Lymph Node Removal Surgery in Sydney by Dr Michael Kernohan
Lymph node removal surgery or lymphadenectomy is an essential surgical procedure done to remove and analyse suspicious lymph nodes. Lymph nodes are small glands distributed all over the body and they serve important immune functions. They can be enlarged due to infection, inflammation, or malignancy.
Suspicious lymph nodes are often removed to rule out malignancy when the risks of leaving them are outweighed by the benefits of removal. If you’ve already been diagnosed with cancer, then a lymph node biopsy can help us know if the cancer has spread and guide further treatment. This includes breast cancer, metastatic skin cancer, advanced melanoma, or head and neck cancer.
Sydney Specialist Plastic Surgeon Dr Michael Kernohan routinely performs lymphadenectomy and lymph node biopsies on his patients in Sydney. His expertise includes sentinel lymph node biopsy – an essential technique in evaluating the spread of melanoma. He follows different plastic surgery techniques to ensure optimal results after your procedure. Read on to learn more about lymphadenectomy and sentinel node biopsy.
The lymph glands are an important part of the immune system. They’re numerous and are distributed all around the body. They filter the lymph fluid coming out from different body regions and trigger the immune system to make antibodies.
The lymph is a high-protein fluid that moves white blood cells and proteins from tissue back to the blood circulation.
Before returning to the blood circulation, lymph passes through lymph nodes or glands to be filtered and for bacteria and microbes including viruses. If the area being drained has developed a cancer, the cancer cells can be trapped by the corresponding lymph nodes.
Lymph nodes are located all around the body. Some examples include cervical lymph nodes (neck lymph nodes), axillary lymph nodes (armpit area), and Inguinal lymph nodes (groin area), these are the nodes that drain our superficial layers.
Enlarged lymph nodes can sometimes be felt under the skin. They feel like firm round growths, and can occasionally become painful. Sometimes, lymphadenopathy is not felt by the patient and is rather seen on imaging studies, like magnetic resonance imaging or CT scan.
There are several causes of lymphadenopathy:
- Infection: Most of the time, lymph nodes enlarge as a response to infection. During an infection, the immune system is activated, and the lymph nodes become inflamed as they fight the microbes by creating antibodies.
- Drug reactions: Inflammatory reaction to certain drugs can cause lymphadenopathy.
- Lymphoma: A common immune tissue cancer that causes lymph node enlargement. Lymph node biopsy is helpful for the diagnosis of lymphoma.
- Advanced melanoma: Cutaneous melanoma is a common type of skin cancer. Sentinel lymph node biopsy is usually done to risk assess for metastatic melanoma. It helps your medical team know how risky the melanoma is and guide treatment like immunotherapy. Sentinel lymph node biopsy is a critical part of assessing advanced melanoma.
- Metastatic skin cancer: Non-melanoma skin cancer (squamous cell carcinoma and basal cell carcinoma) can also spread to nearby lymph nodes. Dr Kernohan performs lymphadenectomy (removal of a collection of lymph nodes) routinely for advanced and metastatic skin cancer
- Other cancers: many cancers tend to spread to nearby lymph nodes or “drainage basins” Dr Kernohan performs analysis of regional lymph node biopsy to establish a diagnosis and guide treatment decisions. This can involve Ultrasound scan, needle biopsy, CT scan, MRI scan or PET scan depending on the situation.
Not every enlarged lymph node (lymphadenopathy) necessitates surgical removal or biopsy. Lymphadenopathy can commonly occur with infections – respiratory tract infections (particularly colds and flu), skin infections or for unknown reasons
Lymph node dissection and removal is usually done for one of two purposes:
- Investigate suspicious lymph nodes: New enlarged lymph nodes that show unusual features might need to be removed and tested. Suspicious signs include failure to regress within weeks, lymphadenopathy without other signs of infection, hard lymph glands, pain, and immobility.
- Assess the extent of the spread of cancer: This is for patients already diagnosed with cancer. Nearby lymph nodes are removed and tested for cancer spread in order to guide treatment decisions (additional tests, hormone therapy, immunotherapy, chemotherapy, further treatment, etc.)
Lymph node removal procedure (lymphadenectomy) is usually done with the help of local or general anaesthesia. If the target lymph tissue is located in a challenging location, then general anaesthesia might be recommended.
Usually, all lymph node biopsy procedures go the same way. First, Dr Kernohan will clean the surgical field with an antiseptic solution. A small skin incision is then strategically made just above the enlarged lymph nodes.
Then, Dr Kernohan surgically explores the area and identifies the target lymph node group. He will isolate the lymph glands and cut any blood and lymph vessels supplying them.
Dr Kernohan follows minimally invasive techniques in order to remove as little healthy tissue as possible. After removing the glands, he closes the wound, layer by layer, to ensure that it heals well with minimal scarring.
The removed glands are sent to the pathology lab to be tested.
