Detection of micrometastasis in the sentinel lymph node via lymphoscintigraphy for a patient with in-transit metastatic melanoma

BACKGROUND. Lymphoscintigraphy and sentinel lymph node (SLN) biopsy are highly accurate methods of detecting regional lymph node status for melanoma. Previously, these procedures were mainly performed in patients with primary melanoma before wide local excision. OBJECTIVE. To present a case with in-transit recurrence melanoma using lymphoscintigraphy and SLN biopsy for detection of nodal basin status. METHODS. The patient discussed here had a subungual melanoma that developed as an in-transit metastatic melanoma on the pretibia area 2 years after right big toe amputation. By using lymphoscintigraphy and SLN biopsy technique with injection of technetium-99m colloid around the in-transit metastatic site, the first node (SLN) draining the in-transit metastatic tumor was identified and harvested on the right inguinal area. Immediate right inguinal node dissection was subsequently performed. RESULTS. Under thorough histologic examination, the first node (SLN) draining the in-transit metastatic tumor was the only node that contained micrometastatic tumor cells in the surgical specimens. CONCLUSION. Lymphoscintigraphy and SLN biopsy techniques are sensitive procedures for detecting the regional nodal basin micrometastasis in in-transit recurrence melanoma patients.