Fanning James E, Singhal Dhruv, Reynolds Hayley M, Don Tharanga D Jayathungage, Donohoe Kevin J, Suami Hiroo, Chung David K V
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
J Surg Oncol. 2025 Jan;131(1):54-61. doi: 10.1002/jso.27811. Epub 2024 Aug 13.
Variations of hand and forearm lymphatic drainage to upper-arm lymphatic pathways may impact the route of melanoma metastasis. This study compared rates of lymphatic drainage to epitrochlear nodes between anatomic divisions of the hand and forearm to determine whether the anatomic distribution of hand and forearm melanomas affects the likelihood of drainage to epitrochlear lymph nodes.
Using a single-institution lymphoscintigraphy database, we identified all patients with cutaneous melanoma on the hand and forearm. A body-map two-dimensional coordinate system was used to classify cutaneous melanoma sites between radial-ulnar and dorsal-volar divisions. Sentinel lymph nodes (SLNs) visualized on lymphoscintigraphy were recorded. Proportions of patients with epitrochlear SLNs were compared between anatomic divisions using χ analysis.
Of 3628 upper extremity cutaneous melanoma patients who underwent lymphatic mapping with lymphoscintigraphy, 1400 met inclusion criteria. Twenty-one percent of patients demonstrated epitrochlear SLNs. Epitrochlear SLNs were observed in 27% of dorsal forearm melanomas and 15% of volar forearm melanomas (p < 0.001). Epitrochlear SLNs were observed in 31% of ulnar forearm melanomas and 17% of radial forearm melanomas (p < 0.001).
Higher proportions of dorsal and ulnar forearm melanomas have epitrochlear SLNs. Metastasis to epitrochlear SLNs may be more likely from melanomas in these respective forearm regions.
手部和前臂淋巴引流至上臂淋巴途径的变异可能影响黑色素瘤转移的路径。本研究比较了手部和前臂不同解剖分区至肘上淋巴结的淋巴引流率，以确定手部和前臂黑色素瘤的解剖分布是否影响引流至肘上淋巴结的可能性。
利用单机构淋巴闪烁显像数据库，我们确定了所有手部和前臂皮肤黑色素瘤患者。采用体表二维坐标系对手部和前臂皮肤黑色素瘤部位进行桡尺侧和背腹侧分区。记录淋巴闪烁显像中显示的前哨淋巴结（SLN）。使用χ分析比较不同解剖分区中出现肘上SLN的患者比例。
在3628例接受淋巴闪烁显像淋巴绘图的上肢皮肤黑色素瘤患者中，1400例符合纳入标准。21%的患者显示有肘上SLN。在27%的前臂背侧黑色素瘤和15%的前臂掌侧黑色素瘤中观察到肘上SLN（p<0.001）。在31%的前臂尺侧黑色素瘤和17%的前臂桡侧黑色素瘤中观察到肘上SLN（p<0.001）。
前臂背侧和尺侧黑色素瘤中出现肘上SLN的比例更高。这些前臂区域的黑色素瘤更有可能转移至肘上SLN。
