17Google Scholar15.Cottingham
C Sentinel node dissection in the treatment of melanoma: report of three cases and review of the literature. Dermatol Surg. 1997;23113- 118Google Scholar16.Bluestein
JHed Periarticular rheumatic complaints. Internal Medicine. 5th ed St Louis, Mo Mosby– Year Book Inc1998;1195- 1196Google Scholar17. Wolfe
et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33160- 172Google ScholarCrossref 18.Buchwald
D Fibromyalgia and chronic fatigue syndrome: similarities and differences. Rheum Dis Clin North Am. 1996;22219- 243Google ScholarCrossref 19.Pehamberger
et al. Adjuvant interferon alfa-2a treatment in resected primary stage II cutaneous melanoma: Austrian Malignant Melanoma Cooperative Group. J Clin Oncol. 1998;161425- 1429Google Scholar20.Cascinelli
et al. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial: WHO Melanoma Programme. Lancet. 1998;351793- 796Google ScholarCrossref
Sentinel Lymph Node Biopsy for Cutaneous Head and Neck Melanoma: Mapping the Parotid Gland
Sentinel lymph node biopsy (SLNB) for primary cutaneous head and neck melanoma (CHNM) has been shown to be successful and is the current standard of care for intermediate-thickness melanoma. We evaluated our experience with CHNM associated with SLNB mapping to the region of the parotid gland.
Retrospective review of a prospectively collected melanoma database identified 1014 CHNMs. Two-hundred twenty-three patients underwent SLNB, and 72 (32%) had mapping in the region of the parotid gland between May 1995 and June 2003.
The mean number of SLNs per patient was 2. 5. A sentinel lymph node (SLN) was successfully identified in 94% of patients, and in 12%, the SLN was positive for metastatic disease. Biopsy of intraparotid SLNs was performed in 51.4% and of periparotid SLNs in 26.4%, and a superficial parotidectomy was performed in 22.2%. Ten patients were found to have lymph nodes in the parotid region with metastatic disease (eight identified by SLNB), and two (20%) patients developed intraparotid lymph node recurrence in the setting of a negative SLNB. Same-basin recurrence in SLN-negative patients was 3.3% with a median follow-up of 26 months. Facial nerve dysfunction was identified in seven (10%) patients. Facial nerve function returned to preoperative status in all patients.
SLNB for patients with primary CHNM mapping to the parotid gland can be performed with a high degree of accuracy and a low morbidity consisting of temporary facial nerve paresis.
Facial nerve; Malignant melanoma; Parotid gland; Sentinel node.
Surgery For Melanoma Skin Cancer
Surgery is the main treatment option for most melanomas, and usually cures early-stage melanomas.
When melanoma is diagnosed by skin biopsy, more surgery will probably be needed to help make sure the cancer has been removed (excised) completely. This fairly minor operation will cure most thin melanomas.
Local anesthesia is injected into the area to numb it before the excision. The site of the tumor is then cut out, along with a small amount of normal skin around the edges (called the margin). The wound is usually stitched back together afterward. This will leave a scar.
The removed sample is then viewed with a microscope to make sure that no cancer cells were left behind at the edges of the skin that was removed.
Wide excision differs from an excisional biopsy. The margins are wider because the diagnosis is already known. The recommended margins vary depending on the thickness of the tumor. Thicker tumors need larger margins (both at the edges and in the depth of the excision).
The margins can also vary based on where the melanoma is on the body and other factors. For example, if the melanoma is on the face, the margins may be smaller to avoid large scars or other problems. Smaller margins might increase the risk of the cancer coming back, so be sure to discuss the options with your doctor.
In some situations, Mohs surgery (also known as Mohs micrographic surgery, or MMS) might be an option. This type of surgery is used more often for some other types of skin cancer, but not all doctors agree on using it for melanoma.
Mohs surgery is done by a specially trained dermatologist or surgeon. In this procedure, the skin (including the melanoma) is removed in very thin layers. Each layer is then looked at with a microscope. If cancer cells are seen, the doctor removes another layer of skin. This is repeated until a layer shows no signs of cancer. This is a slow process, often taking several hours, but it means that more normal skin near the tumor can be saved, which can help the area look better after surgery.
In uncommon situations where the melanoma is on a finger or toe and has grown deeply, part or all of that digit might need to be amputated.
Lymph node dissection
In this operation, the surgeon removes all of the lymph nodes in the region near the primary melanoma tumor. For example, if the melanoma is on a leg, the surgeon would remove the nodes in the groin region on that side of the body, which is where melanoma cells would most likely travel to first.
Once the diagnosis of melanoma is made from the skin biopsy, the doctor will examine the lymph nodes near the melanoma. Depending on the thickness and location of the melanoma, this may be done by physical exam, or by imaging tests (such as ultrasound or CT or PET scans) to look at nodes that are not near the body surface.
If the nearby lymph nodes are abnormally hard or large, and a fine needle aspiration (FNA) biopsy or excisional biopsy finds melanoma in a node or nodes, a lymph node dissection is usually done.
If the lymph nodes are not enlarged, a sentinel lymph node biopsy may be done, particularly if the melanoma is thicker than 1 mm. (See Tests for Melanoma Skin Cancer for a description of this procedure.) If the sentinel lymph node does not contain cancer, then there is no need for a lymph node dissection because it’s unlikely the melanoma has spread to the lymph nodes. If the sentinel lymph node contains cancer cells, removing the remaining lymph nodes in that area with a lymph node dissection is usually advised. This is called a completion lymph node dissection.
It’s not clear if a lymph node dissection can cure melanomas that have spread to the nodes. This is still being studied. Still, some doctors feel it might prolong a patient’s life and at least avoid the pain that may be caused by cancer growing in these lymph nodes.
A full lymph node dissection can cause some long-term side effects. One of the most troublesome can be lymphedema. Lymph nodes in the groin or under the arm normally help drain fluid from the limbs. If they are removed, fluid may build up. This can cause limb swelling, which may or may not go away. If severe enough, it can cause skin problems and an increased risk of infections in the limb. Elastic stockings or compression sleeves can help some people with this condition. For more information, see Lymphedema.
Lymphedema, along with the pain from the surgery itself, is a main reason why lymph node dissection is not done unless the doctor feels it is really necessary. Sentinel lymph node biopsy, however, is unlikely to have this effect. It’s important to discuss the risks of side effects with your doctor before having either of these procedures.
Surgery for metastatic melanoma
If melanoma has spread (metastasized) from the skin to other organs such as the lungs or brain, the cancer is very unlikely to be curable by surgery. Even when only 1 or 2 areas of spread are found by imaging tests such as CT or MRI scans, there are likely to be others that are too small to be found by these scans.
Surgery is sometimes done in these circumstances, but the goal is usually to try to control the cancer rather than to cure it. If 1 or even a few metastases are present and can be removed completely, this surgery may help some people live longer. Removing metastases in some places, such as the brain, might also help prevent or relieve symptoms and improve a person’s quality of life.
If you have metastatic melanoma and your doctor suggests surgery as a treatment option, be sure you understand what the goal of the surgery would be, as well as its possible benefits and risks.
Sentinel Lymph Node Biopsy – Malignant Melanoma
- Reference Number: HEY-259/2019
- Departments: Plastic Surgery
You can translate this page by using the headphones button (bottom left) and then select the globe to change the language of the page. Need some help choosing a language? Please refer to Browsealoud Supported Voices and Languages.
This leaflet has been produced to give you general information about sentinel lymph node biopsy. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.
What is a sentinel lymph node biopsy and why do I need one?
The doctor has explained that you have had a malignant melanoma removed. A malignant melanoma is a cancerous lesion and there is the potential for this cancer to spread to another area of the body through the lymphatic system. The lymphatic system is made up of vessels (similar to blood vessels) that drain away excess fluid from the body. The system also has lymph nodes, which filter lymph fluid and help fight infection. Large collections of these lymph nodes can be found in armpits, groins and the neck area. One of the places cancer cells could potentially spread to is a lymph node which drains the area the melanoma was removed from. This is called the sentinel node. The sentinel node is located and removed during the operation. This is usually performed at the same time as a wide excision procedure which is an operation performed to reduce the risk of melanoma recurring around the scar.
Sentinel lymph node biopsy is an operation to remove a lymph node to look for any evidence that cancer cells have spread. The lymph node is then sent away for analysis. Lymph node biopsy is a test that gives information about prognosis (the chance of the melanoma coming back). There is no evidence that this procedure improves overall survival from the disease. As there is no overall survival benefit from the procedure it is always your decision whether to have this procedure done. It is possible to perform the wider excision procedure without performing the sentinel node biopsy.
