Sunday, November 3, 2002 - 2:39 PM

Lymphoscintigraphy: An Effective Approach to Ear Melanoma

Matt Cole, BS, James Jakowatz, MD, and Gregory R.D. Evans, MD.

Purpose: We reviewed a population of patients with melanoma of the ear undergoing surgical excision and reconstruction to determine the utilization of sentinel lymph node mapping

Material and Methods: A retrospective chart review was performed on all patients diagnosed and treated for malignant melanoma that required reconstruction of the external ear between 1995 and 2001. Nineteen patients were selected of which 9 underwent sentinel node mapping. The average age of the patients was 65.2 years. Evaluation of melanoma depth, medical history, surgical margins, lymph node metastasis and recurrence were also determined.

Results: Lymphoscintigraphy and injection of vital blue dyes demonstrated a wide variable drainage pattern with the parotid and upper cervical area the most common location. The average number of sentinel nodes identified and removed was 3.7. The average Breslow thickness for these patients was 2.3mm. None of these patients demonstrated micrometastatic disease in their sentinel node. The most common reconstructive procedure following surgical resection was a rotational advancement flap. Counts per second with radiolabeled Tc99m was the primary method for detecting sentinel lymph nodes. The average CPS of the primary injection site was 8,375 and the average for the node removed was 973.5. Of the 9 receiving sentinel lymph node mapping only one developed recurrence with an initial depth of 5mm. The average follow-up was 20 months.

Conclusion: Larger studies are indicated, however it appears that this method is viable for approaching and designing therapeutic modalities for patients with melanoma of the ear

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