Kidner Travis B, Yoon Jeong L, Faries Mark B, Morton Donald L
Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Am Surg. 2012 Jun;78(6):702-5.
Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity melanoma. Patient demographics, tumor characteristics, patterns of nodal drainage, and incidence of SLN metastasis were analyzed. Of 255 patients identified, 38 (14.9%) had an epitrochlear SLN. Mean Breslow thickness was 2.26 mm. All patients with epitrochlear drainage had concurrent axillary drainage and underwent axillary and epitrochlear SLN biopsies. Of these 38 patients, two (5.2%) had epitrochlear and axillary SLN metastasis, four (10.5%) had epitrochlear metastasis only, four (10.5%) had axillary metastasis only, and the remaining 28 (73.7%) had tumor-free SLNs. The invariable association of epitrochlear and axillary drainage in this study suggests that epitrochlear nodes function in an interval role with the axillary lymph node basin. Therefore we recommend that all patients with a positive epitrochlear SLN undergo completion axillary dissection.
大多数上肢远端的原发性黑色素瘤转移至腋窝区域的前哨淋巴结（SLN），但偶尔原发性黑色素瘤也会引流至滑车上区域。肿瘤引流的腋窝和滑车上SLN之间的关系尚不清楚。我们假设滑车上SLN与腋窝淋巴结区域以间隔方式发挥作用。我们查询了黑色素瘤数据库，以确定因上肢远端黑色素瘤接受SLN活检的患者。分析了患者的人口统计学特征、肿瘤特征、淋巴结引流模式和SLN转移发生率。在确定的255例患者中，38例（14.9%）有滑车上SLN。平均Breslow厚度为2.26mm。所有有滑车上引流的患者均同时有腋窝引流，并接受了腋窝和滑车上SLN活检。在这38例患者中，2例（5.2%）有滑车上和腋窝SLN转移，4例（10.5%）仅有滑车上转移，4例（10.5%）仅有腋窝转移，其余28例（73.7%）SLN无肿瘤。本研究中滑车上和腋窝引流的恒定关联表明，滑车上淋巴结与腋窝淋巴结区域以间隔方式发挥作用。因此，我们建议所有滑车上SLN阳性的患者接受腋窝根治性清扫术。
