WLE + Sentinel Lymph Node Biopsy
WLE + SENTINEL LYMPH NODE BIOPSY (SLNB)
For some patients, sentinel lymph node biopsy may be offered in addition to wide local excision of the melanoma scar
What is a sentinel node?
Lymp nodes are peanut-sized glands which help your immune system fight infections or cancer.
Melanoma is more likely to spread through the lymph glands (nodes).
The first lymph gland draining the area of your melanoma is called a sentinel node and has been shown to be important in determing prognosis.
This is the gland the melanoma is most likely to pass through before spreading any further.
Testing the sentinel node for cancer therefore gives us a great deal of information about the extent of disease spread, and your outlook.
What is SLNB?
Sentinel lymph node biopsy is a surgical procedure in which the sentinel node is removed surgically and analysed for melanoma.
It is usually performed as a general anaesthetic, and combined with a wide local excision.
Why do it?
SLNB is a staging procedure and not necessarily a treatment for melanoma.
It helps us to know the stage of the disease ie. how far it has spread.
The status of your sentinel node can help us discuss how people with similar disease characteritistics as yourself have fared with various treatments.
If your sentinel node is positive, you become stage 3 and may qualify for newer oncological treatments pending assessment by a specialist Oncologist.
If your sentinel node is negative, this has a positive impact on your prognosis although it does not remove all possiblity of cancer recurrence.
How is it performed?
You will have a nuclear medicine appoointment at which a lymphoscintigram is taken to show the location of your sentinel node and mark it using radioactive tracers.
You may also be asked to undergo a SPEC-CT scan especially if your sentinel node is in the head and neck area.
SLNB is usually performed as a daycase procedure under general anaesthetic.
Methylene blue dye is injected into the melanoma scar at the start of the surgery to help with seeing the sentinel node.
The node is harvested using small incisions and guidance from the radiative tracer and the blue dye.
WLE is then performed followed by the approapriate reconstruction.
What is the recovery and follow up after SLNB?
You can usually go home the same day unless the surgery is done later in the day or if your circumstaces require it.
You will have dissolving stitches and a dressing.
Follow up with the Christie dressings clinic will be arranged for about a week following surgery.
You will also receive a nursing follow up telephone consultation at 6 weeks.
You will be given specific instructions, usually more in line with the type of reconstruction you have undergone following wide local excision.
There will usually be minimal restrictions to your activites but these will be specified for your circumstances.
What risks does SLNB 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.
SLNB of the groin, armpit, neck and parotid all have an incision which will form a scar which will need about 18months or more to fully mature.
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 nerves which may lead to numbness or reduced movement, however this is exceedingly rare in my practice.
You may develop swellings of blood (haematoma), wound fluid (seroma) or lymph (lymphocoele) which can usually be drained as an outpatient and very rarely requires further surgery.
In some instances, we are unable to find the sentinel node or the surgery required to retrieve is too extensive forcing us to abandon. You would still have WLE.
It is possible for the malanoma to return in the lymph glands even if the sentinel node did not show any melanoma.
Some people develop a severe allergic reaction (anaphylais) to the blue dye used. However, since your airway will be protected by an anaesthetist you are in perhaps the best place to be were you to have an anaphylactic reaction.
Do I qualify for SLNB?
There are national and international criteria on who should be offered SLNB.
Firstly, you should not already have evidence of disease spread around the melanoma scar, lymph nodes (stage 3) or to distant organs such as brain, liver and lungs (stage 4).
Cinical examination and/or staging scans may be used to exclude stage 3 or 4 disease.
The Breslow thickness of the melanoma needs to be over 1mm in thickness or if between 0.8-1 mm, the tumour should show ulceration and high division rate.
You also should be fit enough to undergo these surgeries under general anaesthetetic and also fit enough to undergo immunotherapy should the sentinel node be positive.
Mr Mabvuure’s team will discuss your eligibility for this procedure at consultation, where you will also be seen by a Specialist Skin Cancer Nurse.