Based on location, Dr Kernohan performs several types of lymphadenectomy:
Axillary lymph node removal
- Axillary lymph nodes are those located in the armpit region. Dr Kernohan then performs axillary lymph node dissection for known skin cancer metastases, removing the abnormal lymph node and its associated group. This is most commonly done in cases of squamous cell and metastatic melanoma of the upper body region
Cervical lymph node removal
- The cervical lymph nodes are those located under your jaw, ears, and all along the sides of the neck. Cervical lymph node metastases are usually seen with head and neck cancers, oral cancer, skin cancer, advanced melanoma, skin cancer, and other malignancies. Removal can also include removing the parotid gland in front of the ear.
Inguinal lymph node removal
- This group of lymph nodes is located in the groin area, along the sides of the lower abdomen. Like the axillary nodes it can be needed to treat metastatic squamous cell carcinoma and malignant melanomas
Sentinel Node Biopsy
This is a special type of lymph node removal surgery that involves removing only the first lymph node group encountered by cancer cells as they filter from a specific diseased body region.
It is performed with the help of a dye injected into the tumour site before surgery in the radiology department and some further dye injected immediately prior to surgery. The dye will go with the lymph to be filtered in the regional lymph nodes.
Once Dr Kernohan finds the first lymph node group containing the dye, he removes it and sends it to the lab to be tested for cancer cells. If this first lymph node group contains no cancer cells, then the cancer is considered lower risk.
Sentinel node biopsy is usually an essential part of primary melanoma diagnosis and treatment. It helps Dr Kernohan and your cancer care team decide on whether you need further surgery, chemotherapy, radiotherapy, or not. Not everyone needs this but the risk can be calculated and discussed during your consultation which helps decision taking for borderline cases.
This is commonly performed with stage 1 and stage 2 melanoma to assess the extent of cancer. If no melanoma cells are found in the sentinel lymph nodes, then you have localised melanoma. Melanoma surgery alone is usually enough.
Preparing For Lymph Node Removal Surgery
Dr Kernohan will first check your medical history, discuss any medications you’re taking, and ask about any allergies you may have. He will then ask you specific questions about your complaints. Expect to be asked questions like:
- When did you first notice the lymph nodes?
- Do they cause any pain?
- Do they itch?
- Do they become swollen or red?
- Do you have other enlarged lymph nodes around your body?
- Have you been diagnosed with any kind of cancer?
- Do you have any other signs of infection?
If you’ve already been diagnosed with skin cancer, malignant melanoma, or any other kind of cancer, then make sure you bring along any relevant tests. This includes lab tests, imaging tests, and reports.
Lymphadenectomy is usually a 1-day procedure. This means that you will be sent home the same day after your surgery. On rare occasions, you might be asked to stay the night for monitoring.
Dr Kernohan will inform you on whether or not you need to stop your blood-thinning medications. You will be asked to not eat or drink the night before your lymph node removal procedure.
Since you might be given a sedative to relax, you will not be able to drive after your surgery. You should arrange for someone to take you home once you’re cleared to leave.
Recovery After Lymph Node Removal Surgery
Recovery from lymph node removal surgery is very similar to recovery from most surgeries. Dr Kernohan will give you pain medication, antibiotics, and instructions on how to care for yourself at home. You’ll also need to avoid strenuous activities for the first couple of weeks after your procedure.
In general, you can get back to work 2-3 days after lymph node removal. The wounds usually take 1-2 weeks to fully close. Any scars will continue to shrink and should become much less visible after 6-12 months.
Complications of lymph node removal surgery can include:
- Lymphedema – this is when the body region normally drained by the removed lymph nodes swells.
- Seroma formation – this is quite common and involves an egg like swelling at the surgical site a couple off weeks after the procedure. It can be a nuisance but can be readily drained in the rooms
- Nerve damage
Thankfully, most of these complications are rare.
Sentinel node surgery helps reduce the risk of lymphedema by preventing unnecessary removal of further lymph nodes. As the medical options improve radical surgery is thankfully becoming less frequently needed. Moreover, Dr Kernohan follows meticulous techniques to only remove the affected lymph node groups, without damaging the nearby healthy tissue.
If you experience any side effects following lymph node removal surgery, talk to Dr Kernohan immediately. He will assess the problem and will likely prescribe additional medications to treat them.
Check plastic surgery risks page for more details.
How Much Is Lymph Node Removal Surgery in Sydney?
The cost of lymph node removal surgery is not easy to estimate without a consultation. It completely depends on the type of concerns you have and the surgery recommended for your particular case.
Have a look at Dr Kernohan’s prices page to get an idea about the costs involved with surgery.
Please call or contact Dr Kernohan’s team for a price estimate or to schedule a consultation.
Does Medicare Cover Lymph Node Removal?
Medicare and insurance can help cover surgery that is medically necessary for a patient. If you meet the Medicare criteria, you should be eligible for a partial rebate. Check out information on Medicare item numbers here.
