Aberrant lymphatic drainage and risk for melanoma recurrence after negative sentinel node biopsy in middle-aged and older men.
Aberrant lymphatic drainage is believed to contribute to the high recurrence rate of head and neck melanomas. The purpose of this study was to identify the clinical significance of unexpected lymphatic drainage patterns.



A single institution retrospective analysis was performed of middle-aged and older men (mean age, 66.2 years; range, 41-87 years) who underwent successful lymphoscintigraphy with sentinel lymph node biopsy (SLNB) from 1997 through 2012. Node status, distribution, and recurrence were assessed comparing patients with expected and unexpected drainage patterns.



Sixty-six patients were identified with 55.8 months median follow-up (range, 5.6-206.1 months). Unexpected sentinel lymph node drainage was associated with multiple basin drainage (p < .01) and greater recurrence after negative SLNB (p = .03). Both groups had similar anatomic distribution, sentinel lymph node sampling, histopathologic characteristics, follow-up, and survival.



Lymphatic drainage differing from expected patterns is associated with greater recurrence after negative SLNB in middle-aged and older men. © 2015 Wiley Periodicals, Inc. Head Neck 38: E754-E760, 2016.
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.
Anthony H
AH
Kaveh
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.
Nicole M
NM
Seminara
Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Melynda A
MA
Barnes
Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, California.
Aaron J
AJ
Berger
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.
Frank W
FW
Chen
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.|Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Mike
M
Yao
Department of Surgery, Stanford University School of Medicine, Stanford, California.
Denise
D
Johnson
Department of Surgery, Stanford University School of Medicine, Stanford, California.
Sean
S
Parsa
Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California.
Andrew
A
Quon
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.|Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Susan M
SM
Swetter
Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California.|Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
John B
JB
Sunwoo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008208:Lymphatic System / Q000503:physiopathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*
discordant; head and neck melanoma; lymphatic drainage; negative sentinel node biopsy; recurrence