Lymph node dissection is basically a form of surgical procedure where a group of lymph nodes are removed. These dissections fall into two categories, which include therapeutic dissection (sometimes referred to as late dissection) and elective dissection, which is also known as an early dissection. There still remains a great deal of controversy surrounding elective surgery, particularly as any surgery includes some level of risk.
Which Patients May Benefit From Elective Lymph Node Dissection?
There are usually only certain patients who are likely to be considered suitable for undergoing an elective lymph node dissection. Most patients recommended this course of action include those whose melanoma has easy access to regional lymph nodes or those who are more likely to only have melanoma cells in the lymph node region. Extensive research studies carried out on melanoma patients have indicated that it is patients who have melanomas of intermediate thickness that are most likely to benefit from the procedure.
However, more recent research-based evidence has highlighted that this approach is unlikely to offer patients any advantage in terms of cancer survival that just opting to remove the lymph nodes if a tumour develops. It is also the case that many patients who undergo this form of surgery have been put through unnecessary risk despite never being likely to develop melanoma in this area.
Understanding Elective Lymph Node Dissection Procedures
During elective lymph node dissections, surgery is used to remove identified lymph nodes located in the draining lymph node basin. This basin refers to the lymph node area which melanoma cells are most likely to spread towards. A Geiger counter is typically used to detect the most radioactive site within the lymph node basin and the surgeon then aims to remove all lymph nodes from this area. In some cases, an additional procedure may be required prior to the lymph node dissection such as a lymphoscintigraphy. It is also important to be aware of the risks involved such as serious postoperative infection.
Despite most patients not having any significant problems post-surgery, this procedure is recognised to cause several problems postoperatively. Some patients suffer from infections, wound breakdown and also a very swollen extremity known as lymph-edema, which is due to accumulating lymphatic fluid as a result of disruption to the body's lymphatic system following surgery. These postoperative issues may then mean patients have to be admitted into hospital for a prolonged period of time.
As highlighted above, an elective lymph node dissection involves a group of lymph nodes being removed before any melanoma has been found. Recent studies have suggested that this procedure is not worthwhile considering the potential risks involved and the likelihood that it will not improve melanoma survival rates.
Sources:
Kenet, B. & Lawler, P. (1994) Saving Your Skin London: Four Doors Eight Windows
McClay et al. (2004) 100 Questions and Answers About Melanoma and Other Skin cancers Massachusetts: Jones and Bartlett
Kate Le Page - Kate Henning-Le Page writes about eating disorders, body image and recovery issues. She specializes in anorexia recovery.
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