It’s also important to know that there are payment plans and medical financing options available to help you fund the surgery.
Lymph Node Biopsy FAQs
What happens if skin cancer spreads to lymph nodes?
- Malignant melanoma, basal cell carcinoma, and squamous cell carcinoma are all skin cancers that can spread to the regional lymph nodes. If skin cancer spreads to lymph nodes, skin cancer surgery alone might not be enough. You might need further lymph node removal surgery, chemotherapy, immunotherapy, or radiotherapy.
What is the survival rate for melanoma in the lymph nodes?
- If melanoma cells are found in the sentinel lymph nodes, then the 5-year survival rate is estimated to be around 65%. This means that 65% of metastatic melanoma patients will survive more than 5 years with proper treatment.
Can cancerous lymph nodes be surgically removed?
- Yes, metastatic lymph nodes and cancerous lymph glands can be surgically excised. The procedure is called lymphadenectomy.
What happens if melanoma goes to lymph nodes?
- If melanoma spreads, it’s called advanced melanoma or metastatic melanoma. Metastatic melanoma has a worse prognosis compared to primary melanoma that has not spread. It requires further treatment with chemotherapy, radiotherapy, or targeted therapy.
How long does lymph node removal surgery take?
- Surgery to remove lymph nodes can take as little as 30 minutes and as long as a couple of hours or more. This depends on the location of the lymph nodes, and how adhesive they are to the surrounding tissue.
How long does it take to heal from lymph node removal?
- It takes around 1-2 weeks to fully recover from lymph node excision surgery.
Why is lymph node biopsy performed?
- If you have cancer, lymph node biopsy helps your health care team decide on whether or not you need additional treatment, additional tests, additional surgery, or adjuvant treatment for your cancer (hormone therapy, chemotherapy, radiotherapy).
What is axillary dissection?
- Axillary dissection the surgical exploration of the armpit region to remove the axillary lymph node group.
What are the cervical lymph nodes?
- The cervical nodes are the neck lymph nodes. They are located under your jaw, around your ears, and along the neck. Cervical lymph node metastases are commonly seen in head and neck cancers.
What are the supraclavicular lymph nodes?
- The supraclavicular lymph nodes are those located above your clavicle. Supraclavicular lymph node metastases are commonly seen in patients who have gastrointestinal cancers.
What are the long term side effects of lymphadenectomy?
- In most patients, there are no long-term complications for lymphadenectomy. However, some patients might develop lymphadenopathy. This is when the region that’s normally drained through the excised lymph nodes becomes swollen.
How long does it take for skin cancer to spread?
- This depends on the type of skin cancer. Malignant melanoma spreads faster than squamous cell carcinoma and basal cell carcinoma.
What is the survival rate for skin cancer?
- This depends on the type of skin cancer you have. If detected early, melanoma survival rate after 5 years is around 99%. This, however, drops significantly in metastatic melanoma and non-melanoma skin cancer if detected late.
Is lymph node surgery painful?
- Surgery for lymph node removal is not particularly painful. Routine pain medications are usually enough to handle the pain.
Does having lymphadenectomy affect your immune system?
- No. Excision of lymph nodes does not decrease your ability to fight off infections. Your immune system strength is not affected by lymph node removal surgery.
How serious is a lymph node dissection?
- Lymph node dissection in itself is not a dangerous procedure. It is a medium scale procedure but rarely has major complications. Issues like lymphedema of the arm or leg are common.
Is lymph node removal an outpatient surgery?
- Most of the time, lymphadenectomy is a 1-day procedure. You will be discharged the same day after your surgery and won’t spend the night at the hospital.
What happens when skin cancer spreads to lymph nodes?
- First, a lymph node biopsy needs to be done to confirm the diagnosis. Once confirmed, your health care team will determine if you need additional treatment, like surgery, medications, or radiotherapy.
Can skin cancer cause swollen lymph nodes?
- Yes. Metastatic skin cancer can spread to regional lymph nodes and cause them to enlarge and become swollen. This is why lymph node removal is an essential part of the evaluation of aggressive skin cancer.
What does Stage 1 melanoma mean?
- Stage 1 melanoma is when the cancer is still localized in the skin and has not spread to the nearby lymph nodes or any distant organs. Sentinel lymph node biopsy helps your care team confirm that melanoma cells have not yet spread anywhere.
Further Reading and Medical References
- Nodal Metastasis: When Melanoma Spreads to Lymph Nodes
- Melanoma Cells that Pass through Lymph More Likely to Spread
- Diagnosis of melanoma
- Lymph node biopsy | Skin cancer
- Skin Cancer of the Head and Neck
- Sentinel Lymph Node Biopsy
- Sentinel Lymph Node Biopsy in Cutaneous Melanoma—Where Do We Stand?
- Sentinel lymph node biopsy in malignant melanoma
- The Role and Necessity of Sentinel Lymph Node Biopsy for Invasive Melanoma