Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma

Norman, James; Cruse, C. Wayne; Espinosa, Carmen; Cox, Charles E.; Berman, Claudia G.; Clark, Robert A.; Saba, Hussain I.; Wells, Karen; Reintgen, Douglas S.

doi:10.1016/0002-9610(91)90255-c

Cited by 223 publications

(125 citation statements)

References 17 publications

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“…It is hypothesized that if the sentinel node is negative, then the remainder of the nodes in the basin also should be negative, and most melanoma patients can be spared the morbidity and expense of a complete node dissection. 4 The goal of improving the staging of melanoma patients in the hope ofdefining prognosis and for the early detection ofmetastatic disease allows a more rational approach to more extensive surgery (complete node dissections) or enrollment on adjuvant therapies that theoretically, because ofsmaller tumor volumes, are more likely to be successful.…”

Section: Resultsmentioning

confidence: 99%

Detection of Submicroscopic Lymph Node Metastases with Polymerase Chain Reaction in Patients with Malignant Melanoma

Wang

Heller²,

VanVoorhis³

et al. 1994

Annals of Surgery

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258

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Section: Resultsmentioning

confidence: 99%

Detection of Submicroscopic Lymph Node Metastases with Polymerase Chain Reaction in Patients with Malignant Melanoma

Wang

Heller²,

VanVoorhis³

et al. 1994

Annals of Surgery

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258

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“…This variability in lymph drainage and drainage to SNs in unexpected places has also been observed by others. [17][18][19] As of October 2002, we have performed lymphatic mapping in 3280 patients with cutaneous melanoma and have accumulated a large body of data relating to common and uncommon cutaneous lymphatic drainage pathways. The following is a detailed description of the patterns of lymphatic drainage we have observed.…”

Section: Lymphatic Drainage Of the Skinmentioning

confidence: 99%

Lymphatic drainage of the skin

Uren

2004

Annals of Surgical Oncology

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A successful sentinel lymph node biopsy (SLNB) in melanoma patients requires an accurate map of the pattern of lymphatic drainage from the primary site. Lymphoscintigraphy (LS) can provide such a map. LS needs an understanding of lymphatic physiology, an appropriate small-particle radiocolloid, high-resolution collimators, and imaging protocols that detect all sentinel nodes (SNs). Patterns of lymphatic drainage from the skin are not clinically predictable. Unexpected drainage has been found from the skin of the back to SNs in the triangular intermuscular space (TIS) and the paraaortic, paravertebral, and retroperitoneal areas. It can also occur from the base of the neck up to nodes in the occipital or upper cervical areas or from the scalp down to nodes at the neck base, bypassing many node groups. Upper limb drainage can be to SNs above the axilla. Interval nodes not uncommonly can be SNs, especially on the trunk. Lymphatic drainage may involve SNs in multiple nodal fields, and drainage across the midline of the body is quite common. Because micrometastatic disease can be present in any SN regardless of its location, all true SNs must be biopsied. LS is an important first step to ensure this goal is achieved.

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“…Lymphoscintigraphy, a nuclear medicine test that involves a radiocolloid injection around the primary site and a scan of the regional basins, has been used to redefine cutaneous lymphatic flow that has proven to be different than what is described in classical anatomic descriptions. 27 Lymphoscintigraphy, using technetium antimony trisulfide, has been performed in the Sydney Melanoma Unit (SMU)28 to show the great variability in lymph node drainage patterns with the identification of several new lymphatic drainage pathways. Twenty-six percent of melanomas on the back drain into an in-transit node located in the triangular intramuscular space; 20% of the periumbilical melanomas show an initial drainage into an internal mammary node.…”

Section: Molecular Biology Techniquesmentioning

confidence: 99%

Recent Advances in the Care of the Patient with Malignant Melanoma

Reintgen¹,

Balch²,

Kirkwood³

et al. 1997

Annals of Surgery

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137

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ObjectiveThe authors review the recent advances in the surgical care, staging, and adjuvant treatment of the patient with melanoma. Summary Background DataMelanoma care has not changed significantly in the last 20 years, and the controversy of elective lymph node dissections in this disease continues to be discussed. Two advances in the care of the patient with melanoma have occurred in the last 3 years to make this an exciting time for clinicians and to offer more hope for the patients with this disease. The concept of the sentinel lymph node (SLN), defined by Morton as the first node in the lymphatic basin that drains the primary melanoma, has been documented to contain the first site of metastatic disease. This technology can be used to stage nodally the melanoma patient, identifying the subgroup of patients (stage 111) who have a 5-year survival rate less than 50%. Members of this group are candidates for effective adjuvant therapies. MethodsA review of the surgical techniques of melanoma care, including recently reported new studies of elective node dissection (ELND) and SLN biopsy in patients with melanoma was performed. In addition, the Eastern Cooperative Oncology Group (ECOG) 1684 trial, which was the basis for the Food and Drug Administration approval of adjuvant interferon-alpha2b (IFN-a-2b) is discussed. ResultsThe Intergroup Melanoma Trial has reported a survival benefit for performing ELND in patients with melanoma and tumor thickness between 1 and 2 mm or in patients that are younger than 60 years of age. With six reports in the literature that show there is an order to melanoma nodal metastases and that the SLN histology is reflective of the histology of the remainder of the nodal basin, the more conservative SLN biopsy can be performed to adequately stage nodally the patient with melanoma. Patients with nodal metastases who are rendered free of disease with surgical resection have the most to benefit from adjuvant IF-a-2b. If one considers only the lymph node-positive group of patients, the survival benefit associate with adjuvant IFN is significant (p = 0.008).

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Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma

Cited by 223 publications

References 17 publications

Detection of Submicroscopic Lymph Node Metastases with Polymerase Chain Reaction in Patients with Malignant Melanoma

Detection of Submicroscopic Lymph Node Metastases with Polymerase Chain Reaction in Patients with Malignant Melanoma

Lymphatic drainage of the skin

Recent Advances in the Care of the Patient with Malignant Melanoma

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