Question:hard
A patient is found to have a melanoma originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Which axillary nodes would NOT be removed?
A patient is found to have a melanoma originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Which axillary nodes would NOT be removed?
Show Hint
Apical nodes lie medial to the medial border of pectoralis minor, so a dissection stopping at that medial edge spares them.
Updated On: Jun 24, 2026
- Apical lymph nodes
- Central lymph nodes
- Lateral lymph nodes
- Pectoral lymph nodes
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Map the axilla using the pectoralis minor as the landmark. Draw two reference lines - one at its lateral border and one at its medial border. These split the axillary nodes into three levels from outside to inside.
Step 2: The dissection described stops at the medial edge of the pectoralis minor, removing every node that is lateral to that line. That captures the lateral, anterior (pectoral), posterior (subscapular) and central groups, since all of these lie at or below the level of the muscle.
Step 3: The apical group is defined as the nodes medial to the medial margin of the pectoralis minor, near the apex of the axilla and the subclavicular region. Because the operation does not cross to the medial side of that border, the apical nodes are spared.
Step 4: Of the four options only the apical nodes lie outside the cleared field, so they are the ones not removed.
\[\boxed{\text{Apical lymph nodes}}\]
Step 2: The dissection described stops at the medial edge of the pectoralis minor, removing every node that is lateral to that line. That captures the lateral, anterior (pectoral), posterior (subscapular) and central groups, since all of these lie at or below the level of the muscle.
Step 3: The apical group is defined as the nodes medial to the medial margin of the pectoralis minor, near the apex of the axilla and the subclavicular region. Because the operation does not cross to the medial side of that border, the apical nodes are spared.
Step 4: Of the four options only the apical nodes lie outside the cleared field, so they are the ones not removed.
\[\boxed{\text{Apical lymph nodes}}\]
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