Research Article| Volume 65, ISSUE 1, P85-90, January 2012

When should pelvic sentinel lymph nodes be harvested in patients with malignant melanoma?

Published:September 22, 2011DOI:



      Preoperative lymphoscintigraphy for sentinel node biopsy (SNB) combined with intra-operative gamma-probe detection often identifies nodes within the pelvis. This study investigates the role of pelvic SNB harvest.


      Retrospective review of eighty-two stage I/II melanoma patients with primary tumour on the lower limb and trunk who underwent groin SNB, either inguinal or pelvic or both, over a three year period.


      Of the 82 patients, 19 had positive SNBs (24%), all of which were inguinal nodes. None of the 11 patients with pelvic nodes removed had a positive pelvic node. The median follow-up period was 18 months (SD: 10.8; range: 8–43). Although the complication rate was higher following pelvic SNB, the difference was not statistically significant (p > 0.5). The average operative time for an inguinal SNB was 92 min, and increased significantly to 134 min for a pelvic SNB (p < 0.0001). Lymphoscintigraphy of trunk and thigh melanomas identified individual tracks to be leading directly from the tumour to a pelvic node(s). However, when the primary tumour was located at or below the knee, pelvic nodes identified by lymphoscintigraphy appeared to be second level nodes.


      A lymphoscintigraphy protocol that includes dynamic images obtained in frequent intervals following injection of the radiotracer combined with thorough preoperative analysis of the lymphoscintigraphy scans and effective communication between the radiologist and the surgeon allows accurate identification of the primary tracks and prevent unnecessary harvest of second echelon pelvic lymph nodes. In patients with significant co-morbidities due consideration is required before harvesting pelvic sentinel nodes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Morton D.L.
        • Wen D.R.
        • Wong J.H.
        • et al.
        Technical details of intraoperative lymphatic mapping for early stage melanoma.
        Arch Surg. 1992; 127: 392-399
        • Kubik S.
        Anatomie des Lymphgefassystems.
        in: Foldi M. Kubik S. Lehrbuch der Lymphologie. Gustav Fischer Verlag, Stuggart New York1989
        • Reintgen D.
        • Cruse C.W.
        • Wells K.
        • et al.
        The orderly progression of melanoma nodal metastasis.
        Ann Surg. 1994; 220: 759-767
        • Uren R.F.
        • Howman-Giles R.
        • Thompson J.F.
        Lymphatic drainage from the skin of the back to retroperitoneal and paravertebral lymph nodes in melanoma patients.
        Ann Surg Oncol. 1998; 5: 384-387
        • Badgwell B.
        • Xing Y.
        • Gershenwald J.E.
        • et al.
        Pelvic lymph node dissection is beneficial in subsets of patients with node-positive melanoma.
        Ann Surg Oncol. 2007; 14: 2867-2875
        • Nieweg O.E.
        • Tanis P.J.
        • Kroon B.B.
        The definition of a sentinel lymph node.
        Ann Surg Oncol. 2001; 8: 538-541
        • Beitsch P.
        • Balch C.
        Operative morbidity and risk factor assessment in melanoma patients undergoing inguinal lymph node dissection.
        Am J Surg. 1992; 164: 462-465
        • Balch Cm
        • Ross M.I.
        Melanoma patients with iliac nodal metastases can be cured.
        Ann Surg Oncol. 1999; 6: 230-231
        • Mann G.B.
        • Goit D.G.
        Does the extent of operation influence the prognosis in patients with melanoma metastatic to inguinal nodes?.
        Ann Surg Oncol. 1999; 6: 263-271
        • Strobbe L.J.
        • Jonk A.
        • Hart A.A.
        • et al.
        Positive iliac and obturator nodes in melanoma: survical and prognostic factors.
        Ann Surg Oncol. 1999; 6: 255-262
        • McMasters K.M.
        • Reintgen D.S.
        • Ross M.I.
        • et al.
        Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed?.
        Ann Surg Oncol. 2001; 8: 192-197
        • Soteldo J.
        • Ratto E.L.
        • Gandini S.
        • et al.
        Pelvic sentinel lymph node biopsy in melanoma patients: is it worthwhile?.
        Melanoma Res. 2010; 20: 133-137
        • Van der Ploeg I.M.
        • Valdes Olmos R.A.
        • Kroon B.B.
        • Nieweg O.E.
        Tumour-positive sentinel node biopsy of the groin in clinically node-negative melanoma patients: superficial or superficial and deep lymph node dissection?.
        Ann Surg Oncol. 2008; 15: 1485-1491
        • Van der Ploeg I.M.
        • Kroon B.B.
        • Valdes Olmos R.A.
        • Nieweg O.E.
        Evaluation of lymphatic drainage patterns to the groin and implications for the extent of groin dissection in melanoma patient.
        Ann Surg Oncol. 2009; 16: 2994-2999
        • Chu C.K.
        • Delman K.A.
        • Carlson G.W.
        • Hestley A.C.
        • Murray D.R.
        Inguinopelvic lymphadenectomy following positive inguinal sentinel lymph node biopsy in melanoma: true frequency of synchronous pelvic metastases.
        Ann Surg Oncol. 2011 May 4; ([Epub ahead of print])