Lymphatic Drainage to the Popliteal Basin in Distal Lower Extremity Malignant Melanoma

Menes, Tehillah S.

doi:10.1001/archsurg.139.9.1002

Cited by 32 publications

(40 citation statements)

References 13 publications

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“…They can be detected ventrally, dorsally and laterally with respect to the popliteal vessels and so surgical maneuvers in this anatomical region must be careful [7]. Popliteal lymph nodes collect the lymph from anatomical areas of the lower extremity such as the lateral aspect of the sole, the calf, the heel, the fifth toe, the Achilles tendon area, the anterior part of the leg and of the dorsum [9][10][11]. The lymphatic drainage to the popliteal fossa is relatively infrequent and poorly described in the literature, with a general incidence of 6.9-9% [4,6,9].…”

Section: Discussionmentioning

confidence: 99%

“…Popliteal lymph nodes collect the lymph from anatomical areas of the lower extremity such as the lateral aspect of the sole, the calf, the heel, the fifth toe, the Achilles tendon area, the anterior part of the leg and of the dorsum [9][10][11]. The lymphatic drainage to the popliteal fossa is relatively infrequent and poorly described in the literature, with a general incidence of 6.9-9% [4,6,9]. For clinical reasons though, it is highly important to mention that in cases of popliteal lymphatic drainage, three patterns can be detected.…”

Section: Discussionmentioning

confidence: 99%

“…This paucity of reports may be explained as follows. Principally, there is a tendency to avoid clinical examination of the popliteal basin, although its palpation is fundamental and of major importance for the detection of abnormal lymph nodes [1,6,9]. Secondly, even when physical examination is performed, metastasis to the popliteal nodes might be missed, because they lie beneath the powerful popliteal fascia and they might not be palpated promptly [1].…”

Section: Discussionmentioning

confidence: 99%

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

Skarpas¹

2017

MOJOR

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Skarpas¹

2017

MOJOR

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“…In a less frequent form, this phenomenon may possibly be associated with in-transit metastases, as in the present case. 6,9 In-transit metastases occur in approximately 5% to 8% of patients with high-risk melanoma. The management of in-transit metastases remains a challenge because it is dictated by the biological behavior of melanoma, especially in terms of the number and size of the lesions.…”

Section: Discussionmentioning

confidence: 99%

Popliteal lymphadenectomy for treating metastatic melanoma: case report

2008

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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.

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“…In our surgical experience, during the initial dissection of the interval SN we have directly removed all other surrounding lymph nodes to avoid difficulty with further dissections (of the triangular intermuscular space, for example), with the exception of popliteal interval SNs. The popliteal is the principal interval node in the lower limb, varying in incidence from 4.3% to 36% of cases (3,32,33), and radical popliteal lymph node dissection is a validated surgical technique (34). Whether to perform a radical selective lymph node dissection of the distal basin or another basin when the classic SN is not metastatic is still a matter of debate.…”

Section: Further Management Of Metastatic Interval Snsmentioning

confidence: 99%

The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients

Matter

Lalonde²,

Allaoua³

et al. 2007

Journal of Nuclear Medicine

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In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This study aimed to review the incidence, lymphatic anatomy, and metastatic risk of interval SNs. Methods: SN biopsy was performed at a tertiary center by a single surgical team on a cohort of 402 consecutive patients with primary melanoma. The triple technique of localization was used-that is, lymphoscintigraphy, blue dye, and g-probe. Otolaryngologic melanoma and mucosal melanoma were excluded from this analysis. SNs were examined by serial sectioning and immunohistochemistry. All patients with metastatic SNs were recommended to undergo a radical selective lymph node dissection. Results: The primary locations of the melanomas included the trunk (188), an upper limb (67), or a lower limb (147). Overall, 97 (24.1%) of the 402 SNs were metastatic. Interval SNs were observed in 18 patients, in all but 2 of whom classic SNs were also found. The location of the primary was truncal in 11 (61%) of the 18, upper limb in 5, and lower limb in 2. One patient with a dorsal melanoma had drainage exclusively in a cervicoscapular area that was shown on removal to contain not lymph node tissue but only a blue lymph channel without tumor cells. Apart from the interval SN, 13 patients had 1 classic SN area and 3 patients 2 classic SN areas. Of the 18 patients, 2 had at least 1 metastatic interval SN and 2 had a classic SN that was metastatic; overall, 4 (22.2%) of 18 patients were node-positive. Conclusion: We found that 2 of 18 interval SNs were metastatic: This study showed that preoperative lymphoscintigraphy must review all known lymphatic areas in order to exclude an interval SN.

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Lymphatic Drainage to the Popliteal Basin in Distal Lower Extremity Malignant Melanoma

Abstract: Hypotheses: Melanoma of the distal lower extremity may drain to the popliteal basin. Drainage pathways and retrieval of the popliteal sentinel nodes may affect patient outcome.

Cited by 32 publications

References 13 publications

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

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

Popliteal lymphadenectomy for treating metastatic melanoma: case report

The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients

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