Utility of lymphoscintigraphy in directing surgical therapy for melanomas of the head, neck, and upper thorax

Lymphoscintigraphy with technetium^99m antimony sulfur colloid or technetium^99m human serum albumin helped direct the surgical management of 24 patients who had melanomas of the head, neck, and upper thorax. Eighteen (75%) patients had documented lymphatic flow to other than a single adjacent predictable lymph nodal group. Nineteen patients underwent lymphadenectomy. Availablility of the scan altered surgical management in nine patients (47%) who required resection of nodes in addition to resection of adjacent nodes. The discovery of metastatic disease in one patient was clearly attributable to lymphoscintigraphy. This demonstrates the unpredictable lymphatic anatomy of this region and suggests that preoperative lymphoscintigraphy may be useful in directing the surgical management of cutaneous melanomas in which lymph node dissection is planned.