If you do opt to have a sentinel node procedure and the test results come back positive showing that melanoma cells have been found in the node this puts you in the American Joint Committee on Cancer (AJCC) staging group of stage 3. This could make you eligible for adjuvant treatments. Adjuvant treatments are in addition to the primary (initial) treatment you have had done to reduce the risk of the cancer recurring after surgery. Adjuvant treatment can be given either intravenously (a needle in the arm) every 4-6 weeks for immunotherapy or by taking tablets orally for targeted treatments. Treatment is intended for a year. The type of treatment you have will be dependent on the type of melanoma that you have.
|Possible advantages of sentinel lymph node biopsy||Possible disadvantages of sentinel lymph node biopsy|
|The operation helps to find out whether the cancer has spread to the lymph nodes. It is better than ultrasound scans at finding very small cancers in the lymph nodes.||The purpose of the operation is not to cure the cancer. There is no good evidence that people who have the operation live longer than people who do not have it.|
|The operation can help predict what might happen in the future. For example, in people with a primary melanoma that is between 1 and 4mm thick:
||The result needs to be interpreted with caution. Of every 100 people who have a negative sentinel lymph node biopsy, around 3 will subsequently develop a recurrence in the same group of lymph nodes.|
|People who have had the operation may be able to take part in clinical trials of new treatments for melanoma. These trials often cannot accept people who have not had this operation.||A general anaesthetic is needed for the operation.|
|The operation results in complications in between 4 and 10 out of every 100 people who have it.|
|If your sentinel node comes back positive you could be eligible for adjuvant treatments for a year to reduce the likelihood of recurrence.||Please note adjuvant treatments are not suitable for all patients and they do have side effects.|
What does the procedure involve?
The procedure involves two stages. The first stage is a diagnostic test and the second stage is when the surgery is performed.
The diagnostic test
The first stage of the procedure is to perform sentinel lymph node imaging (lymphoscintrigraphy) which will identify the location of the sentinel node. This involves injecting a small amount of radioactive liquid into the original scar from where your melanoma was removed. This may be is slightly uncomfortable depending on where your melanoma was removed from. The radioactive liquid then travels slowly through the lymphatic system; this usually takes about 2 hours. During this time you are free to do what you want; it may be a good idea to bring a book to read or something to occupy you.
The site of the original melanoma usually defines where the sentinel node will be found. For instance, if the melanoma was on the right leg the sentinel node is found in the right groin. If the melanoma was on the stomach or back the sentinel node could either be in the groins, armpits or neck. If this occurs it may mean more than one sample being taken from the lymph nodes.
After this period you will be asked to either lay or stand in front of a machine for a few minutes. The machine produces an outline of your body which is seen on the screens in the room. After a few minutes you will be able to see a glow developing on your body outline. This glow is produced by the radioactive liquid that was injected into your melanoma scar earlier. The radioactive liquid is taking the same journey as the cancer cells would take if they had entered your lymphatic system. This does not mean that cancer cells are present. The radioactive liquid has located the most likely place the cancer cells would go to – the sentinel node. The procedure may be done on the same day as your operation or the day before. If the procedure is being done the day before your operation, you will be able to go home or be admitted to the ward at Castle Hill Hospital.
The surgical procedure
On the day of your operation, you will be seen by the doctors and nurses and prepared for theatre. Preparing for theatre involves being placed into a gown and the possibility of wearing white stockings. These stockings may feel tight but they prevent blood clots from forming in the legs (deep vein thrombosis – DVT).
The surgery is usually performed under a general anaesthetic (while you are asleep) and involves the removal of the sentinel node. A blue dye is injected into the original scar from where your melanoma was removed. This dye then travels quickly through the lymphatic system to the sentinel node. Before this sentinel node is removed, the surgeon scans your body with a hand held gamma detector, which detects the presence of the radioactive material that you had injected. The surgeon is able to follow the radioactive material with this detector from your original melanoma site to the sentinel node. An incision (cut) is made into the area shown by the detector i.e. armpit, groin or neck. The surgeon will be looking for the presence of blue dye in one or more of the sentinel nodes. It is these lymph nodes that are then removed and sent away for analysis.
It is also necessary at the same time to remove some more of the surrounding skin from where you had your melanoma removed (wide excision). This is done to ensure that no cancerous cells are present. The wide excision is dependent on how thick your melanoma was. The wide excision wound is then stitched together or may require a local flap or skin graft to reconstruct the wound. A local flap involves skin being moved about and instead of being left with a straight stitch line you will have an unusual shaped stitch line. If you are having a skin graft you will be given a separate leaflet about what this involves.
Can there be any complications or risks?
Because this procedure is usually performed under a general anaesthetic there are the risks of DVT, pulmonary embolism (a clot in the lungs) and the chances of developing a chest infection are increased if you smoke.
Because you are having an incision made there are the risks of developing an infection, wound breakdown, permanent scarring, bruising and temporary numbness to the area. The blue dye used to locate the sentinel node at the time of your operation can leave a localised bluish tinge to the skin which may take up to 6 months to disappear. With the incision involving the removal of lymph nodes, which are usually there to get rid of excess fluid, there is a chance that you may develop temporary swelling around the area where your nodes are removed (seroma). There is a risk of developing generalised swelling of the area operated on (lymphoedema) and this needs to be brought to the attention of a health professional.
You may notice some discolouration in your urine for a few hours after surgery. This is due to the chemicals used in the lymphoscintrigraphy and dye during surgery.
The sentinel node can be found in 95% of patients. Occasionally no sentinel node can be found, but you will still be followed up closely as an outpatient.
How do I prepare for the operation?
Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.
Please take your medication as normal unless given other information by the pre admission nurses. The preadmission nurses will also inform when you should stop eating and drinking before your operation and what medication you can take.
What happens afterwards?
After this operation, most patients can go home the same day, but for some individuals it may be necessary to be kept in hospital for one night. If you are kept in hospital, the next morning the doctors will come and see you. As long as you feel fine, have recovered from the anaesthetic and there are no problems with your wounds, you will be allowed to go home. When you go home you must keep your wounds, which will be covered by dressings, clean and dry. If you notice any excessive leakage or bleeding from the area or you are concerned about anything, please do not hesitate to contact the ward you had your surgery on (you will be given their number on discharge), or the Plastic Surgery Outpatients (01482) 623085.
You should not do any strenuous exercise or lifting with the affected areas for at least 3 weeks. It is advised that you take 2-3 weeks of work to convalesce; the doctors on the ward or in the clinic can provide you with a Statement of Fitness for Work (formerly a sick certificate) for that period.
Once discharged from the ward you will be given an outpatient appointment for 10 – 14 days after your operation. At this appointment the nurses will remove your stitches if necessary and may re-apply a dressing. If the results from your biopsy (what has been removed) are back, you will be seen by a doctor. If not, a further appointment will be made. Once the results are back the doctor will go through them with you and explain them. If the results show that there are cancer cells in the sentinel nodes then they will discuss the need for possible further surgery with you. If the results come back clear (no cancer cells present) you will still be followed up regularly and examined because there is still a small chance (approximately 5%) for the cancer to spread.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact your Clinical Nurse Specialist
on tel no.(01482) 461078.
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
Removing the lymph nodes | Melanoma
Many people with early melanoma will not need to have any lymph nodes removed.
Learn more about:
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.
Side effects of lymph node removal
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.
90,000 BIOPSY OF SENDER LYMPH NODES IN PREVENTION OF REGIONAL RECURRENCES IN PATIENTS WITH LOCALIZED SKIN MELANOMA | Kudryavtsev
1. Anisimov V.V., Semiletova Yu.V., Barchuk A.S., Radzhabova Z.A. Topical issues of surgical treatment of patients with primary skin melanoma. Siberian Journal of Oncology. 2010; 2 (38): 55-8. [Anisimov V.V., Semiletova Yu.V., Barchuk A.S., Radzhabova Z.A. Problems in surgical treatment of patients with primary skin melanoma.Sibirskiy Onkologicheskiy Zhurnal (Siberian Journal of Oncology, Russian journal). 2010; 2 (38): 55–8 (in Russ.).]
