Figure 2b.  Stage T3 lesion in the left parietotemporal region of the scalp. (a) Anterior image obtained immediately after injection demonstrates a lymphatic.

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Figure 2b.  Stage T3 lesion in the left parietotemporal region of the scalp. (a) Anterior image obtained immediately after injection demonstrates a lymphatic channel that drains into an upper lymph node (long arrow) and a lower node (short arrow). (b) Subsequent left lateral image obtained 5 minutes later allows precise localization and identification of the lymph nodes (from top to bottom): a temporal node (upper straight arrow), preauricular node (upper black arrowhead), periparotid nodes (lower straight arrow), posterior auricular node (lower black arrowhead), and high jugular node (curved arrow). The temporal node is an SLN. (c) Anterior image of the left side of the thorax obtained 45 minutes later reveals multiple secondary lower left cervical nodes (arrow). At histologic analysis, all nodes were tumor free.