title: Can lymphatic drainage of head and neck melanoma be predicted?
abstract: BACKGROUND
  The lymphatic drainage patterns of the head and neck (H&N) is complex. Therefore, identification of the sentinel lymph node (SLN) for H&N melanoma can be challenging.
  
  
  METHODS
  Retrospective review of a prospectively collected melanoma database, from February 1997 through October 2008, identified 137 patients with H&N melanoma. All underwent pre-operative lymphoscintigraphy, and after 2007, patients underwent single photon emission computed tomography combined with computed tomography (SPECT/CT).
  
  
  RESULTS
  The mean number of SLNs per patient was 2.6. An SLN was successfully identified in 97% of patients, and in 9%, the SLN was positive for metastatic disease. The majority of patients (88%) drained to a unilateral level. Bilateral drainage occurred in 10%, with only two patients draining outside of the neck. The majority of patients (58%) had an SLN in level IIa (jugulodigastric lymph nodes). The regional recurrence rate was 4%, which all occurred prior to the use of SPECT/CT.
  
  
  CONCLUSIONS
  Utilization of SPECT/CT and knowledge of common lymphatic drainage patterns in neck lymph node levels can assist the surgeon in properly locating and excising the SLN with minimal morbidity, limiting unnecessary dissections, as well as reducing false negative results.
authors.affiliation: Midwestern University, Arizona College of Osteopathic Medicine, Glendale, Arizona, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Jensen
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Michael C
authors.initials: MC
authors.lastname: Roarke
authors.forename: William J
authors.initials: WJ
authors.lastname: Casey
authors.forename: Peter
authors.initials: P
authors.lastname: Kreymerman
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000378:metabolism*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging*; D013671:Technetium Tc 99m Sulfur Colloid; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid