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Video: Sentinel Lymph Node Biopsy for Melanoma

Narrator: The thicker the melanoma, the more it spreads to the lymphatic system and lymph nodes. Unless the lymph nodes are swollen and visible on a physical exam or imaging test, the only way to know for sure if the cancer has spread to the lymph nodes is to remove them.

The path of initial lymphatic drainage and the extent of tumor spread can be determined by locating the sentinel lymph nodes – the first nodes that filter the lymphatic fluid drained from the melanoma . In some melanomas, tumor cells can travel in multiple directions within the lymphatic system. Sometimes there is more than one sentinel lymph node.

To locate one or more sentinel lymph nodes prior to surgery, a radioactive substance is injected into the skin surrounding the surgical site. The original melanoma. The radioactive material travels through the lymphatic vessels and collects in the sentinel lymph nodes. Body scans taken minutes after injection identified the location of the outposts.

To help visualize the sentinel node during surgery, the surgeon injects a blue dye into the skin surrounding the melanoma. Like the radioactive material, the dye drains through the lymphatic vessels to the sentinel lymph nodes. A small incision is made near the sentinel lymph node. The presence of the blue dye and instruments that detect the radiation allow surgeons to identify sentinel nodes.

The node is removed and sent to the pathologist, who cuts it into pieces. Each section was examined under a microscope for melanoma cells. Special stains can also be used to help visualize small numbers of cancer cells.

If the melanoma has spread to the sentinel lymph nodes, other lymph nodes in the area are surgically removed to make sure they do not contain additional melanoma cells.

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      1. Outpost Lymph node biopsy. National Cancer Institute. https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet. Accessed August 17, 2020.

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