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A triangular intermuscular space sentinel node in melanoma: association with axillary lymphatic drainage
Sara A Hennessy1, Lynn T Dengel, Tjasa Hranjec
1Department of Surgery, University of Virginia, Charlottesville, Virginia, USA. sa2v@virginia.edu
Annals of Surgical Oncology
|March 12, 2010
Summary
Triangular intermuscular space (TIS) sentinel nodes (SNs) are important for upper back melanoma staging. Evaluating TIS SNs and clearing the TIS is recommended for optimal nodal staging and melanoma management.
Area of Science:
- Oncology
- Surgical Pathology
- Dermatology
Background:
- Triangular intermuscular space (TIS) sentinel nodes (SNs) have been described for back melanomas, but their management is controversial.
- Optimal surgical management for TIS SNs, particularly concerning the axilla, requires further characterization.
Purpose of the Study:
- To summarize institutional experience with TIS SNs in upper back melanoma patients.
- To contribute to defining appropriate surgical management strategies for TIS SNs.
Main Methods:
- Retrospective review of surgical patients from January 1993 to April 2009.
- Data collection focused on patients with upper back melanoma and TIS SN identification.
Main Results:
- 14 patients (5%) with upper back melanoma had TIS SNs; 6 were misidentified as axillary.
- 11 patients (79%) had concurrent axillary SNs.
- Micrometastatic disease was found in TIS SNs in 2 patients (14%) and axillary SNs in 1 patient (9%).
- Lymphatic drainage patterns included independent drainage to TIS and axilla, and sequential drainage to TIS then axilla.
Conclusions:
- Three patterns of lymphatic drainage to TIS and axillary nodes were identified.
- The TIS and axilla are anatomically linked; biopsy of both is crucial for nodal staging.
- Directed evaluation and clearing of TIS SNs are recommended for upper back melanomas.
- Management of the axilla in patients with positive TIS nodes requires careful consideration.
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