Popliteal Lymph Node Dissection in Lower Extremity Malignant Melanoma

Kim, Hark Young; Chang, Hak; Minn, Kyung Won

Abstract

PURPOSE
Malignant melanoma of the lower extremity is well known to metastasize to the lymph nodes of the groin. However, in rare cases, the initial site of the nodal disease can be the popliteal fossa. As of yet, there has not been any report on cases with popliteal lymph node metastasis in Koreans. In the following report, authors would like to present two cases of popliteal node metastasis.
METHODS
A 60-year-old male patient presented with nodular mass in his left sole. He had popliteal node metastasis detected on preoperative positron emission tomography(PET). Another 67-year-old man presented with pigmented lesion in his right heel. He also had popliteal node metastasis detected on the MRI. They underwent wide excision of the primary lesion with popliteal node dissection.
RESULTS
In the first case, 2.5x2.5cm sized metastatic melanoma in popliteal node was pathologically confirmed. There were no postoperative complications, and to date (18 months after the surgery), the patient is alive with no evidence of disease. In the second case, multiple(4) metastatic melanoma in popliteal nodes was confirmed. The patient is alive, but has had interferon therapy for liver metastasis.
CONCLUSION
By increasing the use of lymphoscintigraphy or PET as a preoperative diagnostic work-up for metastasis, even popliteal node metastasis undetectable in a physical exam becomes detectable. When metastatic lymph node is found, node dissection is the standard of care. Therefore, it is essential that we know the anatomy and surgical technique for popliteal lymph node dissection.