In-transit metastases of melanoma almost certainly results from lymphatic dissemination of melanoma cells to tissues between the primary melanoma site and the draining regional lymph nodes. Most in-transit metastases occur after lymphatic obstruction, due either to tumor involvement or to surgical removal. The treatment of in-transit metastatic melanoma has not been standardized, and should be tailored accordingly. We report a case of in-transit metastatic melanoma in head and neck after regional lymph node dissection. In-transit metastases in the cheek were excised with tailored surgical margins based on the evaluation of lymph flow using indocyanine green (ICG) fluorescence lymphography. ICG fluorescence lymphography has been reported recently in non-invasive sentinel lymph node mapping, and lymphaticovenous anastomosis. Using this system, not only sentinel lymph nodes and lymph vessels but also dermal lymphatic back flow caused by previous surgery is detectable as a white spot through fluorescence high-sensitivity near-infrared video camera system. This enables our detection of abnormal lymphatic flow, which indicates possible areas of melanoma cell spreading through the lymphatic system. Although a preliminary case report, we propose tailored excision of in-transit metastatic melanoma based on ICG fluorescence lymphography.
European Journal of Plastic Surgery – Springer Journals
Published: Apr 1, 2012
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