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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.
Literature
1.
Balch CM, Morton DL, Gershenwald JE, et al. Sentinel node biopsy and standard of care for melanoma. J Am Acad Dermatol. 2009;60:872–5.PubMedCrossRef
2.
De Wilt JH, Thompson JF, Uren RF, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg. 2004;239:544–52.PubMedCrossRef
3.
O’Brien CJ, Uren RF, Thompson JF, et al. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am J Surg. 1995;170:461–6.PubMedCrossRef
4.
Chao C, Wong SL, Edwards MJ, et al. Sentinel lymph node biopsy for head and neck melanomas. Ann Surg Oncol. 2003;10:21–6.PubMedCrossRef
5.
Jansen L, Koops HS, Nieweg OE, et al. Sentinel node biopsy for melanoma in the head and neck region. Head Neck. 2000;22:27–33.PubMedCrossRef
6.
Pan WR, Suami H, Taylor GI. Lymphatic drainage of the superficial tissues of the head and neck: anatomical study and clinical implications. Plast Reconstr Surg. 2008;121:1614–24.PubMed
7.
Klop WM, Veenstra HJ, Vermeeren L, et al. Assessment of lymphatic drainage patterns and implications for the extent of neck dissection in head and neck melanoma patients. J Surg Oncol. 2011;103:756–60.PubMedCrossRef
8.
Lin D, Franc BL, Kashani-Sabet M. Lymphatic drainage patterns of head and neck cutaneous melanoma observed on lymphoscintigraphy and sentinel lymph node biopsy. Head Neck. 2006;28:249–55.PubMedCrossRef
9.
Pathak I, O’Brien CJ, Petersen-Schaeffer K, et al. Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern? Head Neck. 2001;23:785–90.PubMedCrossRef
10.
O’Brien CJ, Petersen-Schaefer K, Ruark D, et al. Radical, modified, and selective neck dissection for cutaneous malignant melanoma. Head Neck. 1995;17:232–41.PubMedCrossRef
11.
Wagner JD, Park HM, Coleman JJ III, et al. Cervical sentinel lymph node biopsy for melanomas of the head and neck and upper thorax. Arch Otolaryngol Head Neck Surg. 2000;126:313–21.PubMed
12.
Reynolds HM, Dunbar PR, Uren RF, et al. Three-dimensional visualisation of lymphatic drainage patterns in patients with cutaneous melanoma. Lancet Oncol. 2007;8:806–12.PubMedCrossRef
13.
Uren RF, Howman-Giles R, Thompson JF. Patterns of lymphatic drainage from the skin in patients with melanoma. J Nucl Med. 2003;44:570–82.PubMed
14.
Van der Ploeg IM, Valdés Olmos RA, Kroon BBR, et al. The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma. Ann Surg Oncol. 2009;16:1537–42.PubMedCrossRef
15.
Nieweg OE, Tanis PJ, Kroon BBR. The definition of a sentinel node. Ann Surg Oncol. 2001;8:538–41.PubMedCrossRef
16.
Van der Ploeg IM, Kroon BBR, Antonini N, et al. Is completion lymph node dissection needed in case of minimal melanoma metastasis in the sentinel node? Ann Surg. 2009;249:1003–7.PubMedCrossRef
17.
Van der Ploeg IM, Kroon BBR, Antonini N, et al. Comparison of three micromorphometric pathology classifications of melanoma metastases in the sentinel node. Ann Surg. 2009;250:301–4.PubMedCrossRef
18.
Starz H, Siedlecki K, Balda BR. Sentinel lymphonodectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol. 2004;11:162S–8S.PubMed
19.
Diaz EM Jr, Austin JR, Burke LI, Goepfert H. The posterolateral neck dissection. Technique and results. Arch Otolaryngol Head Neck Surg. 1996;122:477–80.PubMedCrossRef
20.
Thiel W. Photographic atlas of practical anatomy II. New York: Springer; 1999. p. 104–5.
21.
Reynolds HM, Smith NP, Uren RF, et al. Three-dimensional visualization of skin lymphatic drainage patterns of the head and neck. Head Neck. 2009;31:1316–25.PubMedCrossRef
22.
De Rosa N, Lyman GH, Silbermins D, et al. Sentinel node biopsy for head and neck melanoma: a systematic review. Otolaryngol Head Neck Surg. 2011;145:375–82.PubMedCrossRef
23.
Gomez-Rivera F, Santillan A, McMurphey AB, et al. Sentinel node biopsy in patients with cutaneous melanoma of the head and neck: recurrence and survival study. Head Neck. 2008;30:1284–94.PubMedCrossRef
24.
Carlson GW, Murray DR, Lyles RH, et al. Sentinel lymph node biopsy in the management of cutaneous head and neck melanoma. Plast Reconstr Surg. 2005;115:721–8.PubMedCrossRef
25.
Lohuis PJ, Klop WM, Tan IB, et al. Effectiveness of therapeutic (N1, N2) selective neck dissection (levels II to V) in patients with laryngeal and hypopharyngeal squamous cell carcinoma. Am J Surg. 2004;187:295–9.PubMedCrossRef
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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