Surgery to remove lymph nodes

You might have surgery to remove the lymph nodes close to the melanoma if you have swollen lymph nodes and tests show the cancer has spread there. This operation is called a lymph node dissection.

Checking your lymph nodes

After being diagnosed with melanoma, you have tests to find out whether it has spread anywhere else in the body. This is called staging and helps your doctor decide on treatment.

Your doctor might find out that melanoma has spread to your lymph nodes after:

• a physical examination shows your lymph nodes feel abnormally large or hard
• a scan shows that your lymph nodes appear abnormal
• a sentinel node biopsy finds melanoma cells in your lymph nodes - this is when your lymph nodes look and feel normal, but the surgeon removes the first lymph node or nodes that a melanoma could have spread to see if they contain cancer

If your lymph nodes look or feel abnormal

Your doctor usually takes a sample of tissue (biopsy) from lymph nodes that feel swollen (enlarged) or appear abnormal on a scan. If the biopsy shows melanoma in a node or nodes, they usually offer you an operation to remove all of the lymph nodes in that area.

If a sentinel node biopsy shows melanoma in your lymph nodes

This is called a positive sentinel node biopsy. You may have regular ultrasound scans to check your lymph nodes to see if the cancer grows (progresses). Or you might have treatment such as targeted cancer drugs or immunotherapy. You don’t usually have surgery to remove the rest of the lymph nodes after a positive sentinel lymph node biopsy.

What happens

The operation to remove all the lymph nodes close to your melanoma can be a big operation. You usually have a general anaesthetic, so you're asleep for this operation.

The surgery you have depends on which part of the body the lymph nodes are in. For example, if a melanoma on the arm spreads to nearby lymph nodes, those lymph nodes are in the armpit. So surgery involves removing the lymph nodes in the armpit.

Your doctor will tell you more about the operation and how long you might be in hospital. They will also tell you about the possible risks. The risks also depend on which part of the body the lymph nodes are in.

Having all the lymph nodes removed can cause some long term side effects. Lymph nodes drain fluid from your arms and legs. If the surgeon removes the lymph nodes, fluid can build up and cause swelling in your arms or legs. This is called lymphoedema.  Your doctor and nurses will tell you how you can reduce your chance of getting lymphoedema.

Other side effects of lymph node removal can include:

• infection
• a build up of fluid at the site you had surgery (seroma)
• problems with your wound healing
• numbness, tingling or pain in the area - this is due to nerve injury
• blood clots - more common after removal of lymph nodes in the groin area
• scarring
• injury to the nerve that holds your shoulder blade flat, this causes your shoulder blade to stick out (winged scapula)
• less movement of the arm due to injury to the nerve (thoracodorsal nerve) that supplies the large muscle in the middle of your back (latissimus dorsi)

Let your doctor or specialist nurse (key worker) know if you think you have any of these side effects.  

Follow up

At your first follow up appointment, your doctor:

• gives you the results of the surgery
• examines you
• asks how you are and if you've had any problems

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says and provide support.

Between appointments, you can also contact your specialist nurse. So don't worry if you do forget to ask something. 

How often you have follow up appointments depends on the results of your surgery. Ask your doctor or specialist nurse how often you need to have check ups and what they will involve.