The surgical management of the sentinel lymph node in cutaneous melanoma might be different when the primary lesion was previously resected with 1 cm margin.
OBJECTIVE
To simulate the effects of previous wide cutaneous melanoma excision in sentinel lymph node (SLN) biopsy feasibility through a change in the radiotracer injection site.


METHODS
Thirty-three patients with cutaneous melanoma underwent two preoperatory lymphoscintigraphic studies. In the first, the radiopharmaceutical was injected intradermally 0.3 cm away from the lesion/scar. Dynamic images were acquired to find the SLN. On the following day, the procedure was repeated with the radiopharmaceutical injected 1 cm farther from the previous injection sites. The number of lymph nodes and sites of drainage were compared with the findings of the first study. All the patients underwent SLN biopsy using a gamma probe and patent blue.


RESULTS
Seventy-five SLNs were identified with radiopharmaceutical injected at 0.3 cm from the lesion versus 82 SLNs when injected at 1.3 cm. All lymph nodes visualized with close injection were identified with the farther injection. Twenty-seven (81%) patients presented the same number and location of SLNs. Six (19%) patients presented more SLNs with the expanded technique, three patients in the same basin and three in a new lymph node station. All metastatic SLNs were harvested by the two injection techniques.


CONCLUSIONS
The value of the SLN biopsy in patients with cutaneous melanoma is maintained even after the primary lesion has been removed with a margin of up to 1 cm. Some patients might show an increased number of SLNs and some might show drainage to additional lymph node stations.
Complexo Hospitalar Santa Casa, Laboratório de Medicina Nuclear, Porto Alegre, Rio Grande do Sul, Brazil.
Neivo
N
da Silva
Carlos Eduardo
CE
Anselmi
Felice
F
Riccardi
Roque
R
Furian
Daniela Duarte
DD
Fernandes
Renata
R
Brito
Maurício
M
de Lima
Osvaldo Estrela
OE
Anselmi
D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007267:Injections; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D011849:Radioactive Tracers; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
D011849:Radioactive Tracers