Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.173
Peer-review started: September 10, 2014
First decision: September 28, 2014
Revised: January 15, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: March 28, 2015
We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case report and technical description of a procedure performed under general anesthesia on a 19-year-old female patient. Due to the hidden and sensitive location of the primary tumor in the medial external auditory canal, the lymphoscintigraphy injection had to be performed by the surgeon immediately prior to the resection of her cT2aN0M0 lesion. Final pathology revealed clear margins at the primary site resection and 2 intraparotid sentinel lymph nodes with microscopic foci of metastatic malignant melanoma, which led to further surgical management. A completion left parotidectomy and neck dissection yielded no additional metastatic disease in the fifty-five nodes that were evaluated. Using this technique, sentinel lymph node mapping and biopsy accurately predicted the highest risk lymph nodes for the primary lesion of the medial portion of the external auditory canal.
Core tip: We describe sentinel lymph node mapping and biopsy (SLNB) of a primary malignant melanoma in the external auditory canal. The usefulness of SLNB in this procedure allowed a focused surgical dissection to best assess regional lymph nodes and determine the extent of dissection needed to clear the disease. This novel technique is useful because it aids in establishing the single most important prognostic factor of a melanoma in the external auditory canal, regional lymph node status.