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Utility of Lymphoscintigraphy in the Treatment of Extremity Melanoma
*Mohammad Mertaban, Ted James, *Michael Cunningham
University of Vermont College of Medicine, Burlington, VT
Background: Lymphoscintigraphy is used to determine the lymphatic drainage patterns for sentinel lymph node (SLN) biopsy in patients with cutaneous melanomas. However, due to the relatively predictable anatomy of the lymphatic system, it may be of little utility in the case of extremity melanomas. We hypothesized that primary melanomas originating in the extremities would drain to the expected lymph node basin, thus potentially negating the necessity for routine preoperative lymphoscintigraphy.
Methods: Through a single institution retrospective review, we identified patients that were (1) diagnosed with a primary extremity cutaneous melanoma and (2) received preoperative lymphoscintigraphy. Patients were excluded if the cutaneous melanoma was located in the torso, flank, shoulder, head or neck; did not undergo lymphoscintigraphy or were diagnosed with more than one concurrent melanoma. Drainage patterns were first assessed by preoperative lymphoscintigraphy and the final results were determined by operative reports of the SLN procedure. The SLN drainage patterns were then classified as either expected (SLN(s) identified in the major anatomical nodal basin proximal to the melanoma), multiple (SLN(s) identified in multiple successive nodal basins proximal to the melanoma) or aberrant (SLNs bypassed the closest regional basin and/or drained to a contralateral nodal basin).
Results: 60 patients were identified meeting the study criteria. The median age of patients was 63 years. The median Breslow depth was 1.62mm. 38% were lower extremity melanomas and 62% were upper extremity melanomas. Of these patients, none had aberrant drainage patterns (95% CI: 0, 5.2%), and two (3.3%) demonstrated multiple drainage patterns (95% CI: 0.25, 12.03%).
Conclusion: Our results suggest that lymphoscintigraphy for extremity melanoma may be of low utility and little added value when drainage patterns are predictable.
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