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