Hybrid SPECT/CT for detection of in-transit sentinel lymph nodes and treatment tailoring in early stage malignant melanoma

The status of sentinel lymph nodes (SLN) in the regional to the tumor lymphatic basin is a well known prognostic and therapy-tailoring factor in early stage malignant melanoma (MM). Nuclear medicine mapping of lymph flow is a major prerequisite for successful intraoperative SLN detection and hybrid SPECT/CT allows a precise topographic and morphologic characterization both of the SLN and the whole scanned region. This case report from our clinical routine demonstrates the possibility on modern nuclear medicine to detect a sentinel node not only in the regional basin but also in-transit lymph nodes, neighboring the primary tumor lesion. A close interdisciplinary collaboration is needed - nuclear medicine physicians, oncodermatologists, surgeons, pathologists and medical oncologists should work closely together for the standardization of procedures and the consequent adjuvant treatment tailoring. (author)