INTRAOPERATIVE LYMPHATIC MAPPING FOR EARLY-STAGE MELANOMA OF THE HEADAND NECK

BACKGROUND: We previously reported dye-directed intraoperative lymphat ic mapping and selective sentinel lymphadenectomy for primary cutaneou s melanomas draining to the neck lymph nodes, In this study we determi ned whether combining the dye with a radiopharmaceutical agent would e nhance our rate of sentinel node detection. METHODS: One hundred seven teen patients with primary cutaneous melanomas of the upper chest and head and neck underwent preoperative cutaneous lymphoscintigraphy to c onfirm lymphatic drainage to neck nodes, followed by intraoperative ly mphatic mapping and sentinel lymphadenectomy. In 94 cases, isosulfan b lue dye was injected at the primary site; in the remaining 23 cases, a 1:3 mixture of radiopharmaceutical and dye was injected, and a hand-h eld probe was used to determine the radioactive counts. RESULTS: Preop erative cutaneous lymphoscintigraphy identified 129 drainage basins; 1 2 patients (10%) had dual-basin drainage, During intraoperative lympha tic mapping and sentinel lymphadenectomy, 183 sentinel nodes were iden tified and excised from 120 basins (1.5 nodes/basin). The blue dye alo ne identified sentinel nodes in 93 of 101 basins (92%). The probe iden tified sentinel nodes in 28 of 28 basins, only one of which failed to reveal blue-staining sentinel nodes; thus, the probe plus dye identifi ed sentinel nodes in 27 of 28 basins (96%), Histopathologic analysis r evealed metastasis in sentinel nodes from 11 patients (12%) who underw ent sentinel lymphadenectomy with blue dye alone and in 3 patients (13 %) who underwent sentinel lymphadenectomy with dye plus probe. There w ere no same-basin recurrences over a mean follow-up of 46 months (rang e 1 to 125). CONCLUSIONS: Selective sentinel lymphadenectomy is a high ly accurate method of staging the regional nodes in patients with prim ary tumors of the head and neck, Although we initially demonstrated th e utility of this technique with blue dye alone, our results now sugge st that the combination of dye and radiopharmaceutical may be a more s ensitive method to detect sentinel nodes, (C) 1997 by Excerpta Medica, Inc.