NCCN Guidelines for Patients® | Melanoma - page 21

21
NCCN Guidelines for Patients
®
: Melanoma
Version 1.2013
Par t 1
Par t 2
Par t 3
Par t 4
Par t 5
Par t 6
Par t 7
Par t 8
Par t 9
Part 2: Overview of cancer tests
Definitions:
Biopsy:
Removal of small
amounts of tissue or fluid to
be tested for disease
Local anesthesia:
A
controlled loss of feeling in
a small area due to drugs
administered to that area
Lymph:
A clear fluid with
white blood cells that fight
infection and disease
Lymph node:
Small
groups of special disease-
fighting cells located
throughout the body
Microscopic:
Something
so small it can’t be seen by
the naked eye
Radioactive:
Containing
a powerful energy called
radiation
Surgeon:
A doctor who’s
an expert in operations to
remove or repair a part of
the body
2.3 Lymph node tissue tests
After a skin biopsy confirms melanoma, a biopsy of the lymph nodes may be
recommended to check if the cancer has spread. Most melanomas are found early,
when the chance that cancer cells have spread to a lymph node is small. For early
melanomas, lymph node testing is usually not recommended. Your doctor will discuss
this with you based on findings in the pathology report. There is more than one type
of lymph node biopsy. Which type is recommended depends on different factors such
as whether or not there are signs of cancer spread.
Sentinel lymph node biopsy
A sentinel lymph node biopsy is a surgery that removes lymph nodes to test for
cancer cells. This type of lymph node biopsy is recommended when there’s an
increased chance that the melanoma has spread to a lymph node, but the physical
exam did not find any enlarged lymph nodes that may be a sign of cancer spread.
Sentinel lymph node biopsy is performed to find microscopic cancer cells in a lymph
node that cannot be found by physical exam or imaging tests (discussed in Part 2.5).
It is a surgical test and is therefore not recommended when the chance of spread is
very small. For this biopsy, a radioactive dye is injected into the skin near the primary
tumor. The dye follows the path the lymph takes when it leaves the tumor. This allows
your surgeon to find the first lymph node to which lymph (and possibly a cancer cell)
travels. This is called the sentinel lymph node or sentinel node. The sentinel node is
usually removed during the same surgery to remove the primary melanoma tumor.
FNA biopsy
This biopsy is often used when your doctor can feel an enlarged lymph node during
the physical exam. An FNA (
f
ine-
n
eedle
a
spiration) biopsy uses a very thin needle
to remove small pieces of a lymph node to test for cancer cells. Local anesthesia
is sometimes used to numb the area. This test causes little discomfort and doesn’t
leave a scar. Your doctor may use an imaging test called computed tomography
(discussed in Part 2.5) to guide the needle into the lymph node.
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