{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:35:35Z","timestamp":1771331735419,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,26]],"date-time":"2021-11-26T00:00:00Z","timestamp":1637884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p &lt; 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p &lt; 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and\/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.<\/jats:p>","DOI":"10.3390\/jcm10235544","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T23:22:56Z","timestamp":1638314576000},"page":"5544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2457-0636","authenticated-orcid":false,"given":"Roberto","family":"Cirocchi","sequence":"first","affiliation":[{"name":"Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Metaj","sequence":"additional","affiliation":[{"name":"Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Cicoletti","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Arcangeli","sequence":"additional","affiliation":[{"name":"Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"De Sol","sequence":"additional","affiliation":[{"name":"Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Poli","sequence":"additional","affiliation":[{"name":"Section of Pathology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7124-1245","authenticated-orcid":false,"given":"Paolo","family":"Bruzzone","sequence":"additional","affiliation":[{"name":"Department of General and Specialist Surgery \u201cParide Stefanini\u201d, Sapienza University, 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Gioia","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Anagnostou","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Service, \u201cS. Maria\u201d Hospital, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Loreti","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Service, \u201cS. Maria\u201d Hospital, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Francesconi","sequence":"additional","affiliation":[{"name":"Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Ricci","sequence":"additional","affiliation":[{"name":"Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Elena","family":"Laurenti","sequence":"additional","affiliation":[{"name":"Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1337-8315","authenticated-orcid":false,"given":"Andrea","family":"Capotorti","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Informatics, University of Perugia, 06121 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8786-7007","authenticated-orcid":false,"given":"Marco","family":"Artico","sequence":"additional","affiliation":[{"name":"Department of Sensory Organs, \u201cSapienza\u201d University of Rome, 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2530","authenticated-orcid":false,"given":"Vito","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Surgical Science, \u201cSapienza\u201d Universit\u00e0 di Roma, 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon Michael","family":"Henry","sequence":"additional","affiliation":[{"name":"Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2287-2582","authenticated-orcid":false,"given":"Piergiorgio","family":"Fedeli","sequence":"additional","affiliation":[{"name":"School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Carlini","sequence":"additional","affiliation":[{"name":"Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,26]]},"reference":[{"key":"ref_1","unstructured":"Sappey, M.P.C. (1874). Anatomie, Physiologie, Pathologie des Vaisseaux Lymphatiques Consideres chez L\u2019homme at les Vertebres, A, Delahaye et E. Lacrosnier."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/bcr281","article-title":"History of sentinel node and validation of the technique","volume":"3","author":"Tanis","year":"2001","journal-title":"Breast Cancer Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/j.1469-7580.2009.01183.x","article-title":"Functional anatomy of the lymphatics draining the skin: A detailed statistical analysis","volume":"216","author":"Reynolds","year":"2010","journal-title":"J. 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Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5544\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:36:14Z","timestamp":1760168174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,26]]},"references-count":28,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["jcm10235544"],"URL":"https:\/\/doi.org\/10.3390\/jcm10235544","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,26]]}}}