2. Demidov L.V., Baryshnikov K.A., Martynova E.V., Samoilenko I.V., Kharatishvili T.K., Khatyrev S.A., Cheremushkin E.A. Wide excision is not a modern standard of surgical treatment of primary skin melanoma. Sarcomas of bones, soft tissues and skin tumors. 2013; 1: 54-9. [Demidov L.V., Baryshnikov K.A., Martynova E.V., Samoylenko I.V., Kharatishvili T.K., Khatyrev S.A., Cheremushkin E.A. Wide excision shoud not be considered as standart of care for primary cutaneous melanoma. Sarkomy Kostey, Myagkikh Tkaney i Opukholi Kozhi (Bone and Soft Tissue Sarcomas and Tumors of the Skin, Russian journal). 2013; 1: 54-9 (in Russ.).]
3. Braun-Falco O., Landthaler M., Hölzel D., Konz B., Schmoeckel C. Therapy and prognosis of malignant melanoma of the skin.Dtsch Med. Wochenschr. 1986; 111 (46): 1750-6.
4. Leong S.P. Paradigm of metastasis for melanoma and breast cancer based on the sentinel lymph node experience. Ann. Surg. Oncol. 2004; 11: 192-7.
5. Morton D.L., Thompson J.F., Cochran A.J., Mozzillo N., Nieweg O.E., Roses D.F. et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma.N. Engl. J. Med. 2014; 370 (7): 599-609.
6. Morera-Sendra N., Tejera-Vaquerizo A., Traves V., Requena C., Bolumar I., Pla A. et al. Value of sentinel lymph node biopsy and adjuvant interferon treatment in thick (> 4 mm) cutaneous melanoma: an observational study. Eur. J. Dermatol. 2016; 26 (1): 34–48.
7. Tsyb A.F., Kudryavtsev D.V., Kudryavtseva G.T., Smolyarchuk M.Ya., Davydov G.A., Gorban N.A. et al. Substantiation of the method and experience in the study of sentinel lymph nodes using domestic equipment and radiopharmaceuticals in patients with skin melanoma. Bulletin of lymphology. 2011; 1: 4-10. [Tsyb A.F., Kudryavtsev D.V., Kudryavtseva G.T., Smolyarchuk M.Ya., Davydov G.A., Gorban ‘N.A. et al. Substantiation of the method and experience in clinical investigation of sentinel lymph nodes in patients with cutaneous melanoma using domestic equipment and radiopharmaceuticals.Vestnik Limfologii (Messenger of Lymphology, Russian journal). 2011; 1: 4-10 (in Russ.).]
8. Tsyb A.F., Kudryavtsev D.V., Kudryavtseva G.T., Smolyarchuk M.Ya., Gorban N.A., Oleinik N.A. et al. Can sentinel lymph node study increase the survival rate of patients with clinically localized skin melanoma? Sarcomas of bones, soft tissues and skin tumors. 2012; 4: 34-40. [Tsyb A.F., Kudryavtsev D.V., Kudryavtseva G.T., Smolyarchuk M. Ya., Gorban ‘N.A., Oleynik N.A. et al. Can sentinel lymph nodes investigation improve the survival of patients with clinically localized cutaneous melanoma? Sarkomy Kostey, Myagkikh Tkaney i Opukholi Kozhi (Bone and Soft Tissue Sarcomas and Tumors of the Skin, Russian journal). 2012; 4: 34-40 (in Russ.).]
9. Uren R.F., Howman-Giles R.B., Thompson J.F., Roberts J., Bernard E. Variability of cutaneous lymphatic flow rates in melanoma patients.Melanoma Research. 1998; 8 (3): 279–82.
10. Reynolds H. M., Walker C. G., Dunbar P. R., O’Sullivan M. J., Uren R. F., Thompson J. F., Smith N. P. Functional anatomy of the lymphatics draining the skin: a detailed statistical analysis. J. Anat. 2010; 2 (16): 344–55.
11. Loyt A.A., Gulyaev A.V. Theory of lymphogenous cancer metastasis and proliferation.SPb .: Elbi-SPb; 2005. [Loyt A.A., Gulyaev A.V. Theory lymphatic cancer spread and proliferation. St. Petersburg: Elbi-SPb; 2005 (in Russ.).]
12. Gambichler T., Scholl L., Bechara F.G., Stockfleth E., Stücker M. Worse outcome for patients with recurrent melanoma after negative sentinel lymph biopsy as compared to sentinel-positive patients. Eur. J. Surg. Oncol. 2016; 42 (9): 1420-6.
13.Georgiev G.P. Molecular genetic mechanisms of tumor progression. Soros educational journal. 2000; 11 (6): 2-7. [Georgiev G.P. Molecular and genetic mechanisms of tumor progression. Sorosovskiy Obrazovatel’nyy Zhurnal (Soros Educational Journal, Russian journal). 2000; 11 (6): 2–7 (in Russ.).]
14. Fuller DM, Shields D. Molecular biology of the cell. M .: Binom-Press; 2006. [Fuller D. M., Shields D. Molecular basis of medical cell biology.Moscow: BinomPress; 2006 (in Russ.).]
90,000 Lymph node biopsy – the price of a lymph node puncture in the armpit, on the neck, in the groin in St. Petersburg
The lymphatic system filters the fluid around the cells. Lymph nodes are part of the immune system. They are found on the neck, behind the ear, underarms, inside the chest, abdomen and groin.
Lymph nodes are small glands that produce white blood cells (lymphocytes) that fight infection.They can trap germs that cause infection. Tumor cells can also spread through the lymphatic system.
Lymph nodes in healthy people are usually poorly felt. When people talk about swollen glands in the neck, they usually mean enlarged lymph nodes. The main areas where lymph nodes are easily felt, especially if they are enlarged, are:
- armpits (armpit),
- above the clavicle (supraclavicular group of nodes),
- on the neck (cervical nodes) and on the back of the head,
- just above the hairline (occipital group).
But with various pathologies, the lymph nodes in the neck, armpits or groin can enlarge and become painful. Swollen lymph nodes usually mean an infection. But their increase can also be caused by skin cuts, deep scratches or insect bites, tattooing, drug reactions, or cancer. For persistent enlargement, the doctor will recommend a lymph node biopsy.
Indications for biopsy, lymph node puncture
Typically, a lymph node biopsy (or more) is performed for:
- Determine the cause of enlarged lymph nodes that do not return to normal size on their own or after treatment.
- Determining the cause of symptoms, such as ongoing fever, night sweats, or weight loss.
- Tests to see if a known cancer has spread to the lymph nodes. This is called staging and is used to plan cancer treatment.
- Removal of a cancerous tumor that has spread to the nodes.
The list of contraindications for the procedure is small. Thus, a biopsy of the lymph nodes of the neck is not performed in case of severe deformity of the spine with the development of pathological kyphosis (forward bending).In addition, puncture of the lymph node or other options for sampling is not performed in case of severe disorders of the blood coagulation system due to the risk of profuse bleeding. Also, biopsy of the lymph nodes will be temporarily prohibited in the presence of purulent lesions, infection or various skin rashes in the area of the site of material sampling.
Relative contraindications include infections, fever, pregnancy and some other conditions, which are determined by the doctor.
Methods of biopsy sampling
There are several ways to get a lymph node biopsy.A sample of cells from the lymph node will be examined under a microscope for various problems. There are several options for obtaining biomaterial:
- Fine needle biopsy of lymph nodes (aspiration) . The doctor uses a fine needle inserted into the nodule to remove a sample of cells for later evaluation.
- Biopsy with thick rod needle . Surgeons insert a needle with a special tip, take a tissue sample about 3-5 mm in diameter.
- Open lymph node biopsy (surgical) .The doctor will make a small incision in the skin and remove the lymph node (lymph node excisional biopsy). If more than one lymph node is taken, a biopsy is called a lymph node dissection. An open biopsy and lymph node dissection allows your doctor to take a larger sample than a lymph node puncture.
Sometimes, if the sampling site is inconvenient enough, a lymph node puncture is performed under ultrasound control.
For a biopsy of a lymph node in the neck, puncture of the supraclavicular lymph node, axillary lymph nodes or in the groin, any other place, some preparation is required.It is necessary to inform the doctor if:
- you are taking any medications or dietary supplements, medicinal herbs;
- are allergic to certain drugs, including anesthetics;
- Previously experienced latex reaction;
- Drinking blood thinners constantly or if you have had bleeding problems;
90,039 are pregnant or there is a high likelihood of pregnancy.
If you are taking blood thinners, you may need to stop taking it one week before the biopsy.If the lymph node biopsy will be performed under local anesthesia, you do not need to do anything to prepare.
If the procedure is to be performed under general anesthesia (mediastinal lymph node biopsy, breast lymph node biopsy), be sure to follow the instructions on when to stop eating and drinking, otherwise the operation may be canceled. On the eve of the intervention, ultrasound, X-ray or blood and urine tests are sometimes prescribed.
