Sentinel Lymph Node Biopsy

The sentinel nodes are the first few lymph nodes to which a tumour drains. Sentinel node biopsy involves injecting a tracer material that helps the surgeon locate the sentinel nodes during surgery. The sentinel nodes are removed and analysed in a laboratory, while leaving the rest of the lymph nodes in the area alone.

Sentinel lymph node biopsy helps to direct on-going care because it is the most predictive factor for the risk of spread of your melanoma. If your biopsy is negative, you are at a lower risk of spread of your melanoma and your follow up can be tailored to take this into consideration, including less intensive investigations and follow up.

If a sentinel lymph node biopsy reveals spread of your cancer, your doctor might recommend additional scans, more frequent reviews to check on your progress and may advise on further management, including possible surgery, medications or post-operative radiotherapy, depending on the nature of the cancer and your needs. This is often undertaken as part of a specialist Melanoma multidisciplinary team review. We are very used to helping patients to navigate this process and will take time to answer your questions so you are properly informed about your diagnosis, management and what it all means.

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Recovery and rehabilitation

Caring for Skin Flaps

You will need to care for the flap site as well as the donor site. When you come home after surgery, you will have a dressing on your wounds. The dressing does several things, including:

Protect your wound from germs and reduce the risk of infection
Protect the area as it heals
Soak up any fluids that leak from your wound

To care for the graft site:

You may need to rest for several days after surgery as your wound heals.
The type of dressing you have depends on the type of wound and where it is.
Keep the dressing and area around it clean and free from dirt or sweat.
Do not let the dressing get wet.
Do not touch the dressing. Leave it in place for as long as your doctor recommends (about 4 to 7 days).
Take any medicines or pain relievers as directed.
If possible, try to elevate the wound so it is above your heart. This helps reduce swelling. You may need to do this while sitting or lying down. You can use pillows to prop up the area.
If your doctor says it is OK, you may use an ice pack on the bandage to help with swelling. Ask how often you should apply the ice pack. Be sure to keep the bandage dry.
Avoid any movement that might stretch or injure the flap or graft. Avoid hitting or bumping the area.
You will need to avoid strenuous exercise for several days. Ask your doctor for how long.
If you have a vacuum dressing, you may have a tube attached to the dressing. If the tube falls off, tell your doctor.
You will probably see your doctor to have your dressing changed in 4 to 7 days. You may need to have the dressing to your flap site changed by your doctor a couple times over 2 to 3 weeks.
As the site heals, you may be able to care for it at home. Your doctor will show you how to care for your wound and apply dressings.
The site may become itchy as it heals. Do not scratch the wound or pick at it.
After the site heals, apply SPF 30 or higher sunscreen to surgical sites if exposed to the sun.

To care for the donor site:

Leave the dressing in place. Keep it clean and dry.
Your doctor will remove the dressing in about 4 to 7 days, or give you instructions for how to remove it.
After the dressing is removed, you may be able to leave the wound uncovered. However, if it is in an area that is covered by clothing, you will want to cover the site to protect it. Ask your doctor what type of dressing to use.
Do not apply any lotions or creams to the wound unless your doctor tells you to. As the area heals, it may itch and scabs may form. Do not pick scabs or scratch the wound as it heals.

Bathing or Showering

Your doctor will let you know when it is OK to bathe after surgery. Keep in mind:

You may need to take sponge baths for 2 to 3 weeks while your wounds are in the early stages of healing.
Once you get the OK to bathe, showers are better than baths because the wound does not soak in water. Soaking your wound could cause it to reopen.
Be sure to protect your dressings while you bathe to keep them dry. Your doctor may suggest covering the wound with a plastic bag to keep it dry.
If your doctor gives the OK, gently rinse your wound with water as you bathe. Do not rub or scrub the wound. Your doctor may recommend special cleansers to use on your wounds.
Gently pat dry the area around your wound with a clean towel. Let the wound air dry.
Do not use soaps, lotions, powders, cosmetics, or other skin care products on your wound unless told to do so by your doctor.

At some point during the healing process, you will not need a dressing anymore. Your doctor will tell you when you can leave your wound uncovered and how to care for it.

When to Call the Doctor

Call your doctor if:

Pain gets worse or does not improve after taking pain relievers
You have bleeding that won’t stop after 10 minutes with gentle, direct pressure
Your dressing becomes loose
Edges of the flap start to come up
You feel something bulging out of the flap site

Also call your doctor if you notice signs of an infection, such as:

Increased drainage from the wound
Drainage becoming thick, tan, green, or yellow, or smells bad (pus)
Your temperature is above 37.8°C for more than 4 hours
Red streaks appear that lead away from the wound

More information

What else you should know

Where is it done?

Sentinel node biopsy is recommended for people with certain types of cancer to determine whether the cancer cells have spread into the lymphatic system.

Sentinel node biopsy is routinely used for people with:

Breast cancer
Melanoma

Sentinel node biopsy is being studied for use with other types of cancer, such as:

Colon cancer
Esophageal cancer
Head and neck cancer
Non-small cell lung cancer
Stomach cancer
Thyroid cancer

Is it a seperate operation?

A sentinel lymph node biopsy will most commonly be done at the same time as the removal of a lesion with a known or suspected pathology

What are some of the risks associated with this surgery?

Sentinel node biopsy is generally a safe procedure. But as with any surgery, it carries a risk of complications, including:

Bleeding
Pain or bruising at the biopsy site
Infection
Allergic reaction to the dye used for the procedure
Lymphedema — a condition in which the lymph vessels can’t adequately drain lymph fluid from an area of your body, causing fluid buildup and swelling

How will my RPS team manage my post-operative care?

Your RPS team will give you specific advice regarding your individual post-operative recovery. They will advise: