PMC8801450_01
(A) Umbilical melanoma (B) Dynamic sequential images showing three lymphatic collectors departing from peritumoral injection sites (C) Detail showing direct drainage from the injection site to the left external iliac lymph node. (D) Fused axial SPECT-CT sections differentiate inguinal sentinel nodes from an external iliac sentinel node on the left. (E) Volume rendering SPECT-CT of the true sentinel nodes used for guiding surgery.
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A 45-year-old man presented to our hospital with an umbilical skin tumor ( Figure 1A ) that had been present for about seven years and that increased in size with occasional bleeding in the last 12 months. Summed dynamic phase images ( Figure 1B ) showed an intense focus in the left inguinal area that was considered a SLN; however, another focus with its direct lymphatic pathway gradually appeared medially to this one. Because of its direct and separate drainage from the injection site, it was deemed another SLN ( Figure 1C ). It had a normal appearance on CT images ( Figures 1D, E ).
Operative views: Sentinel node in the left external iliac area and postoperative photograph.
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The primary tumor was excised including the umbilicus, with >2-cm lateral margins, and down to the underlying peritoneum ( Figure 2 ).