© The Author (2008). Published by Oxford University Press. All rights reserved
A Case of Sentinel Node Metastasis of Superficial Spreading Melanoma with Two Lymphatic Channels
Dermatology Division
National Cancer Center Hospital
Tokyo, Japan
A 62-year-old female noticed asymptomatic gradually enlarging blackish macule on the abdominal wall 2 years ago. When she was admitted to our hospital, irregular shaped blackish skin tumor with elevation overlaid the left periumbilical area of her abdominal wall (Fig. 1; a colour version of this figure is available as supplementary data at http://www.jjco.oxfordjournals.org). As for the recent new concept of melanoma therapy, when preoperative lymphoscintigraphy identifies interval sentinel lymph nodes, these nodes should be excised as well as traditional regional lymph node group. On preoperative lymphoscintigraphy, approximately 98.2 MBq technetium sulfur colloid was injected intradermally in four equal parts around the primary lesion, to reveal the lymphatic flows to internal sentinel lymph nodes. The dynamic image showed two dominant lymphatic channels; one of them passing from the primary tumor to the left axilla (Fig. 2, black arrow head), and another channel passing to the subcutaneous sentinel nodes on the left costal margin (Fig. 2, gray arrow head). Interval nodes of the chest and left axillary nodes began to be visualized 5 min after injection, and these nodes remained visible 180 min later (Fig. 2, black arrow and *). Delayed image of these regions obtained 180 min later demonstrated no changes.
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Intraoperatively, distribution of the sentinel lymph nodes was studied using both gamma probe and injection of blue dye. On histological analysis, the primary lesion was superficial spreading melanoma of 1.9 mm in thickness, the interval node was negative for cancer, but the left axillary nodes had metastatic melanoma cells. Therefore, we performed wide local excision of the primary tumor, interval sentinel node biopsy and left axillary lymph node dissection.
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