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Melanoma & Sentinel Lymph Node Biopsy

Melanoma is a skin cancer that arises from melanocytes — the cells responsible for skin pigmentation. Unlike most skin cancers, melanoma has a significant capacity to spread, and the way it spreads — preferentially through the lymphatic system before the bloodstream — is what makes sentinel lymph node biopsy such a critical part of its surgical management.

Mr Matthew Potter performs wide local excision of melanoma combined with sentinel lymph node biopsy (SLNB) — the procedure that determines whether melanoma has spread to the lymph nodes. He is a member of the National CRUK skin cancer research panel and is involved in an international study into improving outcomes in Merkel cell carcinoma. His outcomes for sentinel lymph node biopsy are among the best recorded nationally and internationally.
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Why Mr Potter

National CRUK panel member for skin cancer research and trials

Part of the international Rational MCC study into improving skin cancer outcomes

0% mortality across skin cancer surgery

PHIN patient satisfaction score: 99%

PHIN is an independent government audit of consultant patient outcomes, randomly sampling post-operative patients. A 99% satisfaction score places Mr Potter among the highest-rated plastic surgeons in the country.

How melanoma spreads

Melanoma is unusual among skin cancers in that it tends to spread initially through the lymphatic system rather than the bloodstream. The lymphatic system is the body’s filtration network — lymph fluid passes from tissues through a series of vessels to lymph nodes, which filter waste products, bacteria and abnormal cells before returning clean lymph to the blood.

Melanoma cells can pass into lymph vessels and travel to the first lymph node draining the site of the tumour — the sentinel node. Whether or not the sentinel node contains melanoma cells is one of the most important indicators of how far the disease has progressed.

Staging

The seriousness of a melanoma is assessed through a staging system. The depth of the melanoma in millimetres indicates how far it has grown within the skin and the likelihood that it has reached lymph vessels. Knowing whether melanoma has reached the sentinel node is a key indicator of disease status — and if spread is confirmed, it allows treatment with immunotherapy to begin as early as possible.

Do's & Don'ts

  • Apply antibiotic ointment to operative sites each evening for two weeks
  • Sleep with two to three pillows for the first week
  • Avoid coughing, straining, and bending for at least two weeks
  • Avoid strenuous exercise for 6 weeks
  • Take oral pain relief for the first two to three days as needed — some patients experience headache rather than operative site pain; this settles with simple oral pain relief
  • Do not drive until you can safely perform an emergency manoeuvre

How melanoma develops

The skin contains four principal cell types in its top layer, one of which is the melanocyte. Melanocytes produce skin pigment and respond to sunlight. Occasionally a melanocyte undergoes an abnormal change, producing a clone of altered cells that behave differently from normal. Once this clone reaches a sufficient size it forms a tumour — not yet a cancer.

If left, the tumour can grow and invade through the barrier between the superficial and deep layers of the skin. At that point it becomes a cancer: melanoma.

Locating the sentinel node

Most melanoma referrals have already had an initial excision with a minimal margin, leaving a linear scar. The centre of that scar corresponds to where the melanoma originated and shares the same lymphatic drainage channels.

Mr Potter injects the centre of the scar with a radio-opaque tracer that travels to the sentinel node, making it visible on a specialist X-ray. The same site is also injected with a coloured dye, which stains the sentinel node — distinguishing it from surrounding non-sentinel nodes during surgery.

The procedure

For melanomas of the head and neck, SLNB is performed under general anaesthetic and takes approximately two hours. The radiographer marks the skin over the node’s location on the X-ray, and Mr Potter reviews both the skin marks and the imaging before proceeding. The sentinel node is identified intraoperatively using a gamma probe and its blue dye staining, then removed and sent for pathological analysis.

What is SLNB?

Sentinel lymph node biopsy is the surgical procedure that identifies and samples the first lymph node the melanoma would drain to — the sentinel node. If this node is clear of melanoma cells, it is highly likely the disease has not spread beyond the skin. If it contains melanoma, this information is critical for planning further treatment.

What Patients Say

Thank you for personally telephoning me as soon as you received the results of the biopsies. I consider myself very fortunate to have been your patient since March 2015. I am greatly indebted to you and indeed to everyone who has been involved in my care since the Cancer diagnosis. A very big thank you. MW

Following removal of a melanoma five years ago, I had developed an amelanotic lentigo maligna on my face which had become quite large, as a result of not being visible. Matthew Potter and Dr Richard Turner worked closely together on this, Richard Turner determined the margins using Johnson’s technique and then Matthew Potter carried out a major surgical procedure (cervico-facial rotation).

He showed me pictures in advance of what to expect immediately after the operation and then long term, and it has worked out exactly as predicted – pretty gruesome on the day of discharge but now settled down so well that no-one notices that anything has been done, despite the scale of the surgery. I am very pleased with the result.

Done privately, as although the same procedure would have been available on the NHS, there was a much longer wait and the procedure may not have been done entirely by Matthew Potter.

I met Mr Potter prior to my melanoma op and he was very informative and helpful, explaining what he was going to do. He reassured me that the scar which looked awful on the photos he showed me, will go away and will be hardly noticeable – and he was right!

I still see him in 6 monthly intervals when he examines me very thoroughly. I can recommend Mr Potter wholeheartedly. He is a wonderful surgeon and has a lovely personality

Following a recent diagnosis of malignant melanoma I met with Matt who was very reassuring. He was very patient and understanding, explaining what had happened so far and the options that were available to me.

