Tanaka Kentaro, Mori Hiroki, Okazaki Mutsumi, Nishizawa Aya, Yokozeki Hiroo
Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Case Rep Oncol Med. 2013;2013:259326. doi: 10.1155/2013/259326. Epub 2013 May 12.
We present a patient with malignant melanoma on his heel. Wide local excision was performed, along with sentinel lymph node biopsy of the inguinal and popliteal lesions. The primary site was clear of tumor at all margins; the inguinal nodes were negative, but the popliteal node was positive for metastatic melanoma. Only radical popliteal lymph node dissection was performed. The patient went on to receive adjuvant chemoimmunotherapy. There was no recurrence or complication until the long-term followup. Popliteal drainage from below the knee is uncommon, and the rate of popliteal-positive and inguinal-negative cases is estimated to be less than 1% of all melanomas. There is no established evidence about how to treat lymph nodes in these cases. Because we considered popliteal nodes as a regional, not interval, lymph node basin, only popliteal lymph node dissection was performed, and good postoperative course was achieved. The first site of drainage is the sentinel node, and the popliteal node can be a sentinel node. The inguinal node is not a sentinel node in all lower extremity melanomas. This case illustrates the importance of individual detailed investigation of lymphatic drainage patterns from foot to inguinal and popliteal nodes.
我们报告一例足跟部恶性黑色素瘤患者。进行了广泛局部切除，并对腹股沟和腘窝病灶进行了前哨淋巴结活检。原发部位各切缘均无肿瘤；腹股沟淋巴结阴性，但腘窝淋巴结转移性黑色素瘤呈阳性。仅进行了根治性腘窝淋巴结清扫术。患者随后接受了辅助化疗免疫治疗。长期随访期间无复发或并发症。膝下腘窝引流并不常见，腘窝阳性且腹股沟阴性病例的发生率估计不到所有黑色素瘤的1%。关于如何治疗这些病例中的淋巴结，尚无确切证据。由于我们将腘窝淋巴结视为一个区域而非区间淋巴结区域，因此仅进行了腘窝淋巴结清扫术，并取得了良好的术后病程。引流的第一站是前哨淋巴结，腘窝淋巴结可以是前哨淋巴结。在所有下肢黑色素瘤中，腹股沟淋巴结并非都是前哨淋巴结。该病例说明了对从足部到腹股沟和腘窝淋巴结的淋巴引流模式进行个体化详细研究的重要性。