Based on the type of procedure, for example, for fine-needle biopsy of the cervical, axillary lymph nodes, puncture of the inguinal lymph nodes the procedure is performed by a surgeon or oncologist, hematologist.If these are deep lymph nodes, CT or ultrasound control is used during material collection. The patient will need to remove all or part of the clothing. If necessary, the body will be covered with disposable sterile sheets. The doctor will pre-anesthetize the place where the needle will be inserted. When the area is numb, the needle is gently inserted through the skin and into the lymph node. The patient’s immobility is important throughout the manipulation. The doctor receives a tissue sample and slowly removes the needle. A plaster is glued to the puncture site.Fine needle aspiration biopsy takes 5 to 15 minutes.
Sentinel lymph node biopsy is sometimes performed with a rod needle . It is performed by a general surgeon or oncologist. The doctor will numb the area where the needle will be inserted. After the area is numb, a small incision is made in the skin. A needle with a special tip is passed through the skin into the lymph node. During the procedure, you need to lie still. After insertion of the needle, a sample of cells is taken and the needle is removed.Pressure is applied to the injection site, stopping the blood, an adhesive bandage is applied. A core needle biopsy takes about 20 minutes.
Open sentinel lymph node biopsy is performed by an oncologist surgeon. To remove lesions near the surface of the skin, the incision site is numbed with a local anesthetic. Sentinel lymph node biopsies deeper in the body or for lymph node dissection may require general anesthesia.
The patient lies on the surgical table and the body is positioned so that the doctor can take a biopsy sample.The skin over the biopsy site is cleaned with a special solution. The area is covered with a sterile sheet. A small incision will be made so that you can remove all or part of the lymph node. After its removal, the skin is sutured, a bandage is applied, on average, the procedure lasts up to an hour. The patient is placed in a recovery room until fully awake. The next day they let him go home.
After lymph node biopsy
After fine-needle aspiration biopsy of the lymph node under the armpit or puncture of the lymph node in the neck with a rod needle, the area of the fence may be slightly painful for up to 2-3 days.Let’s say a small bruise around the puncture site. If there was general anesthesia for an open biopsy, you may feel tired for a couple of days. Throat discomfort is also possible if an anesthetic breathing tube was used. Throat lozenges and gargling with warm salt water may help with sore throat.
After an open biopsy , the area may feel painful, hard, swollen and bruised. Fluid may collect near the biopsy site. An ichor may also leak from the biopsy site.You can use an ice pack or take an over-the-counter pain reliever (not aspirin) to reduce swelling and mild pain. The swelling should go away in about a week, and the bruise usually goes away within 2 weeks. But swelling at an armpit lymph node puncture or inguinal lymph node biopsy can last from 6 to 8 weeks. You can not lift weights and strain the muscles in this area.
A doctor can do a lymph node puncture to confirm or exclude a diagnosis (infection, immune system problems, oncology).A lymph node biopsy removes tissue that can be examined under a microscope for signs of infection or disease, such as cancer. Lymph node biopsy results are usually prepared within a few days. Some types of infections may take longer to identify. The lymph node sample is usually treated with special dyes that stain the cells and make problems more visible.
Signs of infection, such as mononucleosis, tuberculosis, may be present in the abnormal node.Cancer cells, including metastases, can be detected.
In our clinic, you can perform a puncture or excisional biopsy of the lymph node, and the price of the manipulation will be quite affordable. Before carrying out, a doctor’s consultation and examination are required, which can be included in the cost of a lymph node biopsy or are carried out separately. More details can be found by calling the clinic or on the website.
Excisional biopsy of the lymph node – indications for conducting, as it is carried out, the result after the study
Excisional lymph node biopsy: indications, possible complications
A little about biopsy
Lymph node biopsy has two main purposes:
- Detection of oncological diseases;
- Identification of an infectious process in the lymph nodes.
Lymph nodes are an important element of the body’s immune system, working as “barriers” to the lymphatic vessels.
Lymph penetrates into all internal organs and tissues of a person just through the lymphatic vessels. But along with the lymph, unwanted bacteria and cancer cells can penetrate. And here the lymph nodes trap the oncocells. Such lymph nodes are called regional.
While developing, the cancer focus can give metastases, which affect, first of all, the nearby organs.Oncological diseases of the lungs and lymphoproliferative diseases often metastasize to the supraclavicular and cervical lymph nodes.
Diagnostics of the lymph nodes makes it possible to understand whether there are pathogenic cells in them.
In most cases, the manipulation is carried out using a needle and syringe. This process is called a needle aspiration biopsy.
Increasingly, lymph nodes often signal the presence of pathologies, some of which are:
- Metastatic lesion;
Using the diagnostic technique, the doctor gets the opportunity to determine the optimal treatment tactics. The technique is highly informative, but it must be remembered: the positive result of the study remains so, but the negative one can be erroneous.
The latter happens more often in the form of the fact that pathogenic cells simply do not enter the seized material (biopsy).
After the procedure, the biopsy is examined histologically or immunohistochemically.
The problem is that a biopsy sample obtained during puncture manipulation is not enough to carry out these studies.
Excisional lymph node biopsy is a procedure to remove them. It is performed through small incisions. As a result of the intervention, the lymph node is completely removed, using local anesthesia for pain relief.
After removal of the lymph node, it is sent for histological examination.
This approach makes it possible to:
- Lymphoma detection;
- Definitions of the type of disease;
- Determination of optimal treatment tactics.
If, as a result, pathogenic cells are identified, surgical intervention is used.
Indications and Contraindications
In most cases, the procedure is indicated for the purpose of detecting cancerous tumors.
So, in case of skin melanoma, a study of sentinel lymph nodes located in the immediate vicinity of the tumor focus is carried out.This helps to determine the stage of the disease, as well as determine the treatment tactics.
Suspected lymphoma is another indication. When the lymph node is removed and examined, the doctor has an idea of the exact type of pathology, which, in turn, is crucial when choosing a treatment strategy.
The procedure can be indicated for the purpose of detecting non-oncological diseases such as tuberculosis, lymphadenopathy, sarcoidosis, etc.
There are a number of other indications for conducting a study:
- Lack of results in long-term treatment of enlarged lymph nodes;
- Enlarged lymph nodes are palpable on palpation, but there is no pain, there are signs of intoxication;
- The size of the lymph nodes is> 1 centimeter.
Any intervention has a number of contraindications. In the case of the described technique, they become:
- Suppuration of lymph nodes and adjacent tissues;
- Poor blood clotting;
- Curvature of the cervical spine, some others.
How to do
The patient needs to prepare for the procedure in advance.
To do this, he must pass the tests and urine tests prescribed by the doctor.When performing a study of the cervical lymph nodes, an X-ray examination may be prescribed. It is necessary to exclude kyphosis of the spine.
Excisional biopsy is otherwise called open: it requires access to the lymph node. The manipulation is carried out in the operating room.
Before the intervention, the required area is treated and anesthetized. As we have already noted, local anesthesia is often used, in some cases intravenous anesthesia may be indicated.
In the projection of the lymph node, the doctor makes an incision in the skin, after which he exfoliates the tissue and, reaching the lymph node, removes it.
After the completion of the manipulation, the incision is sutured. The duration of the entire procedure can range from ten minutes to half an hour. It all depends on the complexity.
The patient receives a doctor’s recommendation regarding the recovery period. Usually this period is quick and easy, it does not require serious restrictions.
The results of the study are ready in a week – ten days after the procedure. It takes a long time because the process of preparing the slices is laborious. In addition, sometimes it becomes necessary to clarify the diagnosis by means of immunohistochemistry.
Having received a conclusion from the laboratory, the doctor makes a final diagnosis and prescribes the necessary treatment.
Complications with any intervention may appear.In our case, they can be as follows:
- Bleeding during manipulation;
- Numbness in the manipulation area;
- Tumor at the puncture site, which lasts for a long time;
- Temperature rise and some others.
If symptoms of complication appear, you need to see a doctor.
Clinic for Integrative Oncology Onco.Rehab is always on guard for your health!
