The network of lymphatic vessels in the skin has been studied for centuries. In 1984, Sappey published an atlas of lymphatic vessels. The discovery of lymphoscintigraphy around 1950 renewed interest in verifying the pathways of lymphatic vessels in patients with skin melanoma. Lymphoscintigraphy quickly became an indispensable technique for mapping sentinel lymph nodes. Detecting sentinel lymph nodes is essential for conducting adequate diagnostics, appropriately staging patients, and administering necessary therapy. A sentinel lymph node is any lymph node that drains lymph from the tumor site. It may not even be the closest to the tumor site because lymphatic vessels can bypass that group of lymph nodes and drain into other lymph nodes. Lymphoscintigraphy is used in mapping sentinel lymph nodes in patients with skin melanoma. It involves intradermal injections of a radiocolloid in close proximity to the melanoma site or in the vicinity where an excisional biopsy has been performed. The location of all lymphatics is marked with a marker or tattooed with a dot on the skin above the node. Radiocolloids particles used for sentinel identification are in the size range of 5 - 50 nanometers. These particles easily enter lymphatic capillaries, and their entry is facilitated by exercise or massage of that body part. The lymphatic drainage of the skin varies from patient to patient, sometimes even when the tumor is in the same location in two different individuals. Therefore, careful diagnostics will enable the location of all true sentinel lymph nodes.
Cite this paper
Vlač, M. , ić, Erić, M. , Jovanović, M. , Jelč, S. , ić, Beš, I. , enji and Smiljanić, I. (2024). Mapping Sentinel Lymph Nodes among Patients Afflicted with Skin Melanoma. Open Access Library Journal, 11, e1282. doi: http://dx.doi.org/10.4236/oalib.1111282.
Sappey, M.P.C. (1874) Anatomy, Physiology and Pathology of the Lymphatic Vessels in Man and Vertebrates. DeLahaye, A. and Lecrosnier, E., Trans.-Eds., Paris. (In French)
Haagansen, C.D., Feind, C.R. and Herter, F.P. (1972) Lymphatics of the Trunk. In: Haagansen, C.D., Ed., The Lymphatics in Cancer, WB Saunders, Philadelphia, 437-458.
Sugarbaker, E.V. and McBride, C.M. (1976) Melanoma of the Trunk: The Results of Surgical Excision and Anatomic Guidelines for Predicting Nodal Metastasis. Surgery, 80, 22-30.
Bergqvist, L., Strand, S. and Hafstrom, L. (1984) Lymphoscintigraphy in Patients with Malignant Melanoma: A Quantitative and Qualitative Evaluation of Its Usefulness. European Journal of Nuclear Medicine, 9, 129-135. https://doi.org/10.1007/BF00253515
Fee, H.J., Robinson, D.S. and Sample, W.F. (1978) The Determination of Lymph Shed by Colloidal Gold Scanning in Patients with Malignant Melanoma: A Preliminary Study. Surgery, 84, 626-632.
Norman, J., Cruse, W. and Espinosa, C. (1991) Redefinition of Cutaneous Lymphatic Drainage with the Use of Lymphoscintigraphy for Malignant Melanoma. The American Journal of Surgery, 162, 432-437. https://doi.org/10.1016/0002-9610(91)90255-C
Morton, D.L., Wen, D.-R. and Wong, J.H. (1992) Technical Details of Intraoperative Lymphatic Mapping for Early Stage Melanoma. Archives of Surgery, 127, 392-399. https://doi.org/10.1001/archsurg.1992.01420040034005
Krag, D.N., Meijer, S.J., Weaver, D.L., et al. (1995) Minimal-Access Surgery for Staging of Malignant Melanoma. Archives of Surgery, 130, 654-658. https://doi.org/10.1001/archsurg.1995.01430060092018
Dummer, R., Hauschild, A., Lindenblatt, N., Pentheroudakis, G., Keilholz, U. and ESMO Guidelines Committee (2015) Cutaneous Melanoma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Annals of Oncology, 26, V126-V132. https://doi.org/10.1093/annonc/mdv297
Garbe, C., Peris, K., Hauschild, A., Saiag, P., Middleton, M., Bastholt, L., et al. (2016) Diagnosis and Treatment of Melanoma. European Consensus-Based Interdisciplinary Guideline—Update 2016. European Journal of Cancer, 63, 201-217. https://doi.org/10.1016/j.ejca.2016.05.005
Pflugfelder, A., Kochs, C., Blum, A., Capellaro, M., Czeschik, C., Dettenborn, T., et al. (2013) S3-Guideline, “Diagnosis, Therapy and Follow-Up of Melanoma” Short Version. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 11, 563-602. https://doi.org/10.1111/ddg.12044
Wong, S.L., Faries, M.B., Kennedy, E.B., Agarwala, S.S., Akhurst, T.J., Ariyan, C., et al. (2018) Sentinel Lymph Node Biopsy for Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline. Annals of Surgical Oncology, 25, 356-377. https://doi.org/10.1245/s10434-017-6267-7
Bluemel, C., Herrmann, K., Giammarile, F., Nieweg, O.E., Dubreuil, J., Testori, A., et al. (2015) EANM Practice Guidelines for Lymphoscintigraphy and Sentinel Lymph Node Biopsy in Melanoma. European Journal of Nuclear Medicine and Molecular Imaging, 42, 1750-1766. https://doi.org/10.1007/s00259-015-3135-1
Uren, R.F., Thompson, J.F. and Howman-Giles, R.B. (1999) Lymphatic Drainage of the Skin and Breast: Locating the Sentinel Nodes. Harwood Academic Publishers, Amsterdam.
