Scintigraphic imaging of a nuchal sentinel node

Area of Science:

• Oncology
• Anatomy
• Nuclear Medicine

Background:

• The prediction of cutaneous lymphatic drainage from the trunk traditionally relied on Sappey's anatomical concepts.
• Recent lymphoscintigraphy studies indicate significant discrepancies between actual sentinel lymph node basins and predicted drainage sites based on historical anatomy.

Observation:

• This report details a case of upper back melanoma.
• The sentinel lymph node was identified in an unusual nuchal location.

Findings:

• Technetium-99m filtered sulfur colloid scintigraphy was utilized to demonstrate the sentinel node.
• The identified nuchal sentinel node deviated from expected drainage patterns predicted by classic anatomy.

Implications:

• Findings highlight the complexity of trunk lymphatic drainage and the limitations of relying solely on established anatomical maps.
• This case underscores the importance of advanced imaging techniques like lymphoscintigraphy for accurate sentinel node identification in melanoma patients.
• Revising our understanding of lymphatic pathways may improve staging and treatment strategies for cutaneous malignancies.