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Erschienen in: Annals of Surgical Oncology 5/2013

01.05.2013 | Melanomas

The Unpredictability of Lymphatic Drainage from the Ear in Melanoma Patients, and Its Implications for Management

verfasst von: Howard S. Peach, Augustinus P. T. van der Ploeg, Lauren E. Haydu, Jonathan R. Stretch, Kerwin F. Shannon, Roger F. Uren, John F. Thompson

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2013

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Abstract

Background

The ear is known to have variable lymphatic drainage. The purpose of this study was to define better the lymphatic drainage patterns of the ear by correlating the location of primary tumors, classified according to the embryologically derived anatomical subunits of the ear, with their mapped sentinel nodes (SNs) identified by lymphoscintigraphy (LS).

Methods

Lymphatic drainage data for patients with a primary melanoma of the ear were reviewed and correlated with the precise primary melanoma site.

Results

Between 1993 and 2010, LS was performed in 111 patients with a primary melanoma on the ear, identifying 281 SNs in 195 lymph node (LN) fields. The mean numbers of SNs and LN fields identified by LS per patient were 2.65 and 1.76. SN biopsy was performed in 71 patients (64 %). The mean number of SNs removed was 2.36. The 111 ear melanomas were mostly located on the helical rim (55 %), followed by the lobule (24.3 %). The five different primary ear sites drained mainly to SNs in level CII, level CV and the preauricular region. Drainage was most often to level CII (36.4 %). Drainage to the contralateral neck was not observed.

Conclusions

Lymphatic drainage of the ear has no predictable pattern and can be to SNs anywhere in the ipsilateral neck. Most commonly drainage is to cervical level II and the preauricular and postauricular LN fields. LS defines the lymphatic drainage pattern in individual melanoma patients and is essential for accurate SN identification and reliable SN biopsy.
Literatur
1.
Zurück zum Zitat Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.PubMedCrossRef Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.PubMedCrossRef
2.
Zurück zum Zitat Uren RF, Thompson JF, Howman-Giles R. Sentinel lymph node biopsy in patients with melanoma and breast cancer. Intern Med J. 2001;31(9):547–53.PubMedCrossRef Uren RF, Thompson JF, Howman-Giles R. Sentinel lymph node biopsy in patients with melanoma and breast cancer. Intern Med J. 2001;31(9):547–53.PubMedCrossRef
3.
Zurück zum Zitat Alex JC, Weaver DL, Fairbank JT, et al. Gamma-probe-guided lymph node localization in malignant melanoma. Surg Oncol. 1993;2(5):303–8.PubMedCrossRef Alex JC, Weaver DL, Fairbank JT, et al. Gamma-probe-guided lymph node localization in malignant melanoma. Surg Oncol. 1993;2(5):303–8.PubMedCrossRef
4.
Zurück zum Zitat Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American society of clinical oncology and society of surgical oncology joint clinical practice guideline. J Clin Oncol. 2012;30(23):2912–8.PubMedCrossRef Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American society of clinical oncology and society of surgical oncology joint clinical practice guideline. J Clin Oncol. 2012;30(23):2912–8.PubMedCrossRef
5.
Zurück zum Zitat Ross MI, Thompson JF, Gershenwald JE. Sentinel lymph node biopsy for melanoma: critical assessment at its twentieth anniversary. Surg Oncol Clin N Am. 2011;20(1):57–78.PubMedCrossRef Ross MI, Thompson JF, Gershenwald JE. Sentinel lymph node biopsy for melanoma: critical assessment at its twentieth anniversary. Surg Oncol Clin N Am. 2011;20(1):57–78.PubMedCrossRef
6.
Zurück zum Zitat Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144(4):515–21.PubMedCrossRef Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144(4):515–21.PubMedCrossRef
7.
Zurück zum Zitat Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter selective lymphadenectomy trial group. Ann Surg. 1999;230(4):453–63; discussion 463–5.PubMedCrossRef Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter selective lymphadenectomy trial group. Ann Surg. 1999;230(4):453–63; discussion 463–5.PubMedCrossRef
8.
Zurück zum Zitat Mansberg R, Crawford B, Uren RF, Thompson JF. Minimally invasive radio-guided surgery for recurrent thyroid cancer using iodine-123. Clin Nucl Med. 2005;30(1):43–4.PubMedCrossRef Mansberg R, Crawford B, Uren RF, Thompson JF. Minimally invasive radio-guided surgery for recurrent thyroid cancer using iodine-123. Clin Nucl Med. 2005;30(1):43–4.PubMedCrossRef
9.
Zurück zum Zitat O’Brien CJ, Coates AS, Petersen-Schaefer K, et al. Experience with 998 cutaneous melanomas of the head and neck over 30 years. Am J Surg. 1991;162(4):310–4.PubMedCrossRef O’Brien CJ, Coates AS, Petersen-Schaefer K, et al. Experience with 998 cutaneous melanomas of the head and neck over 30 years. Am J Surg. 1991;162(4):310–4.PubMedCrossRef
10.
Zurück zum Zitat Byers RM, Smith JL, Russell N, Rosenberg V. Malignant melanoma of the external ear. Review of 102 cases. Am J Surg. 1980;140(4):518–21.PubMedCrossRef Byers RM, Smith JL, Russell N, Rosenberg V. Malignant melanoma of the external ear. Review of 102 cases. Am J Surg. 1980;140(4):518–21.PubMedCrossRef
11.
Zurück zum Zitat de Wilt JH, Thompson JF, Uren RF, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg. 2004;239(4):544–52.PubMedCrossRef de Wilt JH, Thompson JF, Uren RF, et al. Correlation between preoperative lymphoscintigraphy and metastatic nodal disease sites in 362 patients with cutaneous melanomas of the head and neck. Ann Surg. 2004;239(4):544–52.PubMedCrossRef
12.
Zurück zum Zitat Shpitzer T, Segal K, Schachter J, et al. Sentinel node-guided surgery for melanoma in the head and neck region. Melanoma Res. 2004;14(4):283–7.PubMedCrossRef Shpitzer T, Segal K, Schachter J, et al. Sentinel node-guided surgery for melanoma in the head and neck region. Melanoma Res. 2004;14(4):283–7.PubMedCrossRef
13.
