IDENTIFICATION OF LYMPHATIC DRAINAGE BASINS IN PATIENTS WITH CUTANEOUS MELANOMA

Lymphoscintigraphy has been shown to be of assistance in predicting ly mphatic basins at risk for the development of metastatic disease in pa tients with cutaneous malignant melanoma. To further establish the eff icacy of this method, 212 patients presenting to the H. Lee Moffitt Ca ncer Center and Research Institute at the University of South Florida with primary melanoma of the head, neck, and trunk have been studied. All patients had clinical stage 1 or 2 melanoma and were candidates fo r elective lymph node dissection. Drainage patterns identified by lymp hoscintigraphy were compared to those predicted by historical anatomic al guidelines and were found to be discordant in 63% of patients with tumors of the head and neck, and in 32% of those with primary lesions located on the trunk. Operative intervention was changed because of th ese findings in 47% of all patients, with 19% undergoing dissection of nonclassical lymph node basins. An additional 28% did not have a node dissection because of failure of the scintigram to demonstrate a pred ominant drainage basin or the demonstration of multiple drainage sites . After a mean follow-up of 2.8 years, there have been no recurrences in basins not positive by lymphoscintigraphy. The lymphatic drainage f rom cutaneous melanoma of the head, neck, and trunk cannot be reliably predicted by clinical judgment or classic anatomic guidelines, and ly mphoscintigraphy is indicated in these patients prior to elective lymp h node dissection.