[Aberrant lymphatic drainage from a melanoma located in epigastric area].

An 18-year-old womanwith superficial spreadingmelanoma in the epigastric region arising from a congenital nevus (Clark level III, Breslow thickness 3.56mm, mitotic rate 2mitoses/mm2), previously removed, was referred for a sentinel lymph node biopsy. After intradermal injection of 111MBq of 99mTc-nanocolloid (Nanocoll) around the excisional biopsy scar, lymphatic mapping was initiated. Dynamic (30-seconds-per-image for 10min), early (15min) and delayed (2h) planar images were performed. These images showedbilateral axillarydrainage (Fig. 1). Theyalso showed an increased uptake in the upper abdomen; therefore a SPECT/CT was performed (following the 2h-images). SPECT/CT revealed a faint left parasternal focal tracer accumulation not visualised in the planar images and enabled the location of the upper abdominal uptake in the perihepatic area (Fig. 2). During the surgery the following day, the exeresis of two right and two left axillary sentinel lymph nodes was achieved with the aid of a portable gamma camera and a gamma probe. A mapping of the perihepatic uptake was conducted (and confirmed), but in order to prevent morbidities, it was not surgically pursued. The intraoperative evaluation in the parasternal area did not show significant activity. Thus, this focal area of increased tracer