Frank L. Glass, MDa, John A. Cottam, MDb, Douglas S

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Presentation transcript:

Lymphatic mapping and sentinel node biopsy in the management of high-risk melanoma Frank L. Glass, MDa, John A. Cottam, MDb, Douglas S. Reintgen, MDd, Neil A. Fenske, MDb,c,e Journal of the American Academy of Dermatology Volume 39, Issue 4, Pages 603-610 (October 1998) DOI: 10.1016/S0190-9622(98)70010-6 Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 1 Intraoperative lymphatic mapping: schematic for lymphatic mapping and sentinel node identification for leg and trunk primary melanomas. Note bidirectional lymphatic flow from trunk melanoma to both axilla and groin. The first node in the basin that lymphatics encounter is “sentinel node.” Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 2 Preoperative lymphoscintigraphy: Example of a dynamic lymphoscintigram of left posterior neck showing drainage into posterior cervical sentinel nodes. Drainage patterns different from those expected by classic anatomic drawings are seen in as many as 32% of melanomas on trunk, and in 63% from head and neck. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 3 Intraoperative lymphatic mapping by means of vital dye: Lymphazurin blue vital dye is injected around primary melanoma before excision. Ideally, intraoperative mapping should be performed after initial biopsy and before wide local excision. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 4 Intraoperative lymphatic mapping: Intraoperative photography showing isolation of sentinel node in axilla. In this case, blue dye is clearly identified in afferent lymphatics, and sentinel node is stained blue. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 5 Intraoperative lymphatic mapping by means of radiolymphoscintigraphy. Sentinel node is isolated in vivo by hand-held gamma probe based on level of radioactivity of “hot” sentinel node compared with background. Lymphatic basin is scanned after SLN removal to assure low level of activity. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 6 Measuring radioactivity of sentinel node: Once sentinel node is removed, level of radioactivity can be measured ex vivo by placing it directly on end of gamma probe. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 7 Comparison of localization ratios after immediate and delayed mapping: Sentinel nodes are identified as “hot” by elevated ratios of radioactivity relative to adjacent nonsentinel nodes. Localization ratios are greater if mapping is delayed for 4 hours after injection of radiocolloid. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions

Fig. 8 Detection of sentinel node micrometastasis: After routine processing and paraffin embedding, sections taken from sentinel nodes are stained with (A) hematoxylin-eosin and (B) S-100 antibody for metastasis. Journal of the American Academy of Dermatology 1998 39, 603-610DOI: (10.1016/S0190-9622(98)70010-6) Copyright © 1998 American Academy of Dermatology, Inc Terms and Conditions