title: Reoperative selective sentinel lymphadenectomy combined with lymphoscintigraphy is technically feasible for cutaneous tumors of the upper extremity after radical dissection of regional lymph node basins for breast cancer.
abstract: OBJECTIVE
  The rising incidence of melanoma and the high prevalence of breast cancer have generated a new scientific problem-how do the regional lymph node basins function after radical lymphadenectomy and are lymphatic drainage patterns altered after radical lymphadenectomy? Furthermore, after radical lymphadenectomy, selective sentinel lymphadenectomy is still a technically feasible and valid staging tool in the upper extremity? Thus, our study asks if selective sentinel lymph node dissection is technically feasible after radical lymph node dissection of the regional draining basin of the upper extremity (axilla).
  
  
  METHODS
  Retrospective review of a prospectively maintained database of patients was reviewed to identify patients who had lymphoscintigraphy and sentinel lymph node biopsy of the upper extremity after a radical axillary node dissection procedure. Imaging and pathology results were analyzed.
  
  
  RESULTS
  Seven patients fulfilling the inclusion criteria were identified. The patients all had either melanoma or invasive squamous cell carcinoma, and sentinel lymph nodes were identified in 6 out of 7 patients. One patient had metastases to 2 sentinel lymph nodes. Alternative drainage pathways were identified in 29% of patients, and 14% of patients had no identifiable drainage basin on lymphoscintigraphy.
  
  
  CONCLUSIONS
  Sentinel lymph node dissection is technically feasible after previous axillary dissection. Lymphoscintigraphy is an important perioperative tool as lymphatic drainage may be altered or not observed as evidenced in 43% of the studied patients. However, when lymphatic drainage is detected by lymphoscintigraphy, pathologically significant sentinel lymph nodes are surgically identifiable.
authors.affiliation: Center for Complex Reconstruction, San Francisco, Calif ; Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, Calif.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Miranda
authors.affiliation: School of Medicine, University of California San Francisco.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Bellevue
authors.affiliation: Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, Calif.
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
keywords: lymphadenectomy; lymphoscintigraphy; melanoma; sentinel node; squamous cell carcinoma