E. Vandeweyer Æ M. Van De. Casseye
Decorative sentinel lymph node: a new entity?
Received: 15 January 2004 / Accepted: 2 March 2005 / Published online: 15 July 2005
Ó Springer-Verlag 2005
Abstract Malignant melanoma can be a diﬃcult lesion
to diﬀerentiate clinically. However, when it spreads to
regional lymph nodes, there is usually a characteristic
pigmentation of the node. We describe a case of an
incidental ﬁnding of a pigmented lymph node while
operating on an inguinal lymph node, which raised the
possibility of there being a metastatic melanoma of un-
known origin. Histologically, the observed pigmentation
was due to the migration of a decorative tattoo pigment
instead of malignant cells.
Keywords Sentinel lymph node Æ Surgery Æ Tattoo Æ
A 40-year-old female patient presented with an enlarged
and painful lymph node of the right inguinal area. The
lesion was present for 6 weeks and measured on clinical
examination 15·10 mm. It was ﬁxed to underlying tissue
but free from the skin. Gynaecologic screening was
negative and only the skin examination revealed the
presence of a decorative tattoo performed 8 years before
(Fig. 1). No other enlarged lymph node was noted on
Under local anaesthesia, an excisional biopsy of the
lymph node was performed. Macroscopically, the lesion
appeared grossly involved by a dark pigment evocating
malignant melanoma metastasis into a lymph node.
Pathological ﬁndings concluded in a benign follicular
hyperplasia and noted the presence of a dark mineral
pigment (Fig. 2). Abundant black pigment randomly
occupied any part of the lymphnode.
There is neither inﬂammatory reaction nor foreign
body giant-cell proliferation. Melanoma metastasis was
easily excluded. No additional treatment was proposed
and healing was uneventful.
Clinical detection of an isolated enlarged lymph node
could have two possible origins, an inﬂammatory reac-
tion or regional metastasis of cancer.
For benign causes of adenopathy, usually there is an
evidence of infection or injury in the drainage region.
They tend to be painful, quite soft, resilient and of rapid
progression. On the other hand, a lymph node con-
taining metastatic cancer cells are generally ﬁrmer, more
rubbery and non-tender.
Nevertheless, when clinical examination failed to de-
tect a suspected lesion in the area of lymphatic drainage, a
biopsy should be performed in order to conﬁrm or rule
out the diagnosis of cancer. During this type of biopsy,
the ﬁnding of a grossly pigmented lymph node should be
regarded as a malignant melanoma. Histology can con-
ﬁrm this occurrence easily. In the present case, the lymph
node was not involved by a metastasis of melanoma but
by migration of a decorative tattoo performed 8 years
before. We have found only ﬁve other published reports
of this phenomenon [1–4, 5].
All these previous cases were patients with known
malignant melanoma with either sentinel lymph node or
elective node dissection performed as part of the treat-
ment of their melanoma [1–4, 5]. Suspected lymph node
was biopsied and deﬁnitive pathological evaluation
concluded in the presence of decorative pigment migra-
tion into lymph node instead of secondary metastasis.
Department of Plastic and Reconstructive Surgery,
Hoˆ pital de la Madeleine, RHMS, Rue M. Thome
7800 Ath., Belgium
M. V. D. Casseye
Pathology Departments, Hoˆ pital de la Madeleine,
RHMS, Rue M. Thome
e, 1, 7800, Ath., Belgium
Present address: E. Vandeweyer (&)
Rue des Cendres 29, 1430 Rebecq, Belgium
Eur J Plast Surg (2005) 28: 354–356