Lymph drainage from the skin varies from patient to patient,
sometimes even when the tumor is in the same location in two different
individuals. The pathway of lymph vessels that collect and drain lymph is
unpredictable, as are the locations of SLNs. Therefore, clinical predictions of
SLN locations are unreliable and imprecise. Preoperative lymphoscintigraphy
with small particle radio colloids allows visualization of all these lymph
vessels draining lymph to SLNs. Careful diagnostics will enable the localization
of all true SLNs, even when these lymph nodes are sometimes outside the usual
lymph basin. 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. Any lymph node that removes lymph from the
tumor site is considered a sentinel lymph node. Because lymphatic arteries can
pass through that cluster of lymph nodes and empty into other lymph nodes, it
might not even be the closest to the tumor location. Patients with cutaneous
melanoma have their sentinel lymph nodes mapped with lymphoscintigraphy. It
entails administering intradermal injections of a radiocolloid in the region of
the excisional biopsy site or in close proximity to the melanoma site. The location of all lymphatics is marked with
a marker or tattooed with a dot on the skin above the node. Radiocolloid
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. Careful diagnostics
will enable the localization of all true SLNs, even when these lymph nodes are
sometimes outside the usual lymph basin. This is crucial for accurate staging
of patients with melanoma.
Author(s) Details
Marko Vlacic
University Clinical Center of Vojvodina, Clinic for Plastic and
Reconstructive Surgery, Novi Sad, Republic
of Serbia.
Mirela Eric
Department of Anatomy, University of Novi Sad, Medical Faculty, Novi Sad,
Republic of Serbia.
Mladen Jovanovic
University Clinical Center of Vojvodina, Clinic for Plastic and
Reconstructive Surgery, Novi Sad, Republic of Serbia.
Sandra Jelcic
University Clinical Center of Vojvodina, Clinic for Physical Medicine and
Rehabilitation, Novi Sad, Republic
of Serbia.
Ivan Besenji
Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica,
Republic of Serbia.
Ivana Smiljanic
University Clinical Center of Vojvodina, Emergency Centre, Novi Sad,
Republic of Serbia.
Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v2/973
