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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2012

Open Access 01-11-2012 | Melanomas

Lymphatic Drainage Patterns from Melanomas on the Shoulder or Upper Trunk to Cervical Lymph Nodes and Implications for the Extent of Neck Dissection

Authors: Hidde J. Veenstra, MD, W. Martin C. Klop, MD, PhD, Maarten J. Speijers, MD, Peter J. F. M. Lohuis, MD, PhD, Omgo E. Nieweg, MD, PhD, Harald J. Hoekstra, MD, PhD, Alfons J. M. Balm, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2012

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Abstract

Purpose

To determine the incidence and pattern of cervical lymphatic drainage in patients with melanomas located on the upper limb or trunk, and to evaluate our current neck dissection protocol for those patients with a N+ neck.

Methods

Of 1192 melanoma patients who underwent sentinel node biopsy, 631 were selected with a primary tumor on the upper limb or trunk. All lymphoscintigrams, SPECT/CT images and operative reports were reviewed to determine the exact locations of sentinel nodes visualized preoperatively and dissected during operation.

Results

Thirty-nine (6.2 %) of 631 patients with a melanoma on the upper limb or trunk showing cervical lymph node drainage were identified. In 34 (87 %) of 39 patients, sentinel nodes were excised from level IV or Vb, and in 30 of those 39 patients simultaneous from the axilla. In the remaining five patients (13 %), sentinel nodes were collected from level IIb, level III or the suboccipital region. All collected sentinel nodes were located in the intended dissection area for N+ patients. Thirteen patients (33 %) had a total of 22 tumor-positive sentinel nodes in either the axilla (n = 10), level IV (n = 2), Vb (n = 9) or suboccipital (n = 1).

Conclusions

Only a minority of the patients with upper limb or trunk melanomas demonstrated lymphatic drainage to cervical lymph node basins, with preferential drainage to levels IV and Vb. Our current dissection protocol of levels II–V, with or without extension to the suboccipital region, in those patients with involved cervical sentinel nodes seems sufficient.
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Metadata
Title
Lymphatic Drainage Patterns from Melanomas on the Shoulder or Upper Trunk to Cervical Lymph Nodes and Implications for the Extent of Neck Dissection
Authors
Hidde J. Veenstra, MD
W. Martin C. Klop, MD, PhD
Maarten J. Speijers, MD
Peter J. F. M. Lohuis, MD, PhD
Omgo E. Nieweg, MD, PhD
Harald J. Hoekstra, MD, PhD
Alfons J. M. Balm, MD, PhD
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2387-2

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