LYMPHOSCINTIGRAPHY AS A PREDICTOR OF LYMPHATIC DRAINAGE FROM CUTANEOUS MELANOMA

Background: If cutaneous lymphoscintigraphy (CL) is accurate in predic ting the draining lymph node basins at risk from primary axial melanom as, then regional metastases should only occur in those lymph node bas ins identified by CL. Methods: This study is a retrospective review of patients undergoing CL for primary axial melanomas from June 1, 1985, until June 31, 1992. Data retrieved included age, gender, number of b asins identified, location of basins identified, management of basins, recurrence in lymphatics, development of distant disease, and long-te rm follow-up. Results: A total of 181 patients underwent elective LND, and 48 patients (27%) had melanoma in the nodes within the dissected basin. Of these 181 patients, seven developed nodal metastases as thei r site of first recurrence. All seven recurrences were seen at sites d issected or at sites indicated by CL, which the primary surgeon electe d not to treat initially. Of the 116 patients observed, 16 (14%) devel oped lymph node metastases as their first site of recurrence. Fifteen of these 16 patients had their site of lymph node metastases predicted by CL. In this study, CL predicted 98.6% of all lymph node metastases . Conclusions: The high overall reliability of CL as demonstrated by l ong-term follow-up indicates that the information obtained by CL can b e reliably used to guide intervention. Initial evaluation of patients with high-risk cutaneous melanomas at sites with ambiguous lymphatic d rainage must include CL in order to determine the draining lymph node basins and to plan therapy.