Is lymphedema a risk for melanoma patients who require some of their lymph nodes to be removed?

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PeterBeitschMD (Physician - Surgery - Surgical Oncology (Verified) ) - 04 / 26 / 2012

Sentinel lymph node biopsy has revolutionized melanoma surgery, staging, prognosis, and aids in the decision for adjuvant therapy after definitive surgery. However, like all things there is some down side including pain and restriction of motion (usually limited to post operative period), numbness/paraesthesias (which can be permanent) and most problematic - lymphedema. The cause of post sentinel lymph node biopsy lymphedema is poorly understood but does not appear to be related to the number of lymph nodes removed (average sentinel node biopsy has 2-3 nodes). Complicating the issue further is the actual method of deciding if lymphedema is present. The methods vary from circumferential measurements above and below the elbow/knee at specified distances, perometry (measuring shadow size of each extremity), water displacement (volumetric analysis) and bioeimpedence (as extracellular fluid increases the ability to transmit electrical charge through the limb decreases). With all of those caveats, the risk of lymphedema after sentinel lymph node biopsy is ~5-10%; after a full lymphatic dissection, it is ~15-60% (and above that if the nodal area is radiated).
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member1705 (Survivor (Greater than 20 years)) - 04 / 27 / 2012

In 1992 I was told I would be bedridden for the rest of my life. I had my lymph nodes removed during a malignant melanoma surgery. My leg was as wide as my waist when I woke up from the surgery. I was told not to exercise for a full year. (I waited 9 months and just HAD to start exercising again!) The swelling went down very slowly. Twenty years later, I still deal with lymphedema on a daily basis. I maintain it well... sleep with my leg elevated, wear compression stocking, and I know which exercises reduce or increase the swelling. I recently published a book on my experience as a cancer patient and the twenty years since.

member1136 (Caregiver) - 12 / 05 / 2012

Lymphedema can occur in the breast as well as the better known upper limb. The risk of lymphedema of the breast or upper limb depends on the location of the sentinel node(s) removed in the drainage pathway, and whether radiation follows the surgery. Clinical lymphedema of the breast is noted in 23% of patients undergoing conservative breast cancer surgery and radiation, with 70% risk of pre-clinical lymphedema as measured by skin thickness. [Rönkä 2004, 2005]

With regard to measurement of lymphedema, the traditional methods (limb volume measurement, volume calculation, bioimpedance) do not work on non-limb lymphedema (neck and head, trunkal, breast, genital). New methods being evaluated and actually used in Finland show promise in measuring lymphedema by measuring skin thickness by ultrasound [Rönkä 2004] and by measuring tissue dielectric constant [Mayrovitz 2008]. These methods enable measurement of localized lymphedema anywhere on the body. Status of the skin can be measured by tonometry.
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