Premium
Tattoo Pigment in Sentinel Lymph Nodes: A Mimicker of Metastatic Malignant Melanoma
Author(s) -
Chikkamuniyappa S.,
SjuveScott R.,
Yeh I.T.
Publication year - 2005
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2005.320as.x
Subject(s) - medicine , melanoma , lymph , pathology , sentinel lymph node , lymph node , biopsy , wide local excision , axilla , h&e stain , metastasis , nodular melanoma , immunohistochemistry , cancer , breast cancer , cancer research
Tattoo pigment in sentinel lymph nodes in melanoma patients is a clinical challenge. A 77‐year‐old man presented with a pink nodular lesion of the right upper arm. Biopsy revealed a 1.9 mm thick, Clark level 4 nodular melanoma. A wide local excision with 2 cm margins and sentinel lymph node (SLN) mapping was planned. Pre operative lymphoscintigraphy using technetium‐99 m demonstrated a single strongly pigmented SLN in the right axilla. A prominent tattoo was located on the patient’s upper arm in the area of the melanoma. The clinical impression was highly suspicious for metastatic disease and the tissue was sent to pathology for examination. Frozen section showed a lymph node with benign histiocytes. There were black non‐polarizable coarse granules in the subcapsular, sinusoidal areas and also in the histiocytes. Review of permanent hematoxylin and eosin sections as well as immunohistochemical analysis with MART‐1 and HMB‐45 showed no evidence of metastatic melanoma in the SLN. Pigmentation of lymph nodes is not pathognomic of malignant melanoma. Black pigmented lymph nodes can occur by carbon deposits of tattoo pigment as in our case. Histological confirmation of metastatic malignant melanoma in the SLN is imperative before proceeding to complete regional lymph node dissection.