So far I have had a wide local excision and a sentinel lymph nodes biopsy and the surgical results have been amazing, the scars are healing very well and I am happy at how good they look already, about 1 month on.

Matt is continuing to provide excellent care, both for my physical health and emotional wellbeing, ensuring that I understand my future treatment. I feel very fortunate to be in the care of Matt and have faith in his recommended treatment plan.

After being diagnosed with a malignant melanoma on my left thigh and then a completion Lymphadenectomy. I met Mathew Potter my surgeon and I cannot speak more highly of him.

He explained the procedures clearly and he and his brilliant team gave me great confidence.He was kind, gentle and had a great sense of humour and was very professional in his procedures. I would highly recommend him….he is a total asset to his profession.

John DoeCEO

5 years ago I had skin cancer. No nonsense, spoke to me as an equal, in plain speak, jargon free. He gave me confidence from the off. I had the cancer removed along with a few lymph nodes from my elbow and armpit.

Experienced some swelling in my hand, this disappeared within a couple of weeks. I did not have chemotherapy. Ok, the next 5 years:- Tri-monthly and 6 monthly meetings with Mr Potter and the team. I was visually scanned on each occasion either by Mr Potter or “TP” the Cancer nurse.

If I had a question the Macmillan nurse “TP” was always responsive and helpful. One other integral part of the team was “OM”, always there with Mr Potter. Always friendly and as a first point of contact very reassuring. Where would I be right now without these people? Thank you so much.

John DoeCEO

I had a melanoma removed from my arm, and saw Matt after that for a Wide Local Excision and Sentinel Lymph Node Biopsy. He was extremely patient throughout and explained everything about the cancer and also the procedure thoroughly.

He even rang me the evening after surgery to check I was clear about the aftercare. The wounds have healed well leaving remarkably little scarring. I cannot fault any of my experience with Matt and would highly recommend him. Thanks very much

John DoeCEO
Mr Potter has been carrying out annual examinations to be certain my melanoma has not returned – he performed the lymphadectomy following its excision. He has made me happy, comfortable — and unworried!
John DoeCEO
Matthew Potter has performed three procedures on me, one a very intricate operation. He has a very pleasant manner, gives explanations that are easy to follow, and is very thoughtful and sympathetic in his approach. I can recommend him without any hesitation.
John DoeCEO

Mr Potter removed a lesion from the skin on my side under local anaesthetic. He was very gentle when giving me the local anaesthetic. He explained what he was doing throughout the procedure and made me feel less nervous.

I am happy that the scar left is extremely faint and hardly noticeable now. I would recommend him to others needing lumps and bumps removed.

John DoeCEO

I have recently been seen by Mr Potter for a wide local excision following a NHS initial excision. I wanted a private plastic surgeon in order to ensure the scar is at its best.

Although it is early days and the scare is healing well and the results are looking great thus far, if anyone wants a surgeon who takes time to explain what the condition is you have and has an excellent bed side manner with excellent results, I can assure you that all of these qualities and more Mr Potter displays.

I would say I am the worst patient ever and he definitely put me at ease. After care is excellent and I would not go to anyone else now that I have experienced his professional care and skills.

John DoeCEO
Thank you for looking after my mummy.
John DoeCEO

Dear Mr Potter, a note to say thank you for diagnosing that the facial melanoma had spread. That was in June 2016. Having had to break the news of spread you were instrumental in getting me to Dr N and the subsequent acceptance on his immunotherapy programme.

For nearly a year I have been disease free and been able to resume life including my 25th Wedding anniversary trip to Italy. My heartfelt thanks.

John DoeCEO
Just a note to say thank you for your care and consideration over my Melanoma. Your advice and care has been much appreciated.
John DoeCEO

Frequently Asked Questions

What is a sentinel lymph node?

The sentinel lymph node is the first lymph node that receives lymphatic drainage from the site of the melanoma. Because melanoma tends to spread through the lymphatic system first, the sentinel node is the most likely place to find melanoma cells if the disease has begun to spread.

If the sentinel node is clear of melanoma, it is highly likely the disease has not spread beyond the skin. If it contains melanoma cells, this is critical information — it allows staging to be completed accurately and immunotherapy or other systemic treatments to begin as early as possible.

Not necessarily. A positive sentinel node indicates spread to the regional lymph nodes. It is concerning news, but knowing it is beneficial — it allows treatment to begin promptly, which can prevent further progression.

Mr Potter will discuss the implications of the result and any further treatment options with you. This may include completion lymph node dissection, immunotherapy, or a combination, depending on the individual case.

At the Manor Hospital in Oxford, Ridgeway Hospital in Swindon, Stratum Clinic in Wootton Oxfordshire, ProDerm in Cheltenham, and Interface Business Park in Royal Wootton Bassett.

Book a Consultation

Contact us if you have any health concerns or are looking to get a consultation. You can contact Matthew Potter by using the form below or contact him through one of the available telephone numbers or email addresses listed on this page.

Private Secretary & All Correspondence

T. 07917 965717

Swindon - Ridgeway Hospital

T. 01793 814848

Cheltenham - ProDerm, Festival House

T. 0800 0489230

Oxfordshire - Stratum Clinic,
Wootton Business Park

T. 01865 320790

Wiltshire - Interface Business Park, Royal Wootton Bassett

T: 0808 2803560

Oxford - The Manor Hospital

T. 01865 307777

Contact Lissie on 07917 965717 or use the form below.