Neck Dissection
What is neck dissection?
Lymph glands in the neck help in fighting infections and cancer from the head and neck area and sometimes the upper torso.
They are grouped into levels called 1 to 5 depending on where they are located.
Neck dissection is a procedure in which lymph glands in the neck are surgically removed.
It is also called lymphadenectomy.
This operation is required when cancer has spread to the neck or parotid gland (stage 3).
There are many types of neck dissections:
Radical: removal of levels 1 to 5, sternocleidomastoid muscle (SCM), the spinal accesory nerve (SAN) and internal jugular vein (JV). Uncommonly done.
Modified radical: removal of levels 1 to 5 with preservation of one or more of SAN, SCM and JV. Usually required when the parotid is also involved.
Selective: removal of some levels depending on where the tumour is located, preserving SAN, SCM and IJV.
The type of neck dissection you are offered depends on the disease characteristics and will be discussed at the skin cancer specialist meeting.
How do I know if cancer has spread to the neck?
Neck cancer usually presents with a neck lump.
Such lumps can be picked up in several ways:
You may have noticed the lump yourself or others have pointed it out.
It could be picked up during your routine examinations at your follow up appointments.
It may also be picked on your routine regular staging scans.
Suspected cancer spread is confirmed by a needle sample test performed with ultrasound guidance.
What does it mean if I have neck node cancer?
Confirmed neck metastasis is a sign that the disease has progressed to stage 3 at least.
You will require updated scans to rule out spread to distant organs such as the brains, lungs and liver.
Your care will be discussed at a specialist skin cancer meeting where all your scans are discussed and a management plan made.
Treating neck node cancer is a joint effort between my team and Oncologists.
You will be referred to the Oncologists to discuss other treatments that may be appropriate in addition to surgery (discussed below).
If neck metastasis is found through SLNB, you may be offered Oncology treatments instead of surgery.
However, metastases that can be felt through the skin or visible on scans usually requires neck dissection.
How is neck dissection performed?
Neck dissection is performed under general anaesthetic.
It requires long incisions which start behind the ear, proceed down the side and into the neck.
Care is then taken to peel away the neck lymph gland from the important nerves and blood vessels.
In my practice, parotidectomy is often combined with neck dissection if required.
You will usually have two drains in the neck, and the neck may be closed with sutures/staples.
Neck dissection alone is usually a 2 hour
Parotidectomy and neck dissection is usually a 4 hour surgery.
What is the recovery and follow up after neck dissection?
Patients usually stay in hospital for 3-5 days on average.
You will receive pain killers and other medications as required.
Drains are usually removed when they drain less than 30 mls of wound fluid in 24 hours.
Most patients are walking, washing and doing gentle tasks by themselves after 2-3 days.
Follow up with the Christie dressings clinic will be arranged for about a week following surgery, and more appointments will be made if required.
You will also receive a nursing follow up telephone consultation at 6 weeks.
There will usually be minimal restrictions to your activites but these will be specified for your circumstances.
What risks does neck dissection have?
The risks of anaesthetics will be discussed with you by the anaesthetic teams, but may include chest infections and clots in the legs or lungs.
Your specific risk will be discussed with you after anaesthetic assessment, which is offered to patients who might have higher anaesthetic risks.
The incision will form a scar which will need about 18months or more to fully mature.
You will find that your neck will be stiff to start with and will feel tight due to the scar.
Wounds can also become infected. Most can be treated with oral antibiotics from home but rarely, some need admission and/or surgery to wash the wound.
There is risk of injury to several nerves and large blood vessels but this is exceedingly rare.
There will be some numbness to the neck and potential altered sensation to the ear lobe.
Most wounds heal uneventfully but healing may be delayed at the junction of incisions.
I think my skin cancer may have spread to the neck, what do I do?
If you notice swellings on your neck following a skin cancer diagnosis, you can contact my secretary directly or speak with the skin cancer Specialist Nurse.
Seeing your GP may delay your review and you may be incorrectly referred to Ear Nose Throat surgeons (who also deal with neck tumours).
It is also approriate to contact your dermatologist.