Sentinel Node Lymphoscintigraphy in Cutaneous Malignant Melanoma

Abstract

Until fairly recently radical nodal dissection was the only procedure available to identify and remove micrometastatic foci of nodal spread of malignant melanoma. A less invasive technique, biopsy of the first draining node, the sentinel node, has to been shown to accurately stage lymphatic spread. Identification of the sentinel node is possible using intradermal injection of a blue dye (such as isosulfan blue) and/or radionuclides (sentinel node lymphoscintigraphy). Sentinel node lymphoscintigraphy is advantageous because multiple nodal basins can be simultaneously imaged, and the sentinel node can be relatively easily localized with an intraoperative probe. Successful lymphoscintigraphy requires careful injection technique, rapid imaging, and in many cases acquisition of special views to localize nodes. In this article we will discuss the rationale for, the use of, and the methods for performing lymphoscintigraphy.