Lymph node resection for nonmelanoma skin cancer Medical editor Hans Petter Gullestad MD
Oslo University Hospital
In rare cases, basal cell carcinoma will metastasize to regional lymph nodes. Both squamous cell carcinoma and Merkel cell carcinoma have a greater tendency for this type of spreading. Treatment of regional node metastases is surgery after the diagnosis is made. A node dissection is performed as in melanoma, but may be more technically demanding because of the difference in tumor growth.
Infiltrated lymph nodes are stiff or hard in consistency and have a round or mildly bumpy surface.
For extranodal tumor growth, considerable tumor involvement, or tumor spillage during surgery, radiation therapy should be assessed to prevent local recurrence.
A node dissection is performed in the groin , axilla , and neck.
- Nonmelanoma skin cancer with spreading to regional lymph nodes.
- The surgery is performed under general anesthesia.
- The patient lies in the supine position.
Inguinal Node Dissection
The surface nodes are localized at least 5 cm above the inguinal ligament in the entire femoral triangle and spread on both sides of the great saphenous vein. Except for extremely thin people, the lymph nodes are located deep into the scarpal fascia.
- A vertical lazy-S incision is made starting 10 cm above the inguinal ligament, crosses the midpoint, and continues to approximately 15 cm below the inguinal ligament . Alternatively, an incision is made a few centimeters below and parallel with the inguinal ligament and curves medially down the the femoral triangle.
- The skin flaps are dissected and the specimen is removed en bloc. The great saphenous vein is included in the specimen from the tip of the femoral triangle and to the opening of the femoral vein. For metastastic lymph nodes in the pelvis, the surgery is extended as an ilio-inguinal gland dissection which includes the iliac and obturator glands.
- The incision is rinsed and a drain is installed.
- The incision is closed in two layers.
The drain is kept for 5-10 days or until the fluid volume is reduced to 40-50 ml per 24 hours.
- Postoperative seromas – these are drained sterilely
- Nerve pain and dysfunction – often temporary
- Necrosis of skin edges, lymphedema, and infection in the incision – more frequent for inguinal node dissection
- Deep vein thrombosis in the leg
Lymphedema is a serious and long-lasting complication occurring in about 20% of patients after an inguinal node dissection. Therefore, it is recommended that the patient keeps their feet elevated while sitting or lying for the first three months after the operation. Elastic stockings shoud be worn day and night during this period. Within the next three months, the patient should gradually decrease use of the stockings.
Physiotherapy after the operation may be important for the patient to achieve an optimal rehabilitation process. Many patients can take care of the physiotherapy themselves after receiving information and guidance.