Lymphatic Drainage Patterns from Melanomas on the Shoulder or Upper Trunk to Cervical Lymph Nodes and Implications for the Extent of Neck Dissection

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2012 May 12

PMID 22576065

Citations 6

Authors

Hidde J Veenstra

W Martin C Klop

Maarten J Speijers

Peter J F M Lohuis

Omgo E Nieweg

Harald J Hoekstra

Alfons J M Balm

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the incidence and pattern of cervical lymphatic drainage in patients with melanomas located on the upper limb or trunk, and to evaluate our current neck dissection protocol for those patients with a N+ neck.

Methods: Of 1192 melanoma patients who underwent sentinel node biopsy, 631 were selected with a primary tumor on the upper limb or trunk. All lymphoscintigrams, SPECT/CT images and operative reports were reviewed to determine the exact locations of sentinel nodes visualized preoperatively and dissected during operation.

Results: Thirty-nine (6.2 %) of 631 patients with a melanoma on the upper limb or trunk showing cervical lymph node drainage were identified. In 34 (87 %) of 39 patients, sentinel nodes were excised from level IV or Vb, and in 30 of those 39 patients simultaneous from the axilla. In the remaining five patients (13 %), sentinel nodes were collected from level IIb, level III or the suboccipital region. All collected sentinel nodes were located in the intended dissection area for N+ patients. Thirteen patients (33 %) had a total of 22 tumor-positive sentinel nodes in either the axilla (n = 10), level IV (n = 2), Vb (n = 9) or suboccipital (n = 1).

Conclusions: Only a minority of the patients with upper limb or trunk melanomas demonstrated lymphatic drainage to cervical lymph node basins, with preferential drainage to levels IV and Vb. Our current dissection protocol of levels II-V, with or without extension to the suboccipital region, in those patients with involved cervical sentinel nodes seems sufficient.

Citing Articles

Variability of Sentinel Lymph Node Location in Patients with Trunk Melanoma.

Bobirca F, Leventer M, Georgescu D, Dumitrescu D, Alexandru C, Serban D Diagnostics (Basel). 2023; 13(17).

PMID: 37685328 PMC: 10486776. DOI: 10.3390/diagnostics13172790.

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer-A Narrative Review.

Sinha A, West A, Hayes J, Teoh J, Decaestecker K, Vasdev N Curr Oncol. 2022; 29(3):1335-1348.

PMID: 35323314 PMC: 8947662. DOI: 10.3390/curroncol29030114.

Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma.

Cirocchi R, Metaj G, Cicoletti M, Arcangeli F, De Sol A, Poli G J Clin Med. 2021; 10(23).

PMID: 34884243 PMC: 8658642. DOI: 10.3390/jcm10235544.

Increase of sentinel lymph node melanoma staging in The Netherlands; still room and need for further improvement.

Deckers E, Wj Louwman M, Kruijff S, Hoekstra H Melanoma Manag. 2020; 7(1):MMT38.

PMID: 32399176 PMC: 7212513. DOI: 10.2217/mmt-2019-0018.

Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma.

Lee D, Huynh K, Teng A, Lau B, Vitug S, Lee J Ann Surg Oncol. 2015; 23(3):1012-8.

PMID: 26586498 PMC: 4984404. DOI: 10.1245/s10434-015-4912-6.

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