If lymph nodes are abnormally hard or large on clinical exam or seen on radiologic exams, a fine needle aspiration (FNA) biopsy or excisional biopsy can be done. If melanoma is found in a node or nodes, a lymph node dissection is usually done. Up until recently, most doctors recommended to remove the lymph node if there was a positive sentinel lymph node. However, a recent multi-center international clinical trial, MSLT-II which was conducted from the John Wayne Cancer Institute, showed no difference in survival between patients who underwent a completion node dissection versus those who were observed frequently with clinical exams and ultrasounds of the lymph node basin.
One complication after a complete lymph node dissection is lymphedema. Lymph nodes under the arm or in the groin function to drain fluid. Sometimes when they are removed, the fluid may accumulate and this is called lymphedema. This can cause swelling and may or may not go away. Elastic stockings, compression sleeves and physical therapy can help some people with this condition.