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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

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.