NCCN Guidelines for Patients
Melanoma, Version 1.2014
Tests for melanoma
Lymph node tissue tests
Lymph node tissue tests
A biopsy is the removal of a small amount of tissue
from your body to test for disease. After a skin biopsy
confirms melanoma, a biopsy of the lymph nodes
may be recommended to check if the cancer has
spread. Lymph nodes are small groups of special
disease-fighting cells located throughout the body.
Lymph nodes are connected to one another by lymph
vessels—tubes that carry a clear fluid called lymph
throughout the body. 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 the test results in
the pathology report.
Types of lymph node biopsies
There is more than one type of lymph node biopsy. A
lymph node biopsy may be done during surgery. Or,
it may be done with a very thin needle. Which type of
biopsy is recommended depends on certain factors
such as whether or not there are signs of cancer
Sentinel lymph node biopsy
A sentinel lymph node biopsy is a surgery that
removes the sentinel lymph node(s) to test for cancer
cells. The sentinel lymph node is the first lymph node
to which cancer cells will likely spread from the first
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. It is performed to find very
tiny (microscopic) cancer cells in a lymph node that
cannot be found by physical exam or imaging tests
(described on page 21). Because this is a surgical
test, it is not recommended when the chance of
cancer spread is very small.
For this biopsy, a special 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 doctor to find the first lymph node to which lymph
(and possibly a cancer cell) travels. This is called the
sentinel lymph node. The sentinel node is usually
removed during the same surgery to remove the
primary melanoma tumor.
Possible side effects of sentinel lymph node biopsy
may include numbness, pain, bruising, and fluid
buildup near the biopsy site. Because only one or
very few lymph nodes are removed, serious side
effects such as lymphedema (swelling due to fluid
buildup) are rare.
This biopsy is often used when your doctor can feel
an enlarged lymph node during the physical exam.
An FNA biopsy uses a very thin needle to remove
small pieces of a lymph node to test for cancer cells.
An anesthetic may be applied or injected to numb the
area before an FNA biopsy. An FNA biopsy causes
little discomfort and doesn’t leave a scar. Your doctor
may use pictures from a test called a CT (
omography) scan to guide the needle into the lymph
node. (Read page 21 for details on CT scans.)
Excisional lymph node biopsy
An excisional lymph node biopsy removes enlarged
lymph nodes through a small surgical cut in the skin.
This type of biopsy may be needed if your doctor
finds an enlarged lymph node during the physical
exam or imaging test and an FNA biopsy isn’t
possible or is unclear.
After removing the lymph node(s), your doctor will test
the tissue for cancer cells. Local or general anesthesia
may be used for this surgery. Local anesthesia is a
controlled loss of feeling in a small area due to drugs
given in that area. In contrast, general anesthesia is a
controlled loss of wakefulness from drugs.