Lymphoedema, in the context of surgery for melanoma, is swelling in a limb due to the excision of lymph glands and disruption of lymphatic vessels. It can occur when someone has either a dissection (removal) of all lymph nodes in a basin (as in the axilla or armpit) or the groin (inguinal nodes); or a sentinel lymph node biopsy (SLNB).
Although lymphoedema can occur with either a sentinel node biopsy or node dissection, it is more frequent in those having a node dissection.
For example, in trials of SLNB, the rate of lymphoedema range from 4.6-7.2% in the Sunbelt Trial (1) and the MSLT-I (2) trials respectively, with a rate of 12.5% for those having a node dissection in MSLT-I. However, in case series and other studies, higher rates have been described, with a higher risk of lymphoedema associated with higher body mass index, co-morbidities such as diabetes, and in the groin, whether the deep (iliac nodes) are also dissected as part of the operation.
After lymph node surgery, you should be assessed for lymphoedema, and if it occurs, referred on for appropriate management. Although there is no definitive cure if it occurs, it can be successfully controlled with methods to reduce the accumulation of fluid and improve drainage.
Treatment for Lymphoedema after surgery for melanoma
Approaches include compression dressings and garments, massage and exercise as part of a supervised regime. There are many people living well with lymphoedema, and if you have been affected, it may be helpful to contact the Lymphoedema Support Network, to access more information and gain support.
References:
- Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the multicenter selective lymphadenectomy trial (I). Ann Surg Oncol.2010;17:3324–9.
- Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10:676–80.
- https://www.nhs.uk/conditions/lymphoedema/
- http://www.lymphoedema.org/
