Lymphoscintigraphy for melanoma: is it always predictive for lymphatic basin mapping?

Therapeutic decision making in treating patients with melanoma is difficult, with very few investigative tools and a lack of treatment options. Surgical extirpation remains the best method for cure and supports discussion in favor of prophylactic regional node dissection for subgroups of patients with stage I disease. In melanoma of the trunk or head and neck, lymphoscintigraphy has reliably provided guidance for resecting the regional lymphatics draining the involved site. This article describes a patient with a melanoma of the posterior neck, with metachronous metastases to the right and left posterior cervical triangles. Lymphoscintigraphy performed in the context of clinically negative nodal regions did not show drainage to either cervical nodal chain. Several explanations are presented, although a false-negative lymphoscintigraphic finding is the only plausible explanation. To our knowledge, this dilemma has not been previously reported, and raises the question of the infallibility of lymphoscintigraphy in predicting lymphatic basin mapping.