The Royal Marsden Diagnosis and treatment

Lymph node staging for melanoma

The Royal Marsden is now offering a sentinel lymph node biopsy (SLNB) for melanoma patients to determine the staging of their disease

Surgeon Mr Kieran Power

Mr Myles Smith and Mr Kieran Power, Consultant Surgeons at The Royal Marsden, perform the operations, which are done as a day-case procedure.

“This procedure identifies the relevant lymph nodes that can be removed for testing to see if there is any spread of the disease,” said Mr Power.

“Previously, if the biopsy was positive, we would remove all nodes, which is a big operation and can cause lymphoedema. What’s exciting is that now, most patients can avoid this surgery and have ongoing follow-up with ultrasound.”

The procedure involves injecting both a radioisotope and a fluorescent dye, which illuminates lymph nodes that may be cancerous. A SPECT scan – an advanced type of CT scan – then provides a 3D image of the area.

This pioneering biopsy will define the patient pathway of the future

Mr Myles Smith

Mr Smith said: “The Royal Marsden is pioneering in nuclear medicine. Using advanced imaging to guide a biopsy allows us to identify affected nodes with even greater accuracy, telling us even more about the disease. This will define the patient pathway of the future.”

Patients whose biopsy results come back negative for spread of melanoma can be discharged. Those who are positive can be followed up with regular ultrasound scans and may be eligible for clinical trials of adjuvant treatment, which may include immunotherapy.