title: Lymphatic drainage patterns from melanomas on the shoulder or upper trunk to cervical lymph nodes and implications for the extent of neck dissection.
abstract: OBJECTIVE
  To determine the incidence and pattern of cervical lymphatic drainage in patients with melanomas located on the upper limb or trunk, and to evaluate our current neck dissection protocol for those patients with a N+ neck.
  
  
  METHODS
  Of 1192 melanoma patients who underwent sentinel node biopsy, 631 were selected with a primary tumor on the upper limb or trunk. All lymphoscintigrams, SPECT/CT images and operative reports were reviewed to determine the exact locations of sentinel nodes visualized preoperatively and dissected during operation.
  
  
  RESULTS
  Thirty-nine (6.2 %) of 631 patients with a melanoma on the upper limb or trunk showing cervical lymph node drainage were identified. In 34 (87 %) of 39 patients, sentinel nodes were excised from level IV or Vb, and in 30 of those 39 patients simultaneous from the axilla. In the remaining five patients (13 %), sentinel nodes were collected from level IIb, level III or the suboccipital region. All collected sentinel nodes were located in the intended dissection area for N+ patients. Thirteen patients (33 %) had a total of 22 tumor-positive sentinel nodes in either the axilla (n = 10), level IV (n = 2), Vb (n = 9) or suboccipital (n = 1).
  
  
  CONCLUSIONS
  Only a minority of the patients with upper limb or trunk melanomas demonstrated lymphatic drainage to cervical lymph node basins, with preferential drainage to levels IV and Vb. Our current dissection protocol of levels II-V, with or without extension to the suboccipital region, in those patients with involved cervical sentinel nodes seems sufficient.
authors.affiliation: Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. h.veenstra@nki.nl
authors.forename: Hidde J
authors.initials: HJ
authors.lastname: Veenstra
authors.forename: W Martin C
authors.initials: WM
authors.lastname: Klop
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Speijers
authors.forename: Peter J F M
authors.initials: PJ
authors.lastname: Lohuis
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012782:Shoulder / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D060726:Torso / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D055815:Young Adult