Peculiarities of Lymphatic Drainage in Cutaneous Malignant Melanoma: Clinical Experience in 75 Cases
S. Voinea, A. Sandru, M. Gherghe, A. BlidaruOriginal article, no. 1, 2014
In the recent years, the identification and biopsy of the sentinellymph node (SLN) has become standard in the treatment ofcutaneous malignant melanoma (CMM). In order to correctlyapply the technique and to decrease the risk of false negatives,it is compulsory to track the lymphatic drainage of the primarytumor and to detect all SLN, regardless of their site.Method: At the Bucharest Oncologic Institute, over the lastthree years, selective lymphadenectomy was performed in 75patients with CMM, stages I and II (AJCC). In 39 cases, theprimary tumor was at the level of the upper and lower limbsand in 36 on the trunk. In all patients, lymphoscintigraphywas performed through intradermal injection of Nanocoll,with dynamic follow up of the radiotracer, with the purposeof finding the possible unusual locations of the SLN.Results: The sentinel lymph nodes were identified in 100%of the cases. In 63 patients (84%), the primary tumordrained in only one lymphatic field and in the other 12 thedrainage was towards 2 or more lymphatic basins. The CMMsituated on the trunk had a particular behaviour, presentingmore often (33%) with multiple nodal basin drainage.Conclusions: CMM of the trunk, mostly those situated close to the midline, but others as well, tend to drain into severallymphatic areas. The existence of interval lymph nodes andatypical lymphatic drainage, in a minor lymphatic basin,must be determined preoperatively in order to allow thebiopsy of all SLN and establish the right therapy.