Results of the interregional online seminar “Melanoma of the skin and mucous membranes of the head and neck: problems of diagnosis and clinical practice.” In April, the First Oncological Hospital hosted an online seminar “Melanoma of the skin and mucous membranes of the head and neck: problems of diagnosis and clinical practice”, which was attended by oncologists specializing in head and neck tumors from Moscow clinics, oncologic dispensaries of the Samara and Astrakhan regions.This is the second online seminar in 2020, which this time covered the most pressing issues in the treatment of head and neck melanoma and attracted specialized specialists from the regions to participate. The aim of the seminar, as the leading doctor of medical sciences, head of the department of surgery of head and neck tumors of the Oncological Hospital No. 1 Sergey Anatolyevich Kravtsov emphasized, is the exchange of practical experience between oncological clinics, which will help colleagues from the regions more effectively adapt the latest technical and practical recommendations leading scientific institutions for the treatment of malignant tumors.The incidence of melanoma is constantly growing, and the peculiarities of tumor development very often make cancer aggressive and unpredictable, even for an experienced doctor. About 90% of deaths from skin cancer are due to melanoma. The five-year survival rate at the first stage of the disease is 92%, and at the fourth only 10%. Early detection of melanoma is still low. According to the latest data from the Cancer Registry in Russia, the dynamics of the incidence is increasing in both sexes, but is more common in women. The peak incidence of melanoma is between 65 and 70 years of age.Extended comprehensive diagnostics is necessary to assess the prevalence of the tumor, predict the development of the disease and determine the tactics of treatment, Dr. Kravtsov said in his speech. He spoke about the aspects of modern diagnostics and therapy of melanoma. With this approach, even unresectable cases can be treated by removing symptomatic foci of metastases and applying systemic therapy, depending on the presence of BRAF mutations. In the early 2000s, stage 3 melanoma was divided into four substages.Stage IIID turned out to be very similar in aggressiveness to stage IV, which is why such patients began to be prescribed adjuvate systemic therapy and immunotherapy regardless of BRAF status. This therapeutic approach has improved the survival rate of metastatic melanoma in many patients over five years. Based on these data, in 2020, new recommendations of the Ministry of Health were formed for inoperable patients with melanoma, which should increase life expectancy. The second presentation focused on the importance of sentinel lymph node examination for effective treatment of melanoma.He was introduced by Dr. med. Head of the Department of Soft Tissue Tumors of the Oncological Hospital No. 1, Oncologist Dmitry Vladimirovich Kudryavtsev. The need for a minimally invasive biopsy of sentinel lymph nodes in the early stages is due to the fact that approximately 20% of patients with localized melanoma of the skin have subclinical metastases, despite the lack of clinical and instrumental data on the defeat of the lymph nodes, Dr.Kudryavtsev explained the results of clinical observations.The largest amount of lymph, carrying immunological information and tumor cells, enters the sentinel lymph node of the first order (from the localization of the tumor). This makes it the most likely target for regional metastasis. Sentinel lymph node biopsy can identify metastases that cannot be identified using non-invasive diagnostic methods. A positive result about a hidden lesion of the lymph node helps to clarify the stage of tumor development and determine the most effective treatment tactics.The head of the department of the Samara Regional Oncological Dispensary, oncologist Alexander Aleksandrovich Makhonin spoke about the diagnosis and treatment of melanoma of the mucous membranes of the upper respiratory and digestive tract. This is a rare and difficult to diagnose group of oncological diseases with a high metastatic potential, for which there is no single approach to treatment and diagnosis. Three genes are associated with melanoma of the mucous membranes (BRAF, NRAS, KIT), however, molecular genetic analysis for mutations is not yet routinely practiced due to its rare prevalence.The main approach in the treatment of these types of tumors remains surgical intervention – block resection or endoscopic resection, which is performed in conjunction with radiation, targeted and immunotherapy, Makhonin said. The modern possibilities of head and neck melanoma surgery were also discussed by Dr. med. Head of the Oncology Department of the City Clinical Hospital. Bakhrushin brothers, oncologist Nikolai Viktorovich Krivonos. He emphasized that in order to achieve the best therapeutic results, the algorithm for planning a surgical intervention should be carried out based on the availability of cytology results, data on tumor thickness, as well as possible damage to regional lymph nodes.Dr. Krivonos also pointed out the importance of postoperative evaluation of the removed tumor preparation. During the seminar, many interesting clinical cases were discussed. One of them was told by the head of the department of the Astrakhan regional oncological dispensary, oncologist Vladimir Yurievich Yarovoy, who for two years observed a complex patient with melanoma of the scalp. In an elderly man, metastases in the lymph nodes and other organs were confirmed, the main method of treatment after surgery was immunotherapy, however, concomitant metabolic and cardiovascular pathologies ruled out a positive outcome of treatment.As part of the final discussion, the specialists discussed the tactics of treating other patients and expressed interest in regularly sharing their results with colleagues. According to the current results, specialists will publish review scientific articles. In 2020, a whole cycle of online events is planned that will cover the most pressing issues in the treatment of head and neck tumors. Regular meetings will allow specialists to exchange experiences and discuss current clinical cases. According to Sergey Anatolyevich Kravtsov, this approach will help develop and adjust the treatment plan for the most complex clinical cases, based on the experience of leading Russian specialists.You can watch the full webinar at the link: https://youtu.be/KYGN6skE_LU
A new meeting of specialists is scheduled for the end of May 2020, during which it is planned to discuss the features of treatment of patients with malignant neoplasms in the head and neck area in a pandemic … – City Clinical Oncological Hospital 1 – GBUZ GKOB 1 DZM
SUN AND CANCER: tips doctor – oncodermatologist.
With the onset of sunny days, many of us strive to get a beautiful bronze skin tone as soon as possible.And some for the sake of tanning are ready to “fry” in the sun to a state of fire.
What are the consequences of such ill-considered behavior? How to reduce the likelihood of encountering serious diseases such as skin tumors and melanoma? What precautions need to be taken when the summer season begins? How to distinguish benign neoplasm from malignant skin tumors? What methods of early diagnosis and treatment are there in modern medicine? Doctor of Medical Sciences Dmitry Vladimirovich Kudryavtsev, Head of the Department of Skin Tumor Surgery at the City Clinical Oncological Hospital No. 1 in Moscow, oncologist, surgeon, tells about this.
Sun: friend or foe?
The sun gives us life. It carries light and warmth, under its influence, the necessary vitamin D is synthesized in the skin, which, according to recent studies, affects many aspects of health and, among other things, has an oncoprotective property. Under the influence of sunlight, the human body produces substances that improve our mood.
On the other hand, the sun can take this life away. Since its excess is fraught with the development of health problems.Some of them are not dangerous. For example, diseases provoked by excessive ultraviolet irradiation, such as basal cell and squamous cell carcinoma of the skin – the most common tumors that can be caused by the sun, in most cases are curable and, after treatment, may resemble only cosmetic defects of a greater or lesser degree. This is unpleasant (80% of basal cell carcinomas are localized on the face), but, in most cases, not fatal.
However, there is another group of more formidable diseases: melanoma, Merkel’s cancer, dermatofibrosarcoma.The rise in the incidence of melanoma is of particular concern today. It develops rapidly and is most often detected already at a late stage, when treatment, including, in addition to surgery, the most modern drugs, may be ineffective. Therefore, the mortality rate in this malignant skin tumor is high, and the combination of young age, aggressiveness of the course and resistance to drug treatment – leads to the statistical effect of the largest number of “undelivered years” among all adult tumors.
In addition to tumors, there are still many unpleasant changes that occur to the skin under the influence of UV radiation – it thickens, dries out, its elasticity decreases, pigmentation becomes uneven, and certain areas of the skin remain pigmented in winter, that is, the processes of photoaging of the skin develop … All this also brings discomfort and disrupts the quality of life.
Skin phototypes and risk groups.
We are white, but this was not always the case.According to studies of human genetic history, Europe, by our Cro-Magnon ancestors, was inhabited about 30-40 thousand years ago. They came through the Middle East from Africa, while displacing the Neanderthals who lived here. Over the many millennia of living in northern latitudes, we have lost the initially darker color of our skin, at the cost of losing our ability to protect ourselves from the sun’s load in southern latitudes. White skin is an adaptive response of the inhabitant of northern latitudes, which allows us to produce enough vitamin D so that we do not die from rickets.
So the tan we used to boast about after vacation is a vestige of dark skin. The same as the tailbone left in our place of the tail. Alas, tanning, as a rudiment, only slightly protects the skin from ultraviolet radiation, the quanta of which have a higher energy than visible light and are capable, unlike the latter, to destroy chemical bonds. In simple chemical compounds, we can see this effect in the form of paint fading in the sun or destruction of many types of plastics.In humans, ultraviolet light can damage molecules in the skin, in particular, collagen degradation, but more dangerous for us is damage to DNA molecules, which leads to the formation of mutations and the development of diseases associated with this phenomenon.
