Lymphoscintigraphy in a case of Merkel cell tumor

The authors report a rare case of Merkel cell tumor with the findings of lymphoscintigraphy. The study was performed to delineate anatomic lymphatic drainage from the primary skin lesion to help surgeons to decide which lymphatic basin(s) should have elective lymph node dissection. The lesion was situated in the midline on the back and at the border zone in the lumbar area from which it could drain superiorly to the axillary lymph nodes(s), inferiorly to the inguinal node(s), or to both directions. Because of this location, prediction of the lymphatic drainage by applying conventional anatomical knowledge from the lymphatic atlas was not easy. However, the lymphoscintigraphy was very helpful and subsequent pathologic examination of surgical specimens confirmed the interpretation of the lymphoscintigraphy.