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Melanoma has been divided into various stages depending on its severity. After melanoma progresses beyond Stage II, it is more dangerous. Once skin cancer has crossed Stage II it means the cancer has spread to other parts of the body, such as the lymph nodes.
In order to find if the melanoma cells have spread to other parts from the primary tumor, the doctor feels the lymph nodes. If the lymph nodes in the vicinity of the skin cancer feel enlarged, it is called palpable and the physician identifies this through examination. A palpable lymph node can be removed surgically. It is sent for examination microscopically for cancerous cells. If cancerous cells are found, the remaining nodes are also removed and immune system stimulating treatments are given. Chemotherapy can be recommended at this point of time.
Even though melanoma is present and it has spread beyond the lymph nodes, it does not always have to palpable. It can be non-palpable. There was a lot of debate about the behavior of lymph nodes. Some doctors suggested the wait and watch method, while some doctors suggest in removing all the nodes that are present in the region of the tumor. Dissecting the node to examine cancer cells is also preferred and it is called elective lymph node dissection.
There are specific guidelines in the cancer diagnosis sector that are followed today. There are two diagnostic procedures called the sentinel node biopsy and lymphoscintigraphy. These procedures will let us know if a biopsy has to be performed or not.
The nodal dissection or a surgery is required only if the melanomas are 1 mm in thickness. Lymphoscintigraphy is a technique that is used to map the path of the lymph nodes. This tracking system helps to track the melanoma cells and to see whether they have metastasized. The primary tumor can be found using this technique. Harmless radioactive substance is injected at the site of the melanoma. The nodes are tested for fluids and also examined microscopically.
Another procedure is to inject blue dye into the skin where the tumor is present so that they trace the path of the lymph nodes using the lymph fluid.
Most often, a second lymphatic mapping technique is also used to increase certainty: Blue dye is injected into the skin around the tumor, and the dye passes into the lymph. These are radioactive tracking tests. Even if there are more than one affected lymph nodes, they can be identified using this test and the results.
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Skin Cancer Foundation: Lymph Node Involvement