Final answer:
The apical lymph nodes would not be removed in the described surgery for melanoma as they are located superior to the medial edge of the pectoralis minor muscle, which is not encompassed in the removal of nodes lateral to this muscle.
Step-by-step explanation:
The question pertains to the anatomy of the axillary lymph nodes and their relationship with the removal of a melanoma from the left forearm. The axillary lymph nodes are grouped into several clusters based on their location in the armpit (axilla) area. These clusters include the apical, central, lateral, pectoral, and subscapular groups. In the described surgical procedure, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed. Given this information, apical lymph nodes (A) would not be removed by this procedure, as they are located superior to the pectoralis minor muscle and are considered to be the most medial nodes in the axilla. The axial nodes that are removed include the central, lateral, pectoral, and subscapular nodes which are all located lateral to the medial edge of the pectoralis minor muscle.
When considering melanomas, they can spread to nearby lymph nodes, making the examination and possible removal of these nodes an important part of the treatment process. Melanomas are a type of skin cancer that arise from melanocytes, which are pigment-producing cells in the skin. The fact that melanomas are highly metastatic underscores the importance of lymph node assessment during treatment.