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

Biopsy of head and neck sentinel nodes (SNs) can be technically problematic due to the unpredictable and variable drainage patterns of this anatomic region. The aim of the present study was to evaluate the feasibility of SN biopsy for cutaneous melanoma of the head and neck. We performed SN biopsy in 17 patients affected by stage I cutaneous melanoma of the head and neck on the basis of lymphoscintigraphy, blue dye and gamma probe. A total of 24 procedures were performed. Drainage to more than one lymphatic basin was observed in five patients (two basins in three cases and three basins in two cases) and in all cases SN biopsy was performed in all basins. The biopsy distribution by site was: six cervical nodes, five parotid nodes, four supraclavicular and submandibular nodes, three auricular and axillary nodes. The SN identification rate was 87.5% (21/24); metastases were discovered in four cases, with a positivity rate of 23.6%. At the time of writing, 1 patient is alive with local disease, 3 patients are dead and 13 are alive and free of disease with a follow-up ranging from 1 to 40 months (median, 21 months) following SN biopsy. In our opinion preoperative lymphoscintigraphy and the intraoperative use of a gamma probe are useful for the identification of lymphatic drainage of cutaneous melanoma of the head and neck.

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Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2011.12.027 ◽

2012 ◽

Vol 41 (4) ◽

pp. 413-420 ◽

Cited By ~ 20

Author(s):

P. Suton ◽

I. Lukšić ◽

D. Müller ◽

M. Virag

Keyword(s):

Lymph Nodes ◽

Head And Neck ◽

Cutaneous Melanoma ◽

Primary Melanoma ◽

Lymphatic Drainage ◽

Drainage Patterns ◽

Anatomic Distribution

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The Lymphoscintigraphic Study of Unpredictable Head and Neck Cutaneous Melanoma Lymphatic Drainage

Biomedicines ◽

10.3390/biomedicines8040070 ◽

2020 ◽

Vol 8 (4) ◽

pp. 70

Author(s):

Valentina Lavelli ◽

Cristina Ferrari ◽

Giulia Santo ◽

Corinna Altini ◽

Andrea Ballini ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Confidence Interval ◽

Serum Albumin ◽

Head And Neck ◽

Cutaneous Melanoma ◽

Primary Melanoma ◽

Lymphatic Drainage ◽

Special Focus ◽

Lymphatic Pathways

Head and neck cutaneous melanoma (HNCM) does not always follow standard lymphatic drainage; typical expected lymphatic pathways are associated with unexpected ones. The aim of this study was to investigate the relation between the primary HNCM sites and all possible lymphatic drainage pathways by lymphoscintigraphy with a special focus on the unexpected sentinel lymph node (SLNs) detection. We retrospectively analyzed 67 patients (46 M, 21 F; mean age 63 years) who underwent lymphoscintigraphy from January 2004 to November 2018. 99mTc-serum albumin was injected intra-dermally at the dose of 18–37 MBq in 0.2–0.4 mL. All patients underwent dynamic and static image acquisition. For all patients, the relation between the expected and unexpected SLNs was performed using the “Sidney Melanoma Unit Database” as our reference. The relation was performed also according to the primary HNCM localization. Cohens’ kappa was calculated. In 61/67 (91%) of patients, SLNs were detected only in predictable sites, while in six/67 (9%), unexpected SLNs were revealed. In all patients, the agreement proportion was 91% (95% confidence interval CI 0.8–0.96) and Cohen’s K was 0.11 (95% CI 0–0.43). Regarding the primary melanoma sites, the nasolabial field HNCM showed the highest rate of concordance (K = 0.60; 95%, CI 0.32–0.89) while the preauricular region HNCM revealed the highest rate of discordance with the clinically predictable drainage. The HNCM lymphatic drainage is extremely variable in regard to both the sites and the number of involved SLNs. The lymphoscintigraphic study is highly recommended to identify all possible SLNs in order to perform an accurate staging for all patients and to avoid missing unexpected SLNs.

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