Abstract
Background: Preoperative lymphoscintigraphy (LS) with99mTc antimony sulphide colloid is now part of the routine management of patients with intermediate thickness melanoma at the Sydney Melanoma Unit. Over a 13-year period, 1375 patients have been examined using LS, and we have observed many unusual lymphatic drainage pathways, including direct drainage through the body wall to retroperitoneal and paravertebral lymph nodes from the skin of the back. The aim of this study was to determine the incidence of such drainage in the 542 patients who had primary melanoma sites on the posterior trunk.
Methods: The lymphoscintigrams performed on these patients were examined for the presence of direct lymphatic drainage through the posterior body wall to sentinel nodes in the retroperitoneal and paravertebral regions.
Results: Lymphatic drainage directly through the body wall to such lymph nodes occurred in 14 of these 542 patients.
Conclusions: Preoperative knowledge of the presence of this lymph drainage pattern may influence surgical management, and follow-up investigations in these patients can be tailored to ensure that the relevant areas are examined with anatomic imaging or F18-FDG PET scans.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Morton DL, Wen D-R, Wong JH, et al. Technical details of intra-operative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.
Uren RF, Howman-Giles RB, Shaw HM, Thompson JF, McCarthy WH. Lymphoscintigraphy in high risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node.J Nucl Med 1993;34:1435–40.
Uren RF, Howman-Giles RB, Thompson JF, Quinn MJ, O'Brien C, Shaw HM, McCarthy WH. Lymphatic drainage to triangular intermuscular space lymph nodes in patients with melanoma on the back.J Nucl Med 1996;37:964–6.
Norman J, Cruse CW, Espinosa C, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma.Am J Surg 1991;162:432–7.
O'Brien CJ, Uren RF, Shaw HM, Thompson JF, Howman-Giles R, McCarthy WH, Petersen-Schaefer K. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy.Am J Surg 1995;170-461–6.
Uren RF, Howman-Giles RB, Thompson JF, Shaw HM, McCarthy WH. Lymphatic drainage from peri-umbilical skin to internal mammary nodes.Clin Nucl Med 1995;20:254–5.
Uren RF, Howman-Giles RB, Thompson JF, Quinn MJ. Direct lymphatic drainage from the skin of the forearm to a supraclavicular node.Clin Nucl Med 1996;21:387–9.
Alex JC, Weaver DL, Fairbank JT, Rankin BS, Krag DN. Gammaprobe-guided lymph node localization in malignant melanoma.J Surg Oncol 1993;2:303–8.
Thompson JF, Niewind P, Uren RF, Bosch CMJ, Howman-Giles RB, Vrouenraets BC. Single dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patients.Melanoma Res 1997;6:500–6.
Damian D, Fulham MJ, Thompson E, Thompson JF. Positron emission tomography in the detection and management of metastatic melanoma.Melanoma Res 1996;6:325–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Uren, R.F., Howman-Giles, R. & Thompson, J.F. Lymphatic drainage from the skin of the back to retroperitoneal and paravertebral lymph nodes in melanoma patients. Annals of Surgical Oncology 5, 384–387 (1998). https://doi.org/10.1007/BF02303504
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303504