However, the residual rudimentary activity of pigment defense among the white race is not uniform. In general, according to the degree of pigmentation, six skin phototypes are distinguished. The last one is the first: white skin, blonde hair, blue eyes. It is difficult for them to sunbathe, their skin immediately turns red in the sun, they burn easily, pigmentation is practically not formed.On the other hand, the sixth phototype is black skin, dark hair and dark eyes. These are the inhabitants of Central Africa, with a high degree of protection from ultraviolet radiation. The rest of the phototypes are distributed between these two.
In our strip, the first, second and third phototypes are mainly widespread. The second phototype is people with light brown hair, gray, green or blue eyes. They often get sunburn, their tan does not last long, and the skin peels off quickly. The third is more common among the Caucasian peoples.The Arabs have the fourth phototype.
The smaller your phototype, the more likely you are to develop sunburn and malignant skin diseases. The most vulnerable to them are people with the first and second phototypes, as well as those with a large number of moles on the skin.
How to sunbathe correctly?
Almost any disease can be prevented through prevention.
What are the main ways to prevent sun damage to the skin? Of course, ideally, you need to be as careful as possible while in the sun.Beach vacation is contraindicated for people with the first phototype and very limited for the second.
However, if you are determined to sunbathe, do so wisely. Remember that after winter we are especially vulnerable to UV radiation. The first rays of the sun appear in our latitudes in conditions when there is still no dust in the atmosphere that partially scatters the radiation of the sun, therefore the effect of solar radiation in early summer is especially high. And the melanocytic (pigment-forming) system of the body needs at least two weeks of “training” from the moment of the first exposure to the sun on the skin to the first full-fledged tan, which can already “cover” the skin from ultraviolet radiation.During this time, melanocytes are activated and have time to produce the maximum possible amount of melanin pigment, which absorbs the energy of ultraviolet quanta, gradually slowly degrading at the same time.
Golden southern tan is the color of burnt melanin. Only after two weeks of short-term meetings with the sun can you gradually increase the load, because the risks of “burning out” will decrease.
However, as a rule, our vacation lasts exactly two weeks. In this case, you can give advice from the category – “we choose the lesser of two evils.”In order to prepare the skin for the southern sun and save it from burns, it makes sense to visit a solarium before going on vacation for one, or preferably two weeks. Increase the sessions from 1 minute every other day to 7-8 minutes, depending on the power of the lamps: this way you will achieve the appearance of a protective pigment layer in the skin and will be able to sunbathe with the least risk.
Be sure to use sunscreen.
There are recommendations from the World Health Organization for the choice of sunscreen depending on the type of skin.WHO recommends using products with an SPF of at least 15. Inhabitants of our latitudes need to start at 30, and preferably at 50, in order to get good protection from the damaging effects of ultraviolet radiation.
Dress right: which is better – a hat or a baseball cap?
Clothes on hot days must also have a protective function. For example, look at the Arabs: over the centuries of living in hot countries, they have developed a completely recognizable style of clothing: it fully protects exposed areas of the skin. Long sleeves, closed face, closed legs.Covering your face is not necessary, of course. But you can protect it by wearing a wide-brimmed hat. The baseball cap leaves the ears open, which are very easy to burn. Eyes must be protected with dark glasses. After all, blue eyes are the same risk as light skin, the cornea is not protected. Choose glasses with polarizing filters.
By the way, in Australia, where many Irish people with the first skin phototype live, who migrated here at one time, they suffer greatly from the sun, and the incidence of basal cell skin cancer occurs as often as we have a runny nose.In addition, among them there is a very high, ten times higher than ours, the incidence of melanoma. Therefore, for many years, closed clothes, shoes and wide-brimmed hats have been promoted in the country. These measures have slightly reduced the incidence of melanoma in Australia.
If a formation appears on the skin.
Any formations on the skin require attention. If some of them undergo changes (increase in size, change in color) within several months, this is no longer the norm: it is necessary to find a dermato-oncologist.Do not self-medicate, do not do any moxibustion with celandine or iodine. Organic acids cause chemical coagulation of the skin, but skin depth may not be sufficient without treatment. Only a specialist can determine the tactics of observation or treatment. Remember that melanoma detected at an early stage is incomparably less life-threatening than with its advanced forms.
Today, specialists have a good number of methods that allow differentiating formations even without cytological research methods.An experienced doctor, already by the type of education, can often make a diagnosis and even determine its prognosis. In particular, a non-invasive diagnostic method, dermatoscopy, is widely used – examination of the formation with a device emitting special light that overcomes the reflective properties of the upper stratum corneum, which allows you to better see the structure of the formation, as well as with a high probability of diagnosing its belonging.
The correct diagnosis determines the prognosis and allows you to accurately select the methods of prevention and treatment that can improve it.But for this it is better to contact a specialist who deals with this problem on a daily basis.
There are also many treatment methods today. These are both photodynamic therapy and cryodestruction. However, despite the development of minimally invasive technologies, surgical methods today give the best results in treatment. The main thing is to contact a specialist in time!
Photo credit: play.howstuffworks.com
Melanoma – diagnostics, treatment, appointment with a doctor of the Oncology Center Medicine 24/7
Melanoma is a dangerous malignant tumor that develops from melanocytes – cells responsible for skin color and its changes during sunburn.Most often, this tumor develops on the skin, with the most vulnerable areas exposed to frequent sun exposure. However, melanoma can appear in other organs where there are melanocytes – for example, on the retina of the eye, or on the oral mucosa.
Why is melanoma so dangerous?
Melanoma is a very aggressive tumor prone to rapid invasive growth deep into tissues and active metastasis. Tumor cells that travel with the flow of lymph or blood can affect both the nearest lymph nodes and distant organs – the liver, lungs, bones, brain.
How to remove melanoma and how best to do it
Removing melanoma is not only possible, but also necessary – at present, surgery remains the main treatment option for melanoma. In this case, the tumor must be removed radically, that is, completely, otherwise the melanoma can continue its growth from the remaining cells. For this reason, cryodestruction or laser removal is not used to remove melanomas or formations suspicious of melanoma – it is too likely to leave tumor cells invisible to the eye in the tissues and provoke their active spread throughout the body.
It is also necessary to conduct a histological examination of the removed tissues (this, again, cannot be performed with cryodestruction or laser ablation of the tumor). The specialist will study the microscopic structure and properties of the removed tissues, as well as the thickness and depth of tumor growth in the case of a malignant lesion. These data will form the basis for the diagnosis, the stage of the disease and the determination of the tactics of further treatment. Immunohistochemical and genetic testing of melanoma tissue, in turn, will make it possible to assess the susceptibility of tumor cells to various options for drug therapy and to clarify the prognosis.
In general terms, the cause of melanoma is always the same – a change in the cell’s DNA that affects its further behavior. Malignant cells begin to grow and divide rapidly, their programmed death does not occur, while they are very weakly connected to each other and are ready to go “free swimming” through the body with the flow of blood or lymph.
With regard to melanoma, one of the proven causes of malignant cell degeneration is exposure to ultraviolet radiation.Moreover, its source is not important – it can be either natural sunlight or solarium lamps. It has been proven that when you visit a tanning salon more than 20 times a year, your risk of developing skin cancer doubles. Sunburns also provoke melanoma, especially if they occur repeatedly. People with pale skin, multiple moles and age spots, or with a hereditary predisposition to malignant skin diseases are even more at risk.
How does melanoma manifest, what should you look for when examining your skin?
There are several characteristic features of melanoma:
- May resemble an ordinary mole
- usually of irregular asymmetric shape, and its edges are uneven and indented;
- the color is uneven or changes over time;
- large size (more than 6mm), or its size changes;
- There may be peeling or sores on the surface.
If during self-examination you find a formation that is characterized by any of the above signs – consult your oncologist, the sooner melanoma is suspected, the higher the chance of successful treatment.
Other possible causes of tumor development
Another, no less important mechanism for the development of melanoma is the trauma of a mole or a pigment spot. Benign skin lesions can be injured by clothing or during contact sports, and when located on the scalp, when shaving or cutting.
Inflammation is one of the theories of the causes of oncological diseases, and regular trauma will necessarily be accompanied by inflammatory reactions. In this case, the cells of a benign formation may begin to change due to the constant need for restoration, at first these changes will be characterized by the term “dysplasia”. In the future, with the continuation of the irritating effect, their malignant transformation may well occur.
What is the best way to deal with an injured birthmark?
