Complete Lymph Node Dissection for Melanoma
A Complete Lymph Node Dissection (CLND), sometimes called a lymphadenectomy, is a surgical procedure where all lymph nodes in a specific region are removed (such as the underarm, groin, etc.) after detecting melanoma through a positive Sentinel Lymph Node Biopsy (SLNB).
What is a Lymph Node?
Lymph nodes are small organs that play an important role in the body’s immune system. Lymph nodes play a crucial role in filtering and monitoring the lymphatic fluid, which carries waste products, pathogens, and immune cells. Lymph nodes are connected to each other throughout the body by lymphatic vessels – or tubes. The lymphatic vessels are a lot like veins that collect and carry blood throughout the body
Lymph nodes contain white blood cells that help the body fight infection. White blood cells watch out for foreign substances such as viruses and bacteria. If detected, these cells will activate an immune response. This is why your lymph nodes may swell when you aren’t feeling well.
Groups of lymph nodes are found in the neck, underarms, chest, abdomen, and groin. Many cancers – including melanoma – use the lymphatic system of nodes and vessels to spread.
What is a Complete Lymph Node Dissection used for?
A Complete Lymph Node Dissection (CLND) is used to improve regional disease control and may provide additional prognostic information (information that is useful in predicting the course of your disease, such as how aggressive it may be).
A landmark 2017 study published in the New England Journal of Medicine (see below for more information), demonstrated that Complete Lymph Node Dissections do not improve overall survival of melanoma patients with a positive Sentinel Lymph Node Biopsy.
Despite these findings, some doctors may still recommend the procedure because of the improvements to regional disease control and the additional information the procedure can provide. Talk to your surgeon about any questions or concerns.
What Happens During a Complete Lymph Node Dissection?
During a Complete Lymph Node Dissection (CLND), your surgeon will remove all or most lymph nodes surrounding the sentinel lymph node identified through the SLNB procedure you had earlier. In addition to removing the targeted lymph nodes your surgeon may also install a ‘drain’ to help reduce fluid buildup. The drain will be removed weeks later during a clinic visit.
Once the lymph nodes are removed, a pathologist will carefully inspect these lymph nodes for signs of melanoma. This can provide additional information for you and your care team.
What are the benefits of Complete Lymph Node Dissection?
A Complete Lymph Node Dissection (CLND) can provide additional information to your care team about your melanoma and can dramatically reduce tumor burden in some patients.
In a large study of 1935 patients, those who underwent a CLND had a slightly higher rate of disease-free survival –68% versus 63% (the length of time following a treatment without signs or symptoms of melanoma). However, the procedure did not confer any survival benefit over careful observation alone.1
What are the potential harms of Complete Lymph Node Dissection?
Side effects caused by a Complete Lymph Node Dissection are common and occur in up to 24% of all patients who undergo the procedure.2
Possible side effects include:
- Lymphedema (swelling of a limb or region of body due to a compromised lymphatic system)
- Pain
- Infection
- Sensory Nerve Damage
- Seroma (buildup of fluid at surgical site)
Almost all surgical procedures carry risks such as short-term pain, swelling, and bruising at the surgical site and increase the risk of infection. However, some side effects of a Complete Lymph Node Dissection, such as lymphedema, may be permanent. Learn more about side effects here.
Studies also show that patients who undergo a Complete Lymph Node Dissection (CLND) have a lower quality of life compared to patients who only underwent a Sentinel Lymph Node Biopsy (SLNB).3
What Research Says about Complete Lymph Node Dissection in Melanoma:
Prior to a landmark 2017 study published in the New England Journal of Medicine4, Complete Lymph Node Dissection was part of the standard of care following the detection of melanoma cells during a Sentinel Lymph Node Biopsy. In the study of over 1900 patients, researchers found no significant difference between patients who did or did not undergo the procedure in terms of overall survival.
Today, due to the side effects – and negative impacts to overall quality of life – associated with a Complete Lymph Node Dissection, such as risk of severe swelling in the hands and feet, the procedure is only used in specific instances where additional information about the spread of melanoma is needed or to improve regional disease control.