Zurück zum Zitat Kelly J, Fogarty K, Redmond HP. A definitive role for sentinel lymph node mapping with biopsy for cutaneous melanoma of the head and neck. Surgeon. 2009;7(6):336–9.PubMedCrossRef Kelly J, Fogarty K, Redmond HP. A definitive role for sentinel lymph node mapping with biopsy for cutaneous melanoma of the head and neck. Surgeon. 2009;7(6):336–9.PubMedCrossRef
14.
Zurück zum Zitat Saltman BE, Ganly I, Patel SG, et al. Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma. Head Neck. 2010;32(12):1686–92.PubMedCrossRef Saltman BE, Ganly I, Patel SG, et al. Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma. Head Neck. 2010;32(12):1686–92.PubMedCrossRef
15.
Zurück zum Zitat Kilpatrick LA, Shen P, Stewart JH, Levine EA. Use of sentinel lymph node biopsy for melanoma of the head and neck. Am Surg. 2007;73(8):754–8; discussion 758–9.PubMed Kilpatrick LA, Shen P, Stewart JH, Levine EA. Use of sentinel lymph node biopsy for melanoma of the head and neck. Am Surg. 2007;73(8):754–8; discussion 758–9.PubMed
16.
Zurück zum Zitat Wells KE, Cruse CW, Daniels S, et al. The use of lymphoscintigraphy in melanoma of the head and neck. Plast Reconstr Surg. 1994;93(4):757–61.PubMedCrossRef Wells KE, Cruse CW, Daniels S, et al. The use of lymphoscintigraphy in melanoma of the head and neck. Plast Reconstr Surg. 1994;93(4):757–61.PubMedCrossRef
17.
Zurück zum Zitat Fincher TR, O’Brien JC, McCarty TM, et al. Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2004;130(7):844–8.PubMedCrossRef Fincher TR, O’Brien JC, McCarty TM, et al. Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2004;130(7):844–8.PubMedCrossRef
18.
Zurück zum Zitat Chen SL, Iddings DM, Scheri RP, Bilchik AJ. Lymphatic mapping and sentinel node analysis: current concepts and applications. CA Cancer J Clin. 2006;56(5):292–309; quiz 316–7.PubMedCrossRef Chen SL, Iddings DM, Scheri RP, Bilchik AJ. Lymphatic mapping and sentinel node analysis: current concepts and applications. CA Cancer J Clin. 2006;56(5):292–309; quiz 316–7.PubMedCrossRef
19.
Zurück zum Zitat Pathak I, O’Brien CJ, Petersen-Schaeffer K, et al. Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern? Head Neck. 2001;23(9):785–90.PubMedCrossRef Pathak I, O’Brien CJ, Petersen-Schaeffer K, et al. Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern? Head Neck. 2001;23(9):785–90.PubMedCrossRef
20.
Zurück zum Zitat Lin D, Franc BL, Kashani-Sabet M, Singer MI. Lymphatic drainage patterns of head and neck cutaneous melanoma observed on lymphoscintigraphy and sentinel lymph node biopsy. Head Neck. 2006;28(3):249–55.PubMedCrossRef Lin D, Franc BL, Kashani-Sabet M, Singer MI. Lymphatic drainage patterns of head and neck cutaneous melanoma observed on lymphoscintigraphy and sentinel lymph node biopsy. Head Neck. 2006;28(3):249–55.PubMedCrossRef
21.
Zurück zum Zitat Eberbach MA, Wahl RL, Argenta LC, et al. Utility of lymphoscintigraphy in directing surgical therapy for melanomas of the head, neck, and upper thorax. Surgery. 1987;102(3):433–42.PubMed Eberbach MA, Wahl RL, Argenta LC, et al. Utility of lymphoscintigraphy in directing surgical therapy for melanomas of the head, neck, and upper thorax. Surgery. 1987;102(3):433–42.PubMed
22.
Zurück zum Zitat Uren RF, Howman-Giles R, Chung DK, et al. The reproducibility in routine clinical practice of sentinel lymph node identification by pre-operative lymphoscintigraphy in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14(2):899–905.PubMedCrossRef Uren RF, Howman-Giles R, Chung DK, et al. The reproducibility in routine clinical practice of sentinel lymph node identification by pre-operative lymphoscintigraphy in patients with cutaneous melanoma. Ann Surg Oncol. 2007;14(2):899–905.PubMedCrossRef
23.
Zurück zum Zitat Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000;50(1):7–33.PubMedCrossRef Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000;50(1):7–33.PubMedCrossRef
24.
Zurück zum Zitat Cole DJ, Mackay GJ, Walker BF, et al. Melanoma of the external ear. J Surg Oncol. 1992;50(2):110–4.PubMedCrossRef Cole DJ, Mackay GJ, Walker BF, et al. Melanoma of the external ear. J Surg Oncol. 1992;50(2):110–4.PubMedCrossRef
25.
Zurück zum Zitat Ozao-Choy J, Hiles J, Yoon JL, et al. Scalp melanoma: responsible for the poor prognosis of head and neck melanoma? Ann Surg Oncol. 2012;19(Suppl 1):S23. Ozao-Choy J, Hiles J, Yoon JL, et al. Scalp melanoma: responsible for the poor prognosis of head and neck melanoma? Ann Surg Oncol. 2012;19(Suppl 1):S23.
