Abstract：
Intreduction: Melanoma is an extremely aggressive form of skin neoplasia, an important stage in the diagnostic and treatment is identifying the dissemination at the lymphatic level. For a more accurate staging, the sentinel lymph node biopsy technique is performed, which in most of the time addresses one, respectively 2 locations, but cases with sentinel nodes in 3 lymphatic basins have rarely been described. Case report: We present a case of melanoma located in the right lumbar region, which from the point of view of histopathological features has a Breslow index of 4.2 mm, classified in the pT4b stage. After the CT evaluation was performed, it was decided that there is indication for performing the sentinel lymph node technique and excision with a margin of safety. Scintigraphy revealed that sentinel lymph nodes were identified in 3 different regions, respectively the right axilla and bilateral inguinal. Conclusions: Melanoma located on the trunk can present different lymphatic routes for the sentinel lymph nodes, unlike that on the limbs where certain patterns are present. Identifying these lymph nodes in cases like this involves a challenge both from a diagnostic and surgical point of view.
摘要：
诱导：黑色素瘤是一种极具侵袭性的皮肤瘤形成，诊断和治疗的一个重要阶段是确定淋巴水平的传播。为了更准确的分期，进行前哨淋巴结活检技术，在大多数情况下，分别有2个地点，但是很少描述3个淋巴盆地前哨淋巴结的病例。病例报告：我们提出了一个位于右侧腰椎区域的黑色素瘤病例，从组织病理学特征的角度来看，其Breslow指数为4.2mm，在pT4b阶段分类。CT评估后,已确定有迹象表明可以进行前哨淋巴结技术和安全范围的切除。闪烁扫描显示前哨淋巴结在3个不同的区域被发现，分别为右腋窝和双侧腹股沟。结论：位于躯干上的黑色素瘤可以为前哨淋巴结提供不同的淋巴途径。与存在某些模式的四肢不同。在这种情况下识别这些淋巴结涉及从诊断和手术角度的挑战。