Uren, F.R., Howman-Giles, R. and Thompson, F.J. (2003) Patterns of Lymphatic Drainage from the Skin in Patients with Melanoma. Journal of Nuclear Medicine, 44, 570-582.
Mar, M.V., Miller, S.A., Kim, E.E. and Macapinlac, H.A. (2007) Evaluation and Localization of Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Head and Neck Melanomas by Hybrid SPECT/CT Lymphoscintigraphic Imaging. Journal of Nuclear Medicine Technology, 35, 10-16.
Mariani, G., Gipponi, M. and Moresco, L. (2002) Radioguided Sentinel Lymph Node Biopsy in Malignant Cutaneous Melanoma. Journal of Nuclear Medicine, 43, 811-827.
Strand, S.E. and Persson, B.R.R. (1979) Quantitative Lymphoscintigraphy I: Basic Concepts for Optimal Uptake of Radiocolloids in the Parasternal Lymph Nodes of Rabbits. Journal of Nuclear Medicine, 20, 1038-1046.
Giammarile, F., Alazraki, N., Aarsvold, J.N., et al. (2013) The EANM and SNMMI Practice Guideline for Lymphoscintigraphy and Sentinel Node Localization in Breast Cancer. European Journal of Nuclear Medicine and Molecular Imaging, 40, 1932-1947. https://doi.org/10.1007/s00259-013-2544-2
O’Brien, C.J., Uren, R.F. and Thompson, J.F. (1995) Prediction of Potential Metastatic Sites in Cutaneous Head and Neck Melanoma Using Lymphoscintigraphy. The American Journal of Surgery, 170, 461-466. https://doi.org/10.1016/S0002-9610(99)80330-4
Morton, D.L., Thompson, J.F., Cochran, A.J., et al. (2014) Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma. The New England Journal of Medicine, 370, 599-609. https://doi.org/10.1056/NEJMoa1310460
Pasquali, S. and Spillane, A. (2014) Contemporary Controversies and Perspectives in the Staging and Treatment of Patients with Lymph Node Metastasis from Melanoma, Especially with Regards Positive Sentinel Lymph Node Biopsy. Cancer Treatment Reviews, 40, 893-899. https://doi.org/10.1016/j.ctrv.2014.06.008
Pasquali, S., Mocellin, S., Campana, L.G., et al. (2010) Early (Sentinel Lymph Node Biopsyguided) versus Delayed Lymphadenectomy in Melanoma Patients with Lymph Node Metastases: Personal Experience and Literature Meta-Analysis. Cancer, 116, 1201-1209. https://doi.org/10.1002/cncr.24852
Morton, D.L. (2012) Overview and Update of the Phase III Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II) in Melanoma. Clinical & Experimental Metastasis, 29, 699-706. https://doi.org/10.1007/s10585-012-9503-3
McNeil, C. (2013) Does Every Melanoma Patient with a Positive Sentinel Node Need More Lymph Nodes Removed? The ASCO Post Website. http://www.ascopost.com/issues/may-1,-2013/higher-her2-expression-linked-to-best-results-with-t-dm1-inpatients-with.aspx
Kuhl, D.E. and Edwards, R.Q. (1970) The Mark 3 Scanner: A Compact Device for Multiple-View and Section Scanning of the Brain. Radiology, 96, 563-570. https://doi.org/10.1148/96.3.563
Beyer, T., Townsend, D.W., Brun, T., Kinahan, P.E., Charron, M., Roddy, R., et al. (2000) A Combined PET/CT Scanner for Clinical Oncology. Journal of Nuclear Medicine, 41, 1369-1379.
Even-Sapir, E., Lerman, H., Lievshitz, G., Khafif, A., Fliss, D.M., Schwartz, A., et al. (2003) Lymphoscintigraphy for Sentinel Node Mapping Using a Hybrid SPECT/CT System. Journal of Nuclear Medicine, 44, 1413-1420.
Kretschmer, L., Altenvoerde, G., Meller, J., Zutt, M., Funke, M., Neumann, C., et al. (2003) Dynamic Lymphoscintigraphy and Image Fusion of SPECT and Pelvic CT-Scans Allow Mapping of Aberrant Pelvic Sentinel Lymph Nodes in Malignant Melanoma. European Journal of Cancer, 39, 175-183. https://doi.org/10.1016/S0959-8049(02)00534-8
Van Der Ploeg, I.M.C., Valdes Olmos, R.A., Nieweg, O.E., Rutgers, E.J.T., Kroon, B.B.R. and Hoefnagel, C.A. (2007) The Additional Value of SPECT/CT in Lymphatic Mapping in Breast Cancer and Melanoma. Journal of Nuclear Medicine, 48, 1756-1760. https://doi.org/10.2967/jnumed.107.043372
Uren, R.F. (2009) SPECT/CT Lymphoscintigraphy to Locate the Sentinel Lymph Node in Patients with Melanoma. Annals of Surgical Oncology, 16, 1459-1460. https://doi.org/10.1245/s10434-009-0463-z