26.
Zurück zum Zitat Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242(3):302–11; discussion 311–3.PubMed Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242(3):302–11; discussion 311–3.PubMed
27.
Zurück zum Zitat Norman J, Cruse CW, Espinosa C, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma. Am J Surg. 1991;162(5):432–7.PubMedCrossRef Norman J, Cruse CW, Espinosa C, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma. Am J Surg. 1991;162(5):432–7.PubMedCrossRef
28.
Zurück zum Zitat Eicher SA, Clayman GL, Myers JN, Gillenwater AM. A prospective study of intraoperative lymphatic mapping for head and neck cutaneous melanoma. Arch Otolaryngol Head Neck Surg. 2002;128(3):241–6.PubMed Eicher SA, Clayman GL, Myers JN, Gillenwater AM. A prospective study of intraoperative lymphatic mapping for head and neck cutaneous melanoma. Arch Otolaryngol Head Neck Surg. 2002;128(3):241–6.PubMed
29.
Zurück zum Zitat Cole MD, Jakowatz J, Evans GR. Evaluation of nodal patterns for melanoma of the ear. Plast Reconstr Surg. 2003;112(1):50–6.PubMedCrossRef Cole MD, Jakowatz J, Evans GR. Evaluation of nodal patterns for melanoma of the ear. Plast Reconstr Surg. 2003;112(1):50–6.PubMedCrossRef
30.
Zurück zum Zitat Lee D, Nash M, Har-El G. Regional spread of auricular and periauricular cutaneous malignancies. Laryngoscope. 1996;106(8):998–1001.PubMedCrossRef Lee D, Nash M, Har-El G. Regional spread of auricular and periauricular cutaneous malignancies. Laryngoscope. 1996;106(8):998–1001.PubMedCrossRef
31.
Zurück zum Zitat Klop WM, Veenstra HJ, Vermeeren L, et al. Assessment of lymphatic drainage patterns and implications for the extent of neck dissection in head and neck melanoma patients. J Surg Oncol. 2011;103(8):756–60.PubMedCrossRef Klop WM, Veenstra HJ, Vermeeren L, et al. Assessment of lymphatic drainage patterns and implications for the extent of neck dissection in head and neck melanoma patients. J Surg Oncol. 2011;103(8):756–60.PubMedCrossRef
32.
Zurück zum Zitat Reynolds HM, Smith NP, Uren RF, et al. Three-dimensional visualization of skin lymphatic drainage patterns of the head and neck. Head Neck. 2009;31(10):1316–25.PubMedCrossRef Reynolds HM, Smith NP, Uren RF, et al. Three-dimensional visualization of skin lymphatic drainage patterns of the head and neck. Head Neck. 2009;31(10):1316–25.PubMedCrossRef
33.
Zurück zum Zitat Park C, Roh TS. Anatomy and embryology of the external ear and their clinical correlation. Clin Plast Surg. 2002;29(2):155–74, v.PubMedCrossRef Park C, Roh TS. Anatomy and embryology of the external ear and their clinical correlation. Clin Plast Surg. 2002;29(2):155–74, v.PubMedCrossRef
34.
Zurück zum Zitat Uren RF, Howman-Giles RB, Shaw HM, et al. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med. 1993;34(9):1435–40.PubMed Uren RF, Howman-Giles RB, Shaw HM, et al. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med. 1993;34(9):1435–40.PubMed
35.
Zurück zum Zitat Robbins KT. Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 1998;31(4):639–55.PubMedCrossRef Robbins KT. Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 1998;31(4):639–55.PubMedCrossRef
36.
Zurück zum Zitat Narayan D, Ariyan S. Surgical considerations in the management of malignant melanoma of the ear. Plast Reconstr Surg. 2001;107(1):20–4.PubMedCrossRef Narayan D, Ariyan S. Surgical considerations in the management of malignant melanoma of the ear. Plast Reconstr Surg. 2001;107(1):20–4.PubMedCrossRef
37.
Zurück zum Zitat Gray H. Development of the ear. In: Bannister LH, Berry MM, Williams PL, eds. Gray’s anatomy: the anatomical basis of medicine & surgery. New York: Churchill Livingstone; 1995. p. 1612. Gray H. Development of the ear. In: Bannister LH, Berry MM, Williams PL, eds. Gray’s anatomy: the anatomical basis of medicine & surgery. New York: Churchill Livingstone; 1995. p. 1612.
Metadaten
Titel
The Unpredictability of Lymphatic Drainage from the Ear in Melanoma Patients, and Its Implications for Management
verfasst von
Howard S. Peach
Augustinus P. T. van der Ploeg
Lauren E. Haydu
Jonathan R. Stretch
Kerwin F. Shannon
Roger F. Uren
John F. Thompson
Publikationsdatum
01.05.2013
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 5/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2811-7

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