DOUBLE MELANOMA IN THORAX
Male 56 year old with multiple moles. In recent months he noted that two of them in left posterior and left anterior hemithorax turned darker and grew up quickly. Note the size of the anterior one not operated on (blue arrow points to lesion and site of tracer administration around it) and a small surgical scar in the posterior thorax (green arrow, lesion area and punctures). Anterior lesion was injected first and inmediately after, the posterior one. See red arrows pointing to right axilla and uptake in 1 sentinel node and vessel coming from anterior site in the different projections. Black arrows mark 2 sentinel nodes uptake and 2 vessels coming from the posterior injection site. Sometimes it is difficult to distinguish the second sentinel node from a node after the sentinel proper. It is advisable to mark both, so the surgeon can exctract them for pathology analysis.
Phan GQ et al discussed that "in the Multicenter Selective Lymphadenectomy Trial I, the 5-year survival rate was 72.3% for patients with positive sentinel nodes and 90.2% for those with negative sentinel nodes (P < .001). For thin melanomas, Breslow depth >or= 0.76 mm and increased mitotic rate have been shown to be associated with an increased incidence of SLN metastases. SLNB (Sentinel lymph node biopsy) provides important prognostic and staging data with minimal morbidity and can be used to identify regional node-negative patients who would not benefit from a complete nodal dissection. In our opinion, SLNB should be performed on most patients who have melanomas with a Breslow depth >or= 0.76 mm."
References:
1
Intenzo CM, Truluck CA, Kushen MC, Kim SM, Berger A, Kairys JC. Radiographics.
2009 Jul-Aug;29(4):1125-35. Lymphoscintigraphy in cutaneous melanoma: an updated
total body atlas of sentinel node mapping.
2 Phan GQ, Messina JL, Sondak VK, Zager JS.Sentinel lymph node
biopsy for melanoma: indications and rationale.Cancer Control. 2009
Jul;16(3):234-9.