THE USE OF LYMPHOSCINTIGRAPHY IN MELANOMA OF THE HEAD AND NECK

Lymphoscintigraphy has been shown to be of assistance in defining the lymphatic drainage pattern of melanoma. In this study, lymphoscintigra phy was performed on 25 patients with primary melanoma (stages I and I I at diagnosis) of the head and neck to determine whether the lymphati c drainage seen on lymphoscintigram was the same as the surgeon's expe cted lymphatic drainage. The lymphoscintigrams were discordant in 21 o f the patients (84 percent) with drainage to a lymphatic basin not pre dicted clinically. Based on the discordant lymphoscintigram, a change in surgical therapy occurred in 13 of 21 patients (62 percent). Of the 25 patients, 18 underwent prophylactic node dissections and 7 did not . Of the nodal basins removed, 27 of 38 nodal bases (71 percent) were seen on lymphoscintigraphy. Melanoma metastatic to lymph nodes was rem oved from nodal basins identified by the lymphoscintigram, but not pre dicted clinically, in two patients (8 percent). Historical anatomical patterns of lymph drainage and the clinical impression of experienced surgeons cannot reliably predict the pattern of lymphatic drainage in patients with melanoma of the head and neck.