Wide Local Excision and Sentinel Lymph Node Biopsy

Wide Local Excision

A wide local excision (WLE) is the surgical removal of the primary melanoma along with a rim of normal skin surrounding the tumor, usually ½ to 1 inch. Rarely, a skin graft is necessary to fill in the space.

Lymphoscintography and the Sentinel Lymph Node

Lymphoscintography is a nuclear medicine scan of your lymphatic system used to identify the sentinel lymph node. You will have this scan on the day of your surgery in the Nuclear Medicine Department. 

A small amount of radioactive dye will be injected in the skin around the site of your primary melanoma. As the material moves through the lymphatic channels, a special scan is performed to determine the regional lymph node site at risk for containing metastatic disease. The lymph node that picks up the dye is called the sentinel lymph node. This procedure makes a map for the surgeon to identify and remove the sentinel lymph node.

The nuclear medicine doctor will mark the location of the sentinel lymph node (or nodes) on your skin with ink. The surgeon will use a Geiger counter (a gamma probe) to pick up the radioactive material that you had injected into the skin to help locate the sentinel lymph node.

Lymphadenectomy or Lymph Node Dissection

If you have a lymph node removed that indicates the melanoma has spread, your surgeon will recommend additional surgery to remove the rest of the lymph nodes in that area.

This surgery is called lymphadenectomyor lymph node dissection. In addition, patients with spread of melanoma to lymph nodes sometimes take additional treatments (adjuvant therapy) after recovery from surgery to help prevent recurrence or further spread. These treatments can include medications, such as interferon-alpha; vaccine treatments; chemotherapy; or radiation therapy. Your health care team will discuss these options with you if they are indicated.

Click here to return to main Melanoma Center: Patient Handbook page.