Cutaneous lymphoscintigraphy in malignant melanoma.

Melanoma commonly metastasizes to the regional lymph nodes. With early melanomas the accepted therapy is local wide excision and regional lymphadenectomy for nodes in the lymph drainage path. For some melanoma sites the lymph node groups that should be removed are obvious; however, for other sites the decision as to which nodes are at risk may present a difficult problem, since drainage from these sites may vary unpredictably from classical anatomic descriptions. We reviewed recent reports from four institutions using four radiocolloids (colloidal 198gold, 99mtechnetium antimony sulfur colloid (99mTcSbSC), 99mtechnetium sulfur colloid (99mTcSC), and micro 99mtechnetium sulfur colloid (micro 99mTcSC)) to determine lymph shed from melanomas. Correlation with surgical findings was excellent. In addition, drainage to second and third nodal groups, some of which were not clinically predictable, was frequently observed. While all four agents gave good scans, 99mTcSC and micro 99mTcSC are probably the best radiopharmaceuticals.