Popliteal lymphadenectomy for treating metastatic melanoma: case report

Abstract

CONTEXT: Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy) have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion. CASE REPORT: A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.

Key Anatomical Structures for Safe Popliteal Node Dissection-A Rare Case Series

“…Although rare as an operation, popliteal lymphadenectomy is the treatment of choice in cases of localized clinical or microscopic disease [13][14][15]. Prophylactic dissection of the popliteal nodes is not considered necessary [3,6].…”

Malignant Melanoma with Simultaneous Inguinal and Popliteal Lymph Node Metastases: A Rare Case Report

“…Popliteal lymphatic metastases from melanomas located in the distal region of the lower extremities (lower legs or feet) are extremely rare; there are few reports on such metastases in the literature because of the difficulty in examining the popliteal fossa, where the nodes lie deep in the fascia and are not easily palpable. 1,2 This initial obstacle tends to lead to a delayed diagnosis; therefore, the disease may only be discovered at a late stage. 2 Simultaneous popliteal and inguinal lymph node metastases are also quite rare.…”

“…1,2 This initial obstacle tends to lead to a delayed diagnosis; therefore, the disease may only be discovered at a late stage. 2 Simultaneous popliteal and inguinal lymph node metastases are also quite rare. Kretschmer et al 4 reported that among 166 patients with distal melanomas, only 16 (9.6%) showed popliteal sentinel lymph node (SLN) involvement on lymphoscin-tigraphy.…”

“…Typically, melanomas of the distal leg and foot metastasize to the lymph nodes of the groin. 2 In contrast, popliteal lymph node metastases are quite rare. In a retrospective study at the Sidney Melanoma Unit, only 0.3% of patients with distal leg melanomas had clinically palpable popliteal metastases.…”

“…Therefore, few studies in the literature have reported on popliteal dissection for malignant melanoma metastases. 1,2 We present the case of a patient with a malignant melanoma in the heel with palpable popliteal lymph node involvement but without evidence of inguinal lymph node involvement on performing a clinical examination and positron emission tomography (PET) imaging. However, histopathological analysis revealed the presence of malignant melanoma metastases in both regions.…”