Lymph nodes are small masses of tissue that are part of the body’s immune system. If melanoma spreads, it often goes to nearby lymph nodes first.

The sentinel node is the first lymph node tumor cells travel into. It’s the first place that cancer is likely to spread. Depending on the thickness of your tumor, the sentinel node may need to be removed and checked for cancer cells. A sentinel node biopsy is a test often done during melanoma removal surgery. This helps the healthcare provider know which lymph nodes to remove. If you will have a sentinel node biopsy, your healthcare provider can tell you more about what to expect.

If you have nearby lymph nodes that are enlarged on an imaging test such as a CT scan or can be felt during an exam, your healthcare provider will likely do a needle biopsy to see if they contain melanoma cells. If they do, the healthcare provider might remove all of the lymph nodes in this area. This is known as a lymph node dissection.

Risks and possible complications include:

• Bleeding

• Infection

• Scarring at the surgery site

• Problems with the skin graft 

• Failure to remove all of the cancer, requiring further treatments

• Risks of anesthesia

• Fluid build-up and swelling in an arm or leg (lymphedema) if many lymph nodes were removed

Prepare for the surgery as you’ve been told. In addition:

• Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines, herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.

• If you are having general anesthesia, do not eat or drink during the 8 hours before your surgery, or as directed by your healthcare provider. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)

• If you’re having a sentinel node biopsy, you may have an injection of harmless dye the day before surgery.

The surgery may take up to several hours, depending on what is done. You will likely go home the same day.

If you had only local anesthesia, you can go home shortly after the procedure. If you had general anesthesia, you’ll be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You’ll be given medicine to manage pain. When it’s time for you to be released from the hospital, have an adult family member or friend ready to drive you.

Once at home, follow the instructions you’ve been given. Your healthcare provider will tell you when you can return to your normal routine. Be sure to:

• Take all medicine as directed.

• Care for your incision as instructed.

• Don’t do heavy lifting or strenuous activities as directed.

• Don’t drive until your healthcare provider says it’s OK. Don’t drive if you’re taking medicine that makes you sleepy or drowsy.

• Follow your healthcare provider’s guidelines for showering. Don’t swim, take a bath, use a hot tub, or do other activities that cover the incision with water until your healthcare provider says it’s OK.

Call your healthcare provider right away if you have any of the following:

• Chest pain or trouble breathing (call 911) 

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Chills

• Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worse pain, or foul-smelling fluid

• Pain that cannot be controlled with medicine

You will have follow-up visits so your healthcare provider can see how well you’re healing. If needed, stitches or staples will be removed at 1 of these visits. You and your healthcare provider can also discuss any other treatments you may need.