management of regional lymph nodes

Last reviewed 07/2022

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.


  • 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


  • 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