title: Dominant lymph drainage in the upper extremity and upper trunk region: evaluation of lymph drainage in patients with skin melanomas.
abstract: BACKGROUND
  The objective of this study is to evaluate the lymph drainage from the primary focus to the regional lymph nodes in patients with melanomas of the upper extremity and upper trunk region.
  
  
  METHODS
  The study is a retrospective study of 20 patients with upper extremity melanomas and 14 patients with upper trunk melanomas treated with axillary lymph node dissection (ALND) or sentinel lymph node biopsy at the hospital. ALND was performed in 14 cases. In these cases, 12 were curative dissections and 2 were elective dissections. The dominant lymph drainage patterns from the primary regions were analyzed.
  
  
  RESULTS
  Among the upper extremity and upper trunk region melanomas, lymph drainage to Level I was determined in all cases. In these two regions there were no cases of lymph drainage to Level II not passing through Level I. Furthermore, there were no cases where sentinel lymph node or metastasis of the lymph nodes was clearly determined in Level III. Among the upper extremity melanomas, lymph drainages to the cubital (10 %) and mid-arm nodes (5 %) were established. Among the scapular region melanomas, lymph drainages to the supraclavicular nodes (25 %) were determined.
  
  
  CONCLUSIONS
  There was a dominant lymph drainage pattern of melanomas of the upper extremity and upper trunk region to Level I. No lymph node dissection of Level III in patients with melanomas of the upper extremity and upper trunk region is necessary unless preoperative examination determines a high possibility of metastasis-positive lymph nodes in level III.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan, toshi-116@nifty.com.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oyama
authors.forename: Emi
authors.initials: E
authors.lastname: Funayama
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D034941:Upper Extremity / Q000473:pathology / Q000601:surgery