You might have a lymph node biopsy to find out if your cancer has spread from the skin to the lymph nodes.
This is more likely to happen if you have a squamous cell skin cancer rather than a basal cell skin cancer. But it would still be unusual.
What is a lymph node?
A lymph node is part of the lymphatic system. This is a network of thin tubes (vessels) and nodes that carry a clear fluid called lymph around the body. This is an important part of the immune system. It plays a role in fighting infection and destroying old or abnormal cells.
The nodes are bean shaped structures that filter the lymph fluid and trap bacteria and viruses, and cancer cells.
You might need a biopsy because your doctor felt swollen (enlarged) lymph nodes when they were examining you. Or you might have had a scan that has shown that some lymph nodes look abnormal. This could be a sign that cancer has spread.
Types of lymph node biopsies
Fine needle aspiration (FNA)
Your doctor takes out a sample of cells using a needle and syringe. You might have an ultrasound scan to help guide the needle.
In the laboratory, a specialist (pathologist) looks at the cells under a microscope.
Whole lymph node biopsy
Your doctor takes out the whole lymph node. This is also called an excision biopsy. You may have this if the FNA did not show up any cancer cells but your doctor still suspects there may be cancer there.
You might have a local anaesthetic to numb the area before they take the biopsy. Or you might have the biopsy under general anaesthetic, which means you are asleep. It is a small operation that most people have as a day case.
Your doctor makes a small cut above the swollen lymph node and removes it. They then send it to the laboratory for testing.
There are many lymph nodes throughout your body. So removing 1 or 2 doesn't usually cause any problems.
Before your biopsy
You’ll get an appointment letter explaining how to prepare for your biopsy.
Take your medicines as normal unless you're told otherwise. If you're taking medicines to thin your blood, your doctor might ask you to stop them beforehand.
You meet with your doctor and sign a consent form before you have the test. This is a good time to ask them any questions.
If you’re having a general anaesthetic, you have to stop eating and drinking for a certain amount of time beforehand. You also need a friend or relative to take you home and stay with you overnight.
During your biopsy
You change into a hospital gown and lie on a couch.
Your doctor first cleans your skin on and around the lymph nodes. They then inject medicine to numb the area (if you're not having a general anaesthetic). The medicine can sting a little as it goes in.
Once the area is numb your doctor then finds the lymph node to take the biopsy from. They may be able to feel the swollen lymph node or they can find it using an ultrasound scan. They then put a fine needle through your skin and pull back some cells and fluid into a syringe. Or they make a cut and remove the whole lymph node. They close the cut with a few stitches.
After your biopsy
Your doctor covers the biopsy site with a small dressing. Ask your doctor how best to look after this for the next few days. You should be able to go home the same day as your biopsy.
Check with your doctor if they have used dissolvable stitches or not. For non dissolvable stitches book an appointment with your GP surgery for the practice nurse to take out. Your doctor will tell you when is best to do this.
A lymph node biopsy is a safe procedure but your doctor or nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a lymph node biopsy outweigh any possible risks.
You might have some mild pain or discomfort around the site. Taking a painkiller such as paracetamol can help.
There is a small risk of bleeding. Your doctor can normally control this by pressing on the area. If there is a lot of blood from the biopsy site, let your doctor know straight away or go to your nearest accident and emergency department (A&E).
Contact your GP or the hospital if you have a high temperature or feel unwell. Or if there is redness, swelling or fluid (discharge) at the biopsy site.
Getting your results
You should get your results within 1 or 2 weeks at a follow up appointment.
Waiting for test results can be a worrying time. You can contact your specialist nurse if you’re finding it hard to cope. It can also help to talk to a close friend or relative about how you feel.
Contact the doctor that arranged the test if you haven't heard anything after a couple of weeks.