Melanoma Arising from “Ambiguous” Areas with Clinically Evident Unilateral Node Metastases Role of Lymphoscintigraphy and Sentinel Node Biopsy in Detection of Contralateral Occult Metastases Report of Two Cases

Melanoma arising from areas with ambiguous lymphatic drainage can metastasize to multiple lymph node basins. When unilateral node metastases are clinically evident, one could underestimate the possibility of contra lateral occult node localizations, leading to under treatment and future node relapse in the untreated basin. Preoperative lymphoscintigraphy and Sentinel Node Biopsy (SNB) can help to identify that localization, addressing the correct therapy. We describe two cases in which melanoma arising from the midline with evident unilateral node metastasis had also contralateral occult node localization. In these cases lymphoscintigraphy could detect the lymphatic pathway and SNB could identify the subclinical localizations, leading to a correct staging and to the correct radical therapy.