For the common skin tumours that spread to the lymph nodes (squamous cell carcinoma and malignant melanoma) prognosis is determined by the size, and in particular, the depth to which the tumour has grown down from the skin surface.
Once the tumour has spread to the nearest lymph nodes, your prognosis with these tumours depends on how many lymph nodes are invaded by tumour and whether the tumour is contained within the lymph nodes or has broken out of them.
Lymph node surgery in skin cancer can be both:
Current NZ guidelines recommend that we sometimes perform a procedure called SNB to identify if cancer has spread beyond the primary tumour. This involves identifying and removing the first group of lymph nodes to which an area of skin drains lymphatic fluid, and therefore, the first place to which malignant melanoma or squamous cell carcinoma would be expected to spread. In sentinel node biopsy, a tracer material is used to help the surgeon find the sentinel nodes during surgery. The sentinel nodes are removed and tested in a lab.
If the sentinel nodes are free of cancer, then cancer probably hasn’t spread. This means that removing additional lymph nodes is not necessary. More surgery might not be needed.
Sentinel node biopsy (SNB) involves a scan followed by an operation. A weakly radioactive dye is injected into the skin around the scar that remains where the melanoma once was. The scan picks up the radioactive dye as it passes in the lymph to the sentinel node, and this provides me with a two-dimensional picture that localises the lymph node.
Within a few hours of the scan, you will be admitted for surgery and under a general anaesthetic I shall inject a blue dye at the same point which will also flow in the lymph to the sentinel node.
During the operation I will follow the blue trail left within the lymphatics to the sentinel node, helped along the way by using a Geiger counter that picks up a stronger radioactive signal in the sentinel node when compared with the surrounding tissues.
When you wake up you will have a small scar and a drainage tube leading out to a vacuum bottle which prevents the lymph accumulating until the body can re-route the excess that results from disrupting the lymphatics during the operation. Most people have their drains removed and go home within a day or two.
Completion lymphadenectomy describes the operation that removes all the remaining lymph nodes in a regional basin where the sentinel node is positive for tumour.
Block dissection of regional lymph nodes describes the operation that removes all the lymph nodes in a regional basin where a lymph node is thought to contain tumour clinically and then proved to contain it after imaging studies and, usually, a needle biopsy and cytology.
Regional lymph node basins are situated in the arm pits, the groins and the neck. Which is/are involved is simply a function of where on the body the primary tumour was situated.
Complete lymphadenectomy & block dissection of regional lymph node basins are bigger operations. They take longer for me to do and for you to recover from. The scar that results is bigger, and the wound drains lymphatic fluid for significantly longer as a result of the much larger disruption to lymphatic drainage that results from taking out all the nodes in a particular region.
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