Sentinel node excision for the diagnosis of metastatic neuroendocrine carcinoma of the skin: a case report.

The technology of sentinel node lymphoscintigraphy has made it possible to map and identify the lymph nodes draining the site of a primary cutaneous malignancy. This technique is now being used in the treatment of melanoma, and breast and vulvar carcinoma. With melanoma and breast carcinoma, the histology of the sentinel lymph node (SLN) has been found to be reflective of the histology of the remainder of the nodal basin. The concept of sampling the SLN is to provide an accurate staging for the entire nodal basin, obviating the need for a complete lymphadenectomy if the SLN is negative. It is believed that cutaneous malignancies with a propensity for regional metastasis, such as neuroendocrine carcinoma of the skin, may spread via a similar lymphatic pathway involving an SLN. Using this technique we identified and excised the SLNs in a patient with a neuroendocrine carcinoma of the skin that contained the only focus of metastatic disease. Although this technique is still investigational we believe it holds great promise in being able to detect occult metastatic nodal disease in clinically node-negative patients.