The Unpredictability of Lymphatic Drainage from the Ear in Melanoma Patients, and Its Implications for Management
Annals of Surgical Oncology, Exclusive Author Commentary  Review Article

Peach HS et al. – The ear is known to have variable lymphatic drainage. The purpose of this study was to define better the lymphatic drainage patterns of the ear by correlating the location of primary tumors, classified according to the embryologically derived anatomical subunits of the ear, with their mapped sentinel nodes (SNs) identified by lymphoscintigraphy (LS). Lymphatic drainage of the ear has no predictable pattern and can be to SNs anywhere in the ipsilateral neck. Most commonly drainage is to cervical level II and the preauricular and postauricular LN fields. LS defines the lymphatic drainage pattern in individual melanoma patients and is essential for accurate SN identification and reliable SN biopsy.

There is a significant degree of variability in the patterns of lymphatic drainage within the head and neck region. We considered whether it was possible to predict drainage from a specific anatomical site by correlating it with the embryological development of that site. We analysed our results from a defined region - the ear - using 'X - Y' co-ordinates, recorded at the the time of technetium injection for the sentinel node lymphoscintigraphy, to separate all cases of melanoma of the ear by their embryological subunit of origin. The lymphatic patterns of drainage from each of these embryological subunits were then analysed. We found retrograde, antegrade and transaural patterns of drainage. Specifically 29% of all conchal primaries drained to post-auricular nodes, which together with drainage from the helical rim and lobule accounted for 26% of all nodes retrieved. Post-auricular together with level CII and pre-auricular were the lymph node basins most frequently identified on lymphoscintigraphy. Our paper confirms that even with accurate primary localisation and corresponding lymphoscintigraphy, lymphatic drainage of the ear is highly variable. This degree of variability is likely to be replicated in other less easily defined anatomical areas of the head and neck. The small numbers in some of the embryological subunits prevent us from making specific recommendations regarding the extent of neck dissection. However our study high-lights those unexpected regions of drainage that could be considered for inclusion in a lymph node dissection, particularly for macroscopic SN disease, rather than those that should be excluded.

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Dermatology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Dermatology Articles

1 Topical ivermectin versus crotamiton cream 10% for the treatment of scabies International Journal of Dermatology, July 8, 2014    Clinical Article

2 Sun protection in a pill: The photoprotective properties of Polypodium leucotomos extract International Journal of Dermatology, July 28, 2014    Review Article

3 Airborne contact dermatitis: Common causes in the USA International Journal of Dermatology, July 10, 2014    Review Article

4 Photodynamic therapy using chlorophyll-a in the treatment of acne vulgaris: A randomized, single-blind, split-face study Journal of the American Academy of Dermatology, July 3, 2014    Clinical Article

5 The relationship between alopecia areata and alexithymia, anxiety and depression: A case-control study Full Text Indian Journal of Dermatology, July 2, 2014    Free full text    Clinical Article

6 Sildenafil use and increased risk of incident melanoma in US men: A prospective cohort study JAMA Internal Medicine, June 5, 2014    Evidence Based Medicine    Clinical Article

7 A comparison of a 5% potassium hydroxide solution with a 5-fluorouracil and salicylic acid combination in the treatment of patients with anogenital warts: A randomized, open-label clinical trial International Journal of Dermatology, July 25, 2014    Clinical Article

8 Therapy of chronic urticaria: a simple, modern approach Annals of Allergy, Asthma, and Immunology, April 17, 2014    Review Article

9 Topical epidermal growth factor for the improvement of acne lesions: a randomized, double-blinded, placebo-controlled, split-face trial International Journal of Dermatology, July 14, 2014    Clinical Article

10 Supplementation of a dairy drink enriched with milk phospholipids in patients with atopic dermatitis – A double-blind, placebo-controlled, randomized, cross-over study Clinical Nutrition, July 18, 2014    Clinical Article

11 A randomized, double-blind, placebo-controlled study of a novel pantothenic acid-based dietary supplement in subjects with mild to moderate facial acne Full Text Dermatology and Therapy, May 23, 2014    Free full text    Clinical Article

12 Secukinumab in plaque psoriasis -- Results of two phase 3 trials New England Journal of Medicine, July 17, 2014    Evidence Based Medicine    Clinical Article

13 The efficacy of combined herbal extracts gel preparation in the prevention of postsurgical hypertrophic scar formation Full Text Dermatology and Therapy, July 22, 2014    Free full text    Clinical Article

14 Subcutaneous vs intramuscular botulinum toxin: split-face randomized study JAMA Facial Plastic Surgery, June 2, 2014    Clinical Article

15 The efficacy of azithromycin in pityriasis rosea: A randomized, double-blind, placebo-controlled trial Full Text Indian Journal of Dermatology, Venereology and Leprology , January 22, 2014    Free full text    Clinical Article

16 Vitamin D deficiency in alopecia areata British Journal of Dermatology, March 24, 2014    Clinical Article

17 Autologous serum therapy in chronic urticaria: A promising complement to antihistamines Full Text Indian Journal of Dermatology, July 7, 2014    Free full text    Clinical Article

18 Management of non-healing leg ulcers in Unani system of medicine International Wound Journal, July 30, 2014    Clinical Article

19 Complementary and alternative medicine use among patients with psoriasis Dermatologic Therapy, July 11, 2014    Clinical Article

20 Development of a novel noninvasive adhesive patch test for the evaluation of pigmented lesions of the skin Journal of the American Academy of Dermatology, June 10, 2014    Clinical Article

Indexed Journals in Dermatology: American Journal of Clinical Dermatology, Contact Dermatitis, Dermatologic Surgerymore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close