Statius Muller et al 2002 — Unpredictability of Lymphatic Drainage Patterns
Vrije Universiteit Medical Centre, Amsterdam. 348 consecutive melanoma patients, triple-technique SN procedure (lymphoscintigraphy + intraoperative gamma probe + blue dye), 1993–1999.
Key findings — verified
- Overall unpredictable drainage (multi-basin, contralateral, or interval-node): 34% (119/348)
- By site: head/neck 100% (by definition — the authors classed all head/neck drainage as unpredictable a priori, not purely empirically), dorsal trunk 61% (64/105), frontal trunk 44% (18/41), upper limb 17%, lower limb 1.5%
- Dorsal trunk, below Sappey’s line specifically: unpredictability reaches 79%
- Region 4 (dorsal trunk, unilateral, above Sappey’s line, n=50 — closest match to a lateral/posterior trunk melanoma): ipsilateral axilla only 74%, both axillae 6%, other unpredictable patterns 20%
My take
Published the same year as Uren et al. 2003 and using an even more rigorous triple-technique protocol, this is the natural companion citation — the two papers are frequently cited as a pair in this literature. Gives an independent, second dataset confirming that contralateral/multi-basin drainage from the trunk is common enough (roughly a quarter to a third of dorsal