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DIAGNOSIS DERMATOSCOPY
HISTOLOGY LYMPHATIC
MAPPING
SENTINEL LYMPH NODE BIOPSY
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BACK
PROCEED 
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Lymphatic Mapping is the diagnostic procedure to stereographically "map"
the lymphatic drainage from the site of the primary melanoma location to
the draining lymphatic basin. The procedure is performed either with the
primary melanoma still "in-situ", prior to its surgical removal, or
after The goal is to simulate the lymphatic pathway melanoma cells might
use if tumor cell dissemination is underway. The goal is NOT to detect
lymph node metastases. So, lymphatic mapping is a function-oriented
graphical determination of the peritumoral lymphatic drainage. It is
intended to identify the first draining lymph node in the lymphatic flow
chain (sentinel lymph node), which is indicative for the lymphonodal
disease stage and has to be excised for histological and immunochemical
examination (sentinel lymph node biopsy). The conditions to study
should, therefore, be as close as possible to the situation the melanoma
microenvironment presents before removal of the primary. It is concluded
that the individual drainage pattern can thus be determined reliably. It
is WRONG to assume that lymphatic drainage will follow anatomical
guidelines. Various studies on that issue have emerged that anatomical
lymphatic distribution is likely to be matched in up to 40% only, and
that often multi-directed lymphatic flow may be present, even into
directions primarily left unconsidered for lymphatic spread.
After injection of the radioimmuno-agent tracer and assessing of the
lymphatic drainage pattern by lymphatic mapping, the sentinel lymph
node(s) are selectively being identified, resected, and analysed by
histology, immunohistologiy (S-100, HMB-45), and rT-PCR analysis
(reverse-transcriptase polymerase chain reaction [Tyrosinase]). Since
the tracer had been additionally labelled with blue dye, the drainage
pathway is indicated by green colorization of the lymphatics ("tatoo").
The technique had been developed by MORTON and co-workers in the late
1980's at the JOHN WAYNE CANCER CENTER in Santa Monica, CA, USA, and its
radioimmunological evaluation had been further pioneered by REINTGEN and
co-workers since 1991 with the H. LEE MOFFITT CANCER CENTER in Tampa, FL,
USA.
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