title: Lymphatic drainage from the skin of the back to retroperitoneal and paravertebral lymph nodes in melanoma patients.
abstract: BACKGROUND
  Preoperative lymphoscintigraphy (LS) with 99mTc antimony sulphide colloid is now part of the routine management of patients with intermediate thickness melanoma at the Sydney Melanoma Unit. Over a 13-year period, 1375 patients have been examined using LS, and we have observed many unusual lymphatic drainage pathways, including direct drainage through the body wall to retroperitoneal and paravertebral lymph nodes from the skin of the back. The aim of this study was to determine the incidence of such drainage in the 542 patients who had primary melanoma sites on the posterior trunk.
  
  
  METHODS
  The lymphoscintigrams performed on these patients were examined for the presence of direct lymphatic drainage through the posterior body wall to sentinel nodes in the retroperitoneal and paravertebral regions.
  
  
  RESULTS
  Lymphatic drainage directly through the body wall to such lymph nodes occurred in 14 of these 542 patients.
  
  
  CONCLUSIONS
  Preoperative knowledge of the presence of this lymph drainage pattern may influence surgical management, and follow-up investigations in these patients can be tailored to ensure that the relevant areas are examined with anatomic imaging or F18-FDG PET scans.
authors.affiliation: Nuclear Medicine and Diagnostic Ultrasound, Missenden Medical Centre, Camperdown, New South Wales, Australia.
authors.forename: R F
authors.initials: RF
authors.lastname: Uren
authors.forename: R
authors.initials: R
authors.lastname: Howman-Giles
authors.forename: J F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D001415:Back; D005122:Exudates and Transudates; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012187:Retroperitoneal Space; D012878:Skin Neoplasms / Q000473:pathology*; D013131:Spine
chemical_list: D019275:Radiopharmaceuticals