Related Experiment Video
Updated: Feb 11, 2026
09:38
Minimally Invasive Isolated Limb Perfusion (MI-ILP) for Locally Advanced Melanomas and Sarcomas of the Extremity
Published on: January 31, 2025
981
Eliminating Preoperative Lymphoscintigraphy in Extremity Melanomas
Andrew McGregor1, Sabrina N Pavri1, Samuel Kim1
1Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Conn.; and Yale University School of Medicine, New Haven, Conn.
Plastic and Reconstructive Surgery. Global Open
|May 1, 2018
Summary
Preoperative lymphoscintigraphy (LSG) can be safely omitted for most extremity melanomas, identifying sentinel lymph nodes accurately. This change reduces healthcare costs without compromising patient care.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Preoperative lymphoscintigraphy (LSG) is standard for identifying melanoma nodal basins.
- Institutions often use both preoperative and intraoperative LSG.
- Extremity melanomas have predictable lymphatic drainage, questioning the need for preoperative LSG.
Purpose of the Study:
- To assess the safety and feasibility of eliminating preoperative LSG for extremity melanomas.
- To evaluate the incidence of atypical lymphatic drainage in these cases.
- To quantify the potential cost savings.
Main Methods:
- Retrospective review of the Yale Melanoma Registry (1308012545).
- Calculation of atypical lymph node drainage incidence for upper and lower extremities.
- Elimination of preoperative LSG in 21 selected cases.
- Analysis of potential hospital charge reduction.
Main Results:
- Atypical drainage rates were 3.4% for upper and 2.0% for lower extremities.
- Epitrochlear and popliteal regions were sites of atypical drainage.
- Sentinel lymph nodes were correctly identified in all 21 cases without preoperative LSG.
- Forgoing preoperative LSG resulted in a $2,393 charge reduction.
Conclusions:
- Preoperative LSG is not essential for managing most upper and lower extremity melanomas.
- Exceptions include posterior calf/ankle/heel lesions and patients with prior surgery/radiation.
- Eliminating preoperative LSG offers financial benefits and patient advantages.
- Widespread adoption could lead to significant healthcare system savings.
Related Concept Videos
01:22Absolute and Local Extreme Values
86
The highest and lowest values of a function, relative to a reference axis, are known as extreme values. These include absolute maximum and absolute minimum values, which represent the highest and lowest points the function reaches across its entire domain. Within a restricted portion of the function, the highest and lowest values are referred to as local maximum and local minimum values, respectively.Periodic functions, such as sine and cosine, show extreme values at infinitely many points due...
86
01:05Elimination Kinetics: First-Order and Zero-Order
3.0K
Eliminating drugs from the body is a vital process that occurs through excretion or metabolism. Understanding the kinetics of drug elimination is crucial for drug development, dosage determination, and optimizing patient outcomes.
Drug clearance depends on the rate of drug elimination and its plasma concentration. Another important parameter is a drug's half-life, which is the time required for its concentration to decrease by half. In most cases, drug clearance follows first-order...
Drug clearance depends on the rate of drug elimination and its plasma concentration. Another important parameter is a drug's half-life, which is the time required for its concentration to decrease by half. In most cases, drug clearance follows first-order...
3.0K
02:25Elimination Reactions
17.2K
A nucleophile can react with an alkyl halide to give the substitution product by displacing the halogen. Or it can function as a base to give the elimination product by deprotonation of the neighboring carbon to form an alkene. In an elimination reaction, the substrate loses two groups from adjacent carbons forming at least one π bond. The carbon attached to the halogen is called the α carbon, while the adjacent carbon is called the β carbon; hence, these reactions are called...
17.2K
00:51Radical Formation: Elimination
2.4K
Another method of radical formation is the elimination process. It is the opposite of the addition route and is driven by the instability of the radical. For example, as depicted in Figure 1, dibenzoyl peroxide yields a pair of unstable radicals upon homolysis. Given its instability, this radical spontaneously undergoes elimination via a C–C bond cleavage to form a relatively more stable phenyl radical. The mechanism involves cleavage of the bond between the α and β positions with respect...
2.4K
01:30Gaussian Elimination: Problem Solving
198
Systems of linear equations in several variables are pivotal in modeling complex scenarios involving multiple unknowns and constraints. Such systems are widely used in various fields to represent relationships where several conditions must be simultaneously satisfied. Each variable in the system corresponds to an unknown quantity, while each equation imposes a linear constraint, leading to a structured approach for analyzing and solving real-world problems.A system of three equations with three...
198
01:17Kinetics of Drug Elimination
4.2K
Eliminating drugs from the body is a vital process that occurs through excretion or metabolism. Understanding the kinetics of drug elimination is crucial for drug development, dosage determination, and optimizing patient outcomes.
Drug clearance depends on the rate of drug elimination and its plasma concentration. Another important parameter is the half-life of a drug, which is the time required for its concentration to decrease by half. In most cases, drug clearance follows first-order...
Drug clearance depends on the rate of drug elimination and its plasma concentration. Another important parameter is the half-life of a drug, which is the time required for its concentration to decrease by half. In most cases, drug clearance follows first-order...
4.2K