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NCCN Guidelines for Patients® | Melanoma
37 NCCN Guidelines for Patients ® : Melanoma, 2018 4 Overview of melanoma treatments Surgery Sentinel lymph node biopsy Based on the features of the primary melanoma tumor, there may be an increased risk of microscopic spread of melanoma cells to nearby (regional) lymph nodes. These lymph nodes are often found in nodal basins. Nodal basins are groups or clusters of lymph nodes found in certain parts of the body, such as the neck, armpit, and groin area. Microscopic spread to a lymph node cannot be detected by touch or by imaging tests. If the risk is high enough, your doctor may recommend a sentinel lymph node biopsy. This surgery involves injecting a special dye into the skin near the primary tumor. The dye follows the path lymph takes when it leaves the area of tumor and where cancer cells may invade nearby (regional) lymph vessels and lymph nodes. Your doctor will measure movement of the dye to find the sentinel lymph node—the first lymph node to which lymph, and possibly a cancer cell, travels. The sentinel lymph node will then be removed through a small surgical cut in the skin so a pathologist can test it for melanoma cells. Lymph node dissection Your doctor may perform a complete lymph node dissection if the sentinel lymph node biopsy or other tests show that cancer cells have spread to a lymph node basin. A lymph node dissection is surgery that removes all the lymph nodes in the nodal basin. This surgery is done with general anesthesia. Studies are being done around the world to determine if this more extensive surgery is helpful to patients who have had a positive sentinel lymph node biopsy. Side effects of surgery A side effect is an unhealthy or unpleasant physical or emotional condition caused by treatment. Each treatment for melanoma can cause side effects. The risk and severity of side effects from surgery for melanoma depend on many factors. This includes the type of surgery, extent of surgery, and the size of the melanoma tumor. Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved. www. nucleusinc.com Figure 10 Area of wide excision with a 1.5 cm margin A wide excision is surgery that removes the entire melanoma tumor along with some normal-looking tissue around its edge. The normal-looking tissue is called the surgical margin. The curved cut taken around the circle is needed to close the surgical wound in a flat line.
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