Management of regional lymph nodes
Regional lymph nodes may be excised as a precautionary measure if they are as yet clinically uninvolved - elective lymph node dissection, ELND - or if they are clearly affected - therapeutic lymph node dissection, TLND.
ELND:
- a controversial area as 22% of malignant melanomas recur at distant sites without regional node involvement
- no prospective, randomised trials yet exist to show any benefit
- not generally carried out for stage I disease in the UK
- may benefit those with back, arm, neck or scalp distribution, who are male and have ulceration, nodularity or acra-lentiginous types
TLND:
- may be performed before, during or after treatment of the primary
- indicated in:
- those with obvious regional node involvement at initial presentation
- those whose previously normal nodes grow in size
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