THE ROLE OF LYMPHOSCINTIGRAPHY AND BLUE DYE TECHNIQUES IN DETERMINING SENTINEL LYMPH NODES IN PATIENTS WITH MALIGN MELANOMA

Aim: Regional lymphatic drainage sites may vary in patients with melanoma. It is important to know whether the lymph node is involved with tumor, in order to proceed with subsequent regional lymphatic dissection. Therefore sentinel lymph node detections gained popularity in recent years in patients with melanoma. Material-Method: In this study we investigated lymphatic drainage patterns and detectability of sentinel lymph nodes by using lymhoscintigraphy and blue-dye techniques in 26 patients with melanoma and 10 of them are also evaluated with surgical gamma probe. Results: The lesions of melanoma were localized on head and neck in 3, on trunk in 8 and on upper and lower extremities in 15 patients. There were unexpected drainage sites in 33% of patients with head and neck lesions and 62% of patients with truncal lesions on lymphoscintigraphy. The surgical management was changed in these patients. Sentinel lymph nodes were detected in 26 patients with lymphoscintigraphy and in 25 patients with blue-dye technique. All patients who had intraoperative surgical gamma probe revealed sentinel lymph nodes. There were 6 metastatic sentinel lymph nodes out of 26 patients by histopathology. Conclusion: The results revealed that lymphatic drainage patterns were highly variable particularly in patients with truncal and head and neck melanomas. Therefore preoperative lymphatic mapping is extremely useful in this patient group especially in surgical management. In addition detection of sentinel lymph nodes with blue-dye technique and surgical gamma probe facilitates the procedures in melanoma.