the Long-Term Effects and Prognosis of Lymph Node Removal for Melanoma

Are there many complications after lymph node removal?

I am 23 years old.
The doctor suspected that the mole on my left foot was melanoma, and after surgery, it was highly suspected but not confirmed.
They recommended removing the lymph nodes in my left leg as a preventive measure.
The doctor mentioned several potential side effects, but I am unsure how long these side effects will last and what the prognosis is.
Of course, my biggest concern is not knowing how high my survival rate is, especially if it is stage 0 melanoma.

EVAN, 20~29 year old female. Ask Date: 2001/06/19

Dr. Yang Youhua reply Oncology

The staging of melanoma is determined by the depth of tumor invasion, whether there is lymphatic spread, and if there are distant metastases.
According to the 1997 AJCC staging system, the stages are as follows:
Stage IA: Localized tumor with a thickness of <0.75 mm (T1 N0 M0)
Stage IB: Localized tumor with a thickness of 0.75 mm to 1.49 mm (T2 N0 M0)
Stage IIA: Localized tumor with a thickness of 1.5 mm to 4 mm (T3 N0 M0)
Stage IIB: Localized tumor with a thickness of >4 mm (T4 N0 M0)
Stage III: Localized lymphatic metastasis without distant metastasis (Tany N1 M0)
Stage IV: Extensive regional lymphatic metastasis or distant metastasis (Tany N2 M0) or (TNM 1 or 2)
Prognosis is also related to the depth of invasion:
Depth of invasion Probability of lymphatic metastasis (%) 10-year survival rate (%)
<0.75 mm 8.3 97
0.76-1.5 mm 20.2 87
1.51-3.99 mm 36.6 67
≥4 mm 40.0 40
If malignant melanoma is confirmed, local lymph node dissection can provide more accurate staging and remove potentially metastatic lymph nodes.
Your current concern is that the pathology slides have not confirmed the diagnosis (only highly suspected), and whether to undergo lymph node dissection involves risk considerations and personal choices.
It is recommended that you seek a second opinion from another pathologist to review the slides.
After lymph node removal, there may be localized swelling and poorer lymphatic drainage in the lower limbs, leading to increased swelling.
The duration of symptoms is difficult to determine, so please discuss this with your attending physician.

Reply Date: 2001/06/19

More Info

When it comes to melanoma, particularly in the context of lymph node removal, there are several important factors to consider regarding long-term effects, prognosis, and survival rates. Melanoma is a type of skin cancer that can be aggressive and has the potential to spread to lymph nodes and other parts of the body. The management of melanoma often involves surgical intervention, especially when there is a suspicion of metastasis.

Long-Term Effects of Lymph Node Removal
1. Lymphedema: One of the most common long-term effects of lymph node removal is lymphedema, which is the swelling that occurs when lymph fluid builds up in the tissues. This can happen after lymph nodes are removed because the normal drainage of lymph fluid is disrupted. Lymphedema can be chronic and may require ongoing management, including physical therapy and compression garments.

2. Sensory Changes: Patients may experience changes in sensation in the area surrounding the surgical site. This can include numbness, tingling, or hypersensitivity. These changes can be temporary or, in some cases, permanent.

3. Infection Risk: The removal of lymph nodes can increase the risk of infections in the affected limb. This is due to the compromised lymphatic drainage system, which plays a role in immune function.

4. Scarring and Cosmetic Changes: Surgical removal of lymph nodes can lead to scarring and changes in the appearance of the skin in the surgical area. This can have psychological effects on some patients.

Prognosis and Survival Rates
The prognosis for melanoma largely depends on the stage at which it is diagnosed. If your melanoma is classified as stage 0 (in situ), it is typically associated with a very high survival rate, often exceeding 95%. This is because the cancer is confined to the outer layer of skin and has not invaded deeper tissues or spread to lymph nodes.

For melanoma that has spread to lymph nodes (stage III), the prognosis can vary significantly based on several factors, including:
- Number of lymph nodes involved: The more lymph nodes that are affected, the higher the risk of recurrence and poorer the prognosis.

- Depth of invasion: The thickness of the melanoma (measured in millimeters) is a critical factor in determining prognosis. Thicker melanomas are associated with a higher risk of metastasis.

- Response to treatment: The effectiveness of treatments such as immunotherapy or targeted therapy can also influence long-term outcomes.

Follow-Up and Monitoring
After lymph node removal, it is essential to have regular follow-up appointments with your healthcare provider. This will allow for monitoring for any signs of recurrence or complications from the surgery. Your doctor may recommend imaging studies or blood tests to track your health status.

Conclusion
In summary, while lymph node removal can have significant long-term effects, many patients can manage these with appropriate care and support. The prognosis for melanoma, particularly at an early stage, is generally favorable, but it is essential to remain vigilant and proactive in your follow-up care. If you have concerns about your specific situation, including the potential for recurrence or the management of side effects, it is crucial to discuss these with your healthcare provider, who can provide personalized advice based on your medical history and current health status.

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