If there is palpable lymphadenopathy fine needle aspiration cytology should be used to obtain cytological confirmation of metastases, with ultrasound if required.
If open biopsy is undertaken the incision must be placed in the same line as for a potential radical lymphadenectomy.
Therapeutic lymph node dissection requires complete and radical removal of all draining lymph nodes to allow full pathological examination.
Patients with a confirmed metastatic lymph node(s) should be radiologically staged prior to lymph node dissection.
Regional lymph node dissection carries a well defined and significant morbidity and should be undertaken only by surgeons with appropriate expertise.
Patients should be advised of the risk of lymphoedema following lymph node dissection. If lymphoedema occurs, patients should be referred to a lymphoedema specialist.