First of all, it must be shown to the oncologist, and he will already make a decision on the need to remove it.If melanoma is suspected, it is necessary to remove the tumor completely, indented along the looking healthy skin, since some of its cells may not be visible to the eye. The tissues obtained in this case will need to be sent for histological examination – only it allows you to confirm or exclude the diagnosis of “melanoma” with maximum accuracy.
You can make an appointment by phone: +7 (495) 230-00-01
Every person has moles and age spots on the skin, and their size and number usually increase with age.Most of these formations do not pose a threat to human health, but malignant tumors can also appear among them, the most dangerous of which is melanoma.
We will call you back
Leave your phone number
What signs of skin melanoma can be seen with the naked eye on examination?
- Asymmetry, irregular shape of the mole.
- Rough, “geographic” or “blurred” edges of the formation.
- Uneven color – a mosaic combination of dark and light areas, a gradual color change from one edge of the formation to the other.
- Size – large moles, more than 6 mm in diameter, are more suspicious.
- “Restlessness” of education – the presence of itching, pain, inflammation, ulcers, or peeling.
Even the presence of one of these symptoms is a good reason to consult a doctor for examination for melanoma, but the greatest suspicion should be caused by the appearance or disappearance of these signs over time, including a sharp decrease in the mole or its sharp lightening.
Identifying melanoma at the initial stages of the disease is often within the power of only an experienced specialist.
Can melanoma develop imperceptibly?
It should not be forgotten that some possible localizations of melanoma are practically inaccessible during self-examination – for example, the scalp or the central part of the back, and some are completely impossible to examine without special instruments – these are the nasal mucosa and the retina of the eye.
Most often, melanoma in the initial stages looks like an uneven dark speck on the skin, however, in about 5% of cases, a pigmented form occurs.It can be pink, purple, red, or the same color as the surrounding skin, and still look like a scar or roughness.
Melanoma cells are very weakly connected to each other, breaking away from the main tumor, they can move through the body with the flow of lymph or blood, affecting other organs and leading to the appearance of growing metastases in them. Enlarged lymph nodes, the presence of nodules in the liver, lungs, bones, brain can also be signs of melanoma.Often only at this stage of the disease, the patient begins to significantly disturb the general state of health, symptoms such as headaches, coughs, and bone pains may appear.
If you find any of the symptoms of melanoma, do not delay visiting a doctor, only a specialist will help you plan the necessary examinations, and, upon confirming the diagnosis, will offer a treatment option. You can sign up for a consultation by phone: +7 (495) 230-00-01
Methods of prevention of melanoma are now well known – doctors recommend avoiding exposure to direct sunlight, using sunscreen and not overusing tanning beds.Unfortunately, compliance with these rules can only significantly reduce the risk of developing melanoma; it is impossible to insure against its occurrence by 100%. However, in the initial stages, melanoma responds well to treatment; early diagnosis is key here.
What activities are carried out for the timely diagnosis of melanoma?
A big step towards early detection of melanoma was the annual Melanoma Diagnostic Day, during which free screening examinations for skin malignancies are carried out.Melanoma Diagnostics Day is held both in Moscow and in other cities throughout Russia – for example, in 2016, more than 1000 doctors from more than 90 cities took part in the program. The Diagnostic Day is traditionally held in May – before the start of the swimming season, and in addition to screening is educational in nature.
It is not always easy for a doctor to distinguish melanoma from benign lesions. In our center, consultations and treatment are carried out by experienced qualified specialists using modern high-precision equipment, which ensures optimal accuracy and speed of diagnosis.
What should be alarming when examining moles and age spots?
Moles that change in size or color should not be ignored, especially if they begin to itch, peel off, or a small ulcer has appeared on their surface. In addition, in about 5% of cases, melanoma may not differ in color from the surrounding skin, and at the same time look like a scar or an insect bite mark. It is possible to determine such a pigmented melanoma, as well as to distinguish skin cancer from a benign pigmented nevus, using a special device – a dermatoscope.It allows you to diagnose skin melanoma with high accuracy without damaging the tumor itself, which is the key to successful further treatment.
Tests for suspected melanoma
Almost always, a biopsy is required for the final diagnosis – removal or resection of a suspicious formation. In some cases, the removal of the “sentinel lymph node” – the most likely organ of the lesion in case of melanoma metastasis, is also indicated.The removed tissues will be sent for histological examination, the doctor examines specially prepared and stained tissues under a microscope, assessing cell changes and the presence of tumor cells at the edges of the material. Also, if necessary, additional studies will be carried out with reagents that will accurately determine the type of tumor. If the diagnosis is confirmed, a BRAF mutation test is extremely important, which can also be performed on the material obtained during the operation. The presence or absence of a BRAF mutation will play an important role in choosing a drug for the treatment of melanoma.
Given the high tendency of melanoma to metastasize, even with small tumor sizes, if melanoma is suspected, a number of additional examinations are required. In order to assess the size of the main tumor and the presence of metastases, ultrasound examinations, computed and magnetic resonance imaging, scintigraphy and a number of other methods are used.
For a timely diagnosis of melanoma, it is recommended to consult an oncologist or dermatologist at least once a year.Sign up for a scheduled examination by phone: +7 (495) 230-00-01
The material was prepared by the deputy chief physician for medical work of the clinic “Medicine 24/7”, candidate of medical sciences Sergeev Petr Sergeevich.
- Demidov L.V., Sokolov D.V., Bulycheva I.V., Shashkov B.V., Makhson A.N., Vorozhtsov G.N., Kuzmin S.G., Sokolov V.V. methods for the diagnosis of skin melanoma // Vestn. RONTS them. N.N.Blokhin RAMS.2007. No. 1.
- Demidov LV, Barchuk AS On the issue of surgical treatment of superficial forms of skin melanoma // Vopr. oncol. – 1998. – T. 44, No. 2. – S. 149-153.
- Marochko A. Yu., Kosykh N.E., Bryantseva A.I., Borovskaya T.F., Mayatskaya T.M., Krylova I.E., Zmeul V.K.Metastases of melanoma without a detected primary focus // Far Eastern medical journal. 2009. No. 1.
- Fradkin S.Z., Zalutsky I.V. Melanoma of the skin. – Minsk: Belarus, 2000 .– 221 p.
Skin melanoma – HealthInfo
The average incidence of skin melanoma varies from 3-5 cases per 100 thousand.people per year in the Mediterranean countries up to 12-20 cases per 100 thousand people. per year in the Nordic countries and continues to grow. The mortality rate is 2-3 cases per 100 thousand people. per year with little variation depending on geographic location, and has remained relatively stable over the past decade. However, the death rate in men, in contrast to women, has increased over the past 25 years. The increased exposure to ultraviolet radiation in genetically susceptible populations is at least partly responsible for the continuous increase in the incidence over the past decades.
Suspicious formations are characterized by asymmetry, blurred borders, uneven color, as well as changes in color, level and size during the last months (“ABCD rule”). Currently, many primary neoplasms are less than 5 mm in diameter [B]. Demographics by an experienced physician increase diagnostic confidence [B].
The diagnosis should be made after performing a complete excisional biopsy of the tumor formation indented from the edge of the tumor, followed by morphological examination of the material in a specialized oncological institution.
The histological report must comply with the AJCC (American Joint Cancer Committee) classification and include the maximum tumor thickness in millimeters (according to Below), the level of invasion (according to Clark IV), the presence of ulceration, the presence and severity of signs of regression, and the distance to the edges of resection … However, at a certain point, the assessment of the level of invasion according to Clark was omitted and replaced by the determination of the rate of mitosis in the primary tumor.
A general examination of the patient and special attention to suspicious pigmented skin lesions, satellite lesions, transient metastases, regional lymph node metastases and systemic metastases are required [V, D].
For melanoma with a low risk of recurrence (thickness
Revised version of staging and classification of AJCC, including staging of the sentinel node, is the only recognized international classification (Table 1).
Treatment of local stages
Wide excision of the primary tumors within healthy tissues with resection margins from the tumor border [II, B]:
- 0.5 cm for in situ melanoma;
- 1.0 cm with a Breslow tumor thickness of 1–2 mm;
- 2.0 cm with a tumor thickness of 2 mm.Modified resection options are possible to preserve functions in case of melanoma of the skin of the fingers or the skin of the auricle.
Routine selective lymphadenectomy or radiotherapy to regional lymph nodes is not recommended [II, B].
Sentinel lymph node biopsy for tumors> 1 mm is required for accurate staging. If the sentinel lymph node is affected, subsequent complete removal of the regional lymph nodes is possible, although there is no evidence that this procedure improves overall patient survival [C].This procedure should be performed only in specialized institutions by specialists who are well versed in this technique.
