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Updated: Jul 6, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Is sentinel node mapping useful in anorectal melanoma?
Theodoros Mariolis-Sapsakos1, Julia Malamitsi, Emmanuel Yakoumakis
1Department of General Surgery, Diagnostic and Therapeutic Center of Athens Hygeia, Athens, Greece.
Abstract:
Anorectal melanoma (AM) is a rare disease and few guidelines have been established regarding its therapeutic management. Wide local excision, or less frequently, abdominoperineal resection is the treatment of choice. We present a female patient with an excised AM who was submitted to our Nuclear Medicine department for sentinel lymph node (SLN) mapping of the area. Under rigid proctoscopy the anal scar received four submucosal injections of technetium-99m-sulfur nanocolloid of 29.6 MBq each. Lymphoscintigraphy and intraoperative gamma-probe guided detection of the SLNs followed. SLNs were localized in the inguinal basins bilaterally and were negative on histology. A wide local excision followed the above test. Thirty months postoperatively the patient developed distant metastases, underwent radiotherapy and died six months later. Without changing prognosis sentinel lymph node detection, excision and histology were important in sparing the patient a futile inguinal lymph node dissection.
Insights
Sentinel lymph node (SLN) mapping in anorectal melanoma (AM) identified key nodes, sparing patients unnecessary dissections. While not altering prognosis, this technique is crucial for accurate staging and treatment planning in rare AM cases.
Area of Science:
- Nuclear Medicine
- Oncology
- Surgical Pathology
Background:
- Anorectal melanoma (AM) is a rare malignancy with limited therapeutic guidelines.
- Standard treatment involves wide local excision or abdominoperineal resection.
- Accurate staging is critical for patient management.
Observation:
- A case of excised AM in a female patient is presented for sentinel lymph node (SLN) mapping.
- Technetium-99m-sulfur nanocolloid was used for SLN detection via submucosal injection.
- Lymphoscintigraphy and intraoperative gamma-probe guided detection identified bilateral inguinal SLNs.
Findings:
- Histological examination revealed the detected SLNs to be negative for malignancy.
- The patient underwent wide local excision following SLN mapping.
- Despite negative SLNs, the patient developed distant metastases 30 months post-surgery and passed away six months later.
Implications:
- Sentinel lymph node detection and histology, while not altering overall prognosis for AM, are vital for sparing patients from unnecessary and potentially morbid inguinal lymph node dissections.
- This case highlights the utility of nuclear medicine techniques in the precise staging of rare anorectal cancers.
- Further research into optimizing AM management strategies, including the role of SLN biopsy, is warranted.
