Diagnosis of Metastatic Melanocarcinoma by Lymphography

THE ACCURACY in detecting tumor metastasis to lymph nodes by lymphography has clearly established limitations. After the initial wave of enthusiasm regarding patterns of lymph node opacification in specific disease entities, investigators in the field have developed more sober outlooks for the diagnostic value of lymphography. Our accumulated knowledge is pointing up less reliance on diagnosis of specific disease except for the group of lymphomas which demonstrate with reasonable frequency the "lacy" or "foamy" pattern of lymph node opacification.

The "moth-eaten" pattern of metastatic embolic carcinomatosis to lymph nodes has been an inconsistent finding in our experience, often seen in incomplete opacification from low-volume injections into intralymphatic channels. Fischer et al¹ have likewise revealed radiolucencies in normal contrast medium-filled nodes, so that a filling defect cannot be unequivocally accepted as evidence of metastasis. They showed photographs of lymph nodes in eight individuals of a group of 38 normal males