[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.172.195.82. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Rigel  DS Malignant melanoma: incidence issues and their effect on diagnosis and treatment in the 1990s.  Mayo Clin Proc. 1997;72367- 371Google ScholarCrossref
2.
Parker  SLTong  TBolden  SWingo  PA Cancer statistics, 1997.  CA Cancer J Clin. 1997;475- 27Google ScholarCrossref
3.
Balch  CM The role of elective lymph node dissection in melanoma: rationale, results and controversies.  J Clin Oncol. 1988;6163- 172Google Scholar
4.
Balch  CMMilton  GWCascinelli  N Elective node dissection: pros and cons. Balch  CMHoughton  ANMilton  GW  et al. eds. Cutaneous Melanoma. Philadelphia, Pa Williams & Wilkins1992;345- 364Google Scholar
5.
Sappey  MPC Anatomie, Physiologie, Pathologie des Vaisseaux Lymphatiques Considérés Chez l'Homme et les Vertébrés.  Paris, FranceDeLahaye  ALecrosnier  E1874- 85
6.
Sugarbaker  EVMcBride  CM Melanoma of the trunk: the results of surgical excision and anatomic guidelines for predicting nodal metastasis.  Surgery. 1976;8022- 30Google Scholar
7.
Morton  DLWen  DRWong  JH  et al.  Technical details of intraoperative lymphatic mapping for early stage melanoma.  Arch Surg. 1992;127392- 399Google ScholarCrossref
8.
Leong  SPL The role of sentinel lymph node in human solid cancer. Devita  VTHellman  SRosenberg  SAeds. PPO Updates. Philadelphia, Pa Lippincott-Raven Publishers1998;1- 12Google Scholar
9.
Albertini  JJCruse  WCRapaport  D  et al.  Intraoperative radiolymphoscintigraphy improves sentinel lymph node identification in melanoma.  Ann Surg. 1996;223217- 224Google ScholarCrossref
10.
Reintgen  DSCruse  CWWells  K The orderly progression of melanoma nodal metastases.  Ann Surg. 1994;220759- 767Google ScholarCrossref
11.
Ross  MReintgen  DBalch  C Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma.  Semin Surg Oncol. 1993;9219- 223Google Scholar
12.
Krag  DNMeijer  SJWeaver  DL  et al.  Minimal-access surgery for staging of malignant melanoma.  Arch Surg. 1995;130654- 658Google ScholarCrossref
13.
Thompson  JFMcCarthy  WHBosch  FCJ  et al.  Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes.  Melanoma Res. 1995;5255- 260Google ScholarCrossref
14.
Berger  DFeig  BPodoloff  D  et al.  Lymphoscintigraphy as a predictor of lymphatic drainage from cutaneous melanoma.  Ann Surg Oncol. 1997;4247- 251Google ScholarCrossref
15.
Wells  KECruse  CWDaniels  SBerman  CNorman  JReintgen  DS The use of lymphoscintigraphy in melanoma of the head and neck.  Plast Reconstr Surg. 1994;93757- 761Google ScholarCrossref
16.
O'Brien  CJUren  RFThompson  JF  et al.  Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy.  Am J Surg. 1995;170461- 466Google ScholarCrossref
17.
Wanebo  HJHarpole  DTeates  CD Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk.  Cancer. 1985;551403- 1413Google ScholarCrossref
18.
Uren  DFHowman-Giles  RBShaw  HMThompson  JFMcCarthy  WH Lymphoscintigraphy in high risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node.  J Nucl Med. 1993;341435- 1440Google Scholar
19.
Sullivan  DCCroker  BPHarris  CCDeery  PSeigler  HF Lymphoscintigraphy in malignant melanoma: 99mTc antimony sulfur colloid.  AJR Am J Roentgenol. 1981;137847- 851Google ScholarCrossref
20.
Norman  JCruse  CWEspinosa  C  et al.  Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma.  Am J Surg. 1991;162432- 437Google ScholarCrossref
21.
Lamki  LMLogic  JR Defining lymphatic drainage patterns with cutaneous lymphoscintigraphy. Balch  CMHoughton  ANMilton  GWSober  AJSoong  SJeds.Cutaneous Melanoma.2nd ed. Philadelphia, Pa Williams & Wilkins1992;367- 375
22.
Thompson  JFUren  RFShaw  HM  et al.  Location of sentinal lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy.  J Am Coll Surg. 1999;189195- 206Google ScholarCrossref
23.
Leong  SPLSteinmetz  IHabib  FA  et al.  Optimal selective sentinel lymph node dissection in primary malignant melanoma.  Arch Surg. 1997;132666- 673Google ScholarCrossref
24.
Morton  DLWen  D-RFoshag  LJEssner  RCochran  A Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck.  J Clin Oncol. 1993;111751- 1756Google Scholar
25.
Glass  LFMessina  JLCruse  W  et al.  The use of intraoperative radiolymphoscintigraphy for sentinel node biopsy in patients with malignant melanoma.  Dermatol Surg. 1996;22715- 720Google Scholar
26.
Kapteijn  BANieweg  OELiem  I  et al.  Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye.  Ann Surg Oncol. 1997;4156- 160Google ScholarCrossref
27.
Pijpers  RBorgstein  PJMeijer  SHoekstra  OSvan Hattum  LHTeule  GJ Sentinel node biopsy in melanoma patients: dynamic lymphoscintigraphy followed by intraoperative gamma probe and vital dye guidance.  World J Surg. 1997;21788- 793Google ScholarCrossref
28.
Emilia  JCDLawrence  W Sentinel lymph node biopsy in malignant melanoma: the standard of care?  J Surg Oncol. 1997;65153- 154Google ScholarCrossref
29.
Reintgen  DS Changing standards of surgical care for melanoma patients.  Ann Surg Oncol. 1996;3327- 328Google ScholarCrossref
30.
Coit  DWallack  MBach  C Society of Surgical Oncology practice guidelines: melanoma surgical practice guidelines.  Oncology (Huntingt). 1997;111317- 1323Google Scholar
31.
Houghton  ACoit  DBloomer  W  et al.  NCCN melanoma practice guidelines: National Comprehensive Cancer Network.  Oncology (Huntingt). 1998;12153- 177Google Scholar
32.
Berman  CCNorman  JCruse  WCReintgen  DSClark  RA Lymphoscintigraphy in malignant melanoma.  Ann Plast Surg. 1992;2829- 32Google ScholarCrossref
33.
Gershenwald  JEThompson  WMansfield  PF  et al.  Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.  J Clin Oncol. 1999;17976- 983Google Scholar
Study
December 1999

