Lymphatic Staging and Sentinel Lymph Node Identification in Canine Oral Malignant Melanoma
ACVIM 2008
Deanna R. Worley; Alexander M. Reiter; David E. Holt; Dorothy Cimino Brown; Carrie Tupper; Tiffany Scanlon; Thomas Van Winkle; John R. Lewis
University of Pennsylvania, School of Veterinary Medicine
Philadelphia, PA, USA

Assessment of tumor response to therapy is more accurate with standardized regional lymph node dissection and staging. Study purposes included investigating oral malignant melanoma drainage patterns via removal of ipsilateral mandibular, parotid, and retropharyngeal lymph nodes; identifying potential sentinel lymph node(s) via lymphatic mapping with concurrent isosulfan blue injection; and determining if sentinel lymph node mapping can be incorporated into routine management of oral malignant melanomas.

Patients presenting to the University of Pennsylvania for staging and resection of oral malignant melanomas were prospectively enrolled in this pilot study. All patients received routine pre-surgical staging. Isosulfan blue dye was injected peritumoral and regional lymph node dissection was done through a single incision. Comparisons were made between preoperative fine needle aspiration and histopathology, lymph node size and metastasis, and identifiable sentinel lymph nodes and metastatic nodes.

In the initial three patients enrolled to date, minimal post surgical swelling was the main complication noted. Nodal metastases were not identified histopathologically ex vivo, though a malignant mandibular node not present during regional lymph node dissection was identified two weeks postoperatively. Visual uptake of blue dye was seen in two mandibular lymph nodes which correlated with cytopathologic findings.

Identification of the sentinel lymph node is challenging. An ideal volume of dye to use and injection time prior to surgery are yet to be determined from this study. Further investigation is needed to determine if excisional biopsy of all potential regional lymph nodes can be minimized to a sentinel node(s).

Originally presented at the Veterinary Cancer Society Annual Conference, Ft. Lauderdale, FL, November 2007.

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Deanna Worley

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