Discussion

This case demonstrates the importance of checking carefully beneath a wide excision site for additional sentinel nodes when a primary melanoma site overlies or is in close proximity to a regional lymph node field. The sentinel node close to the primary tumor site was not identified on the preoperative lymphoscintigram because of the radioactive bloom around the tracer injection sites.

A second point demonstrated by this case is that initial lymphatic drainage from primary tumors on the neck can sometimes occur in an upward direction rather than the downward direction that would be expected.

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