We are often asked for information on lymphoedema:  what is it, what causes it, can it be avoided, what is the best way to deal with it, can it be managed?  These are questions we are asked on a very regular basis.   We asked one of our advisors, Mr Myles Smith if he would put something together that would be helpful for patients who are about to undergo surgery, or are struggling with the management of lymphoedema.  Myles enlisted the help of Mary Woods, who is a Nurse Consultant, Lymphoedema, also at the Royal Marsden.


Lymphoedema, in the context of surgery for melanoma, is swelling in a limb due to the excision of lymph glands and disruption of lymphatic vessels.  There is a life long risk of the development of lymphoedema when someone has undergone either a dissection (removal) of all lymph nodes in a basin (as in the axilla or armpit) or the groin (inguinal nodes); or a sentinel lymph node biopsy (SLNB).  Although lymphoedema can occur with either a sentinel node biopsy or node dissection, it is more frequent in those having a node dissection.

Although all patients who have undergone surgery to lymph node areas are at risk of the development of lymphoedema, studies that have been carried out give some indication of its development after surgery for melanoma.  For example, in trials of SLNB, the rate of lymphoedema range from 4.6-7.2% in the Sunbelt Trial (1) and the MSLT-I (2) trials respectively, with a rate of 12.5% for those having a node dissection in MSLT-I.  However, in case series and other studies, higher rates have been described, with higher risk of lymphoedema associated with higher body mass index, co-morbidities such as diabetes, and in the groin, whether the deep (iliac nodes) are also dissected as part of the operation.

After lymph node surgery, you can minimise your risk of developing lymphoedema with some simple daily care. The aim is to ensure that the area where the lymph nodes have been removed and the arm or leg closest to it, are kept free from infection and inflammation, as these can lead to swelling.

To reduce the risk of infection, keep your skin clean, well moisturised and free from cuts, breaks and trauma of any kind. Protecting the skin is important, so consider protecting your arm with gloves for activities such as gardening and your legs with long trousers and well fitting footwear. Reduce the risk of mosquito bites by using a good insect repellent and wear a high factor sunscreen when you are in the sun. If you do notice any signs of infection, you should visit your doctor as you may need a two week course of antibiotics.

To reduce the risk of inflammation, try to avoid extremes of heat or cold as these could trigger swelling. Exercise is good for lymph drainage but return to activities gradually and avoid over strenuous activities which can trigger swelling.

If you notice any signs of swelling, it is important to seek advice from a health care professional. Swelling can be more successfully managed when it is at an early stage and management may involve a number of approaches depending upon your needs. This may include the use of a compression garment to reduce and control the swelling which is particularly effective when you are active. A lymphoedema therapist will be able to advise you about any specific exercises you should complete and some people undergo a special form of skin massage to help with the swelling.

There are many people living well with lymphoedema, and if you have been affected, it may be helpful to contact the Lymphoedema Support Network, to access more information and gain support.

We are very grateful to Myles Smith & Mary Woods for their assistance.


  1. Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the multicenter selective lymphadenectomy trial (I). Ann Surg Oncol.2010;17:3324–9.
  2. Wrightson WR, Wong SL, Edwards MJ, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol.2003;10:676–80.
  3. https://www.nhs.uk/conditions/lymphoedema/
  4. http://www.lymphoedema.org/