Discordancy Between Clinical Predictions vs Lymphoscintigraphic and Intraoperative Mapping of Sentinel Lymph Node Drainage of Primary Melanoma

Author Affiliations

From the Departments of Surgery (Drs Leong, Habib, Steinmetz, and Allen and Mr Achtem), Nuclear Medicine (Dr Morita), and Dermatology (Drs Kashani-Sabet and Sagebiel), University of California–San Francisco Mount Zion Cancer Center.

Arch Dermatol. 1999;135(12):1472-1476. doi:10.1001/archderm.135.12.1472
Abstract

Objective  To evaluate discordancy between clinical predictions and lymphatic drainage patterns of primary cutaneous melanoma as determined by preoperative lymphoscintigraphy and intraoperative lymphatic mapping of sentinel lymph nodes (SLNs).

Design  Before selective SLN dissection, 226 consecutive patients with melanoma underwent preoperative lymphoscintigraphy.

Setting  Teaching hospital tertiary care center.

Main Outcome Measure  Correlation of lymphatic drainage patterns from the following 3 data sources: clinical predictions preoperatively based on anatomical location of primary melanoma, lymphatic drainage patterns as determined by preoperative lymphoscintigraphy, and identification of SLNs during surgery.

Results  Preoperative lymphoscintigraphy was successful in identifying at least 1 SLN in all 226 patients. In head and neck melanomas, at least 1 SLN was identified in an area outside what would have been clinically predicted in 11 (36.7%) of 30 cases. Discordancy for trunk melanomas was seen in 24 (25.3%) of 95 cases. Extremity melanomas showed drainage to unexpected SLNs in 6 (13.6%) of 44 and 3 (5.3%) of 57 patients for the upper and lower extremities, respectively. The overall rate of discordancy was 44 (19.5%) of 226. The SLNs were identified in surgery in all but 4 cases.

Conclusions  Discordancy is most frequent in melanomas of the head and neck region, followed by that of the trunk. Preoperative lymphoscintigraphy identifies the occasional cases in the upper and lower extremities where drainage occurs to a basin that is not clinically predictable. Preoperative lymphoscintigraphy is a prerequisite for characterizing the lymphatic drainage pattern in patients with primary melanoma, especially for sites such as head and neck as well as trunk, before selective SLN dissection.

×