267474.fig.001a
(a)
267474.fig.001b
(b)
267474.fig.001c
(c)
267474.fig.001d
(d)
Figure 1: Patient 13 had a 3.5 cm large poorly differentiated SCC on the dorsal side of left hand that was reaching subcutaneous level with perineural invasion but with no lymphovascular invasion. Dynamic lymphoscintigraphy of the upper left limb demonstrated multiple drainage pathways on the dynamic views (a), and accessories lymph nodes were immediately visualized in the humeral lateral and medial regions (red arrows). These were confirmed not to be only ectatic lymphatic vessels but 2 different sentinel nodes corresponding to 2 basins (b). Delayed views of the arm and shoulder (c, d) showed 2 more SNs in 2 basins: in the axilla (blue arrow) and basicervical (green arrow). All 7 SNs in 4 basins were negative.