There is currently no standard adjuvant therapy for patients at high risk of disease recurrence after removal of the primary tumor (stage IIB / C) or radical removal of regional lymph nodes (stage III).
A number of prospective randomized trials have studied treatment with low, medium and high doses of interferon (IFN-α.). The administration of this therapy after resection of the primary tumor improved the rates of relapse-free survival (RFS), but did not significantly affect overall survival (OS).
The first study that noted an improvement in overall survival was the ECOG 1684 study: it included 287 patients, the 1st group of patients received therapy with high doses of IFN-alpha, the 2nd group was left under observation. Due to severe side effects, treatment was canceled in 25% of patients.The 5-year disease-free survival rate was 37% versus 26%, and the overall survival rate was 46% versus 37%. The results of this protocol led to FDA registration of this therapy regimen as an adjuvant treatment. A meta-analysis of studies of severe high-dose interferon therapy showed no statistically significant effect on overall survival. Then it was suggested that IFN treatment is most effective with long-term therapy.
The assumption of the advisability of prolonged administration of high-dose IFN served as a prerequisite for the European Organization for Research and Treatment of Cancer (EORTC) to conduct a large prospective randomized study to investigate the efficacy of pegylated interferon-alpha-2b (PEG-IFN-alpha-2b) in an adjuvant regimen in patients with stage III melanoma.A total of 1256 patients with only stage III melanoma after removal of the primary tumor were randomized to a treatment group or observation group. Randomization was stratified according to microscopic (N1) and gross (N2) lymph node involvement, number of nodes involved, presence of ulceration, and tumor thickness. Disease-free survival (primary endpoint), distant metastasis-free survival, and overall survival were analyzed in all enrolled patients who received at least one dose of the drug.
In the treatment group, interferon was administered at the induction stage at a dose of 6 μg / kg per week for 8 weeks, followed by maintenance therapy of 3 μg / kg per week for 5 years. The 4-year disease-free survival rate was 45.6% in the PEG-IFN-alpha-2b group versus 38.9% in the follow-up group. Survival without distant metastases was not significantly improved (P = 0.11). Overall survival did not change in both groups. In stage III-N1a (sentinel node micrometastases), relapse-free survival rates (relative risk 0.72; 57.7% versus 45.4%, P = 0.01) and survival without distant metastases (relative risk 0.73 ; 60.5% versus 52.6%, P = 0.01) increased in the PEG-IFN-alpha-2b group, while no positive changes were noted in stage III-N1b (macroscopic metastases).
This study showed that prolonged adjuvant therapy with IFN-alpha improved disease-free and metastasis-free survival in a subgroup of patients with low tumor mass.
Thus, in this patient population, pegylated interferon can be recommended for use if the patient tolerates its use well [C].
Adjuvant therapy of patients with resection of the affected gross nodules is preferably carried out in the framework of randomized clinical trials in specialized centers.Nevertheless, this diagnosis is an approved indication for the use of high doses of IFN-alpha-2b.
Adjuvant chemotherapy or hormone therapy does not improve treatment outcome.
Adjuvant immunotherapy with other cytokines with the inclusion of interleukin-2, vaccine therapy and immunochemotherapy are experimental therapeutic approaches [III], which are not recommended for use outside clinical trials.
Radiation therapy should be considered in the event of inadequate resection of the tumor margins, impossibility of re-resection in patients with melanoma such as malignant lentigo, or inadequate resection (R1) of melanoma metastases [B].
Treatment of locoregional stages
In the case of isolated involvement of regional lymph nodes, all patients should undergo radical lymph node dissection. Removal of only the affected lymph node is an insufficient volume of surgery [II – III, C].
In the presence of transient metastases or inoperable primary tumors of the extremities, isolated regional perfusion therapy with the inclusion of melphalan and tumor necrosis factor (TNF) can be used [II – III, C].This therapy requires extensive surgical intervention and should be used in selected hospitals with experience in such treatment. Radiation therapy can be used as an alternative, although there is no clear evidence of its beneficial effect on treatment outcomes [V, D].
Treatment of disseminated stages (stage IV; 2002 AJCC classification)
Treatment should mainly be carried out in the framework of clinical trials.However, not all patients with distant metastases of melanoma can participate in them. In these cases, well-tolerated cytostatics such as dacarbazine (DTIC), taxanes, fotemustine, etc., as well as cytokines (interferon, interleukin-2) or their combinations. There is no standard therapy. However, in such situations, dacarbazine is considered the drug of choice.In an aggressive metastatic process, multicomponent polychemotherapy [C], including paclitaxel and carboplatin or cisplatin, vindesine and dacarbazine, give a partial response and stabilize the process in a large number of patients.
There are no randomized clinical trials of interleukin-2 in monotherapy.
Some centers still use it as a first line of therapy for small tumors. The randomized trials showed no improvement in survival with intensive IL-2 therapy.Over the past decades, several phase II clinical studies have shown the possibility of CTLA4 blockade, as well as its use in combination with vaccines or chemotherapy. Treatment with CTLA4 blockade has contributed to an increase in the survival rate of patients with melanoma with metastatic lesions up to two years or more. However, these promising results must be confirmed by randomized phase III clinical trials (Table 2).
Surgical removal of visceral metastases can be performed in individual cases in patients with good somatic status and isolated tumor lesions.
Palliative radiation therapy is considered for symptoms of brain damage or localized bone damage.
Follow-up of patients with local and locoregional stages
Patients and their families (especially young children) should be warned about the need for regular examination of the skin and lymph nodes, as well as the need to avoid sunburn or prolonged exposure to artificial UV radiation without protective equipment.Patients should be warned about the increased risk of developing the disease in their family members [B].
Recurrent disease develops in 8% of patients within 2 years after the detection of primary melanoma. Patients with skin melanoma have an increased risk of developing other skin tumors. In patients with malignant lentigo, the likelihood of developing other skin tumors within 5 years reaches 35%.
Patients with melanoma after primary treatment are actively monitored for the earlier detection of recurrence or re-tumor.
Currently, there is no consensus regarding the required frequency of observation of patients and the recommended scope of examination. There is insufficient evidence to recommend regular blood tests, radiographic examinations including ultrasound, CT and PET examinations outside the protocols for the study of adjuvant therapy and patient follow-up.
Patients with hereditary or sporadic dysplastic nevus syndrome are at high risk and should be followed up for life.
Recommendations for monitoring patients are based on the risk of recurrence of the disease.
Clinical examination is recommended every 3 months for the first 3 years and then every 6-12 months. Since patients with a primary tumor, research methods or specific blood tests when monitoring patients.
oncologists have successfully implemented the global cancer treatment method
Reducing mortality from cancer is one of the objectives of the national project “Health”, implemented at the initiative of the President.
Surgeons of the Penza Regional Oncological Dispensary for the first time applied a new breakthrough diagnostic technique for further treatment of breast cancer and skin melanoma.
A sentinel lymph node biopsy was performed on a patient with breast cancer.
“Breast cancer is increasingly diagnosed in the early stages, when the tumor has not yet metastasized and has not affected the lymph nodes,” explains and.O. Deputy Chief Physician for Diagnostics and Radiology of the Penza Regional Oncological Dispensary Anton Stolyarov. “For such patients,” classical “removal of an organ with all lymph nodes is completely unjustified and is a crippling procedure.”
Previously, it was standard practice to remove all breast tissue, lymph nodes and even muscles. Thanks to the modern advances in surgical oncology, operations have come into practice that allow to preserve not only the mammary gland, but also the lymph nodes.
The sentinel lymph node biopsy method allows you to leave the axillary lymph nodes and avoid crippling complications in the form of limitation of arm mobility.
“Sentinel lymph node biopsy is one of the modern methods of early diagnosis of metastases, which helps to assess the situation with early metastasis as accurately as possible, and to choose the optimal treatment option,” says Anton Anatolyevich. – The essence of the technique is to determine the condition of the axillary lymph nodes, find and conduct a study of the sentinel lymph node, which is the first on the path of lymph flow.If the absence of metastases is recorded in it, then with a high degree of probability they will not be present in the entire regional collector. Such a picture will make it possible to determine the tactics of further surgical intervention. ”
The sentinel lymph node biopsy technique is recognized worldwide and is the standard of surgical treatment of the European Organization for the Study and Treatment of Cancer (EORTC).
Thanks to the introduction of this technique, on the basis of the Penza Regional Oncological Dispensary, an opportunity has been opened for the development of new high-tech medical care.It is planned that about 300 organ-preserving oncoplastic surgeries will be performed a year.