Nuclear Medicine: Case Review Series by Ziessman Harvey A

Author:Ziessman, Harvey A. [Ziessman, Harvey A.]
Language: eng
Format: epub
Publisher: Elsevier Health
Published: 2010-11-18T08:00:00+00:00

References

Berman CG, Choi J, Hersh MR, et al. Melanoma lymphoscintigraphy and lymphatic mapping. Semin Nucl Med. 2000;30:49–55.

Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 1: sentinel node lymphoscintigraphy in malignant melanoma. Br J Radiol. 2007;80:132–139.

Cross-Reference

Nuclear Medicine: THE REQUISITES, 3rd. 299–300.

Comment

Regional lymph node sampling is routine clinical practice for the staging of malignant melanoma. Cutaneous melanomas originate from cells located between the dermis and epidermis and drain to the lymphatics in the reticular dermis. Thus, the radiopharmaceutical is best administered with intradermal injection in melanoma patients. As skin melanoma lesions progress, they move deeper into the dermis. Spread from the primary tumor to local lymph nodes occurs before systemic metastases. The pattern of lymphatic drainage is highly variable between patients. In many cases, there is drainage to a solitary regional sentinel node. However, for melanomas located in the midline of the head, neck, and trunk, there may be quite variable drainage. Axillary and femoral regions must be imaged. The current approach is to locate the first lymph node (i.e., the sentinel node) that drains the nodal basin. This sentinel node is located on the lymphoscintigram and marked on the patient’s skin preoperatively. At the time of surgery, a gamma probe is used to aid in the localization of the sentinel node that is then removed for pathologic examination. If the node is positive for tumor, the other nodes in that basin are resected. If the node is negative, no further dissection is performed. Because no effective therapy for melanoma exists once it has become widely metastatic, this aggressive surgical approach is now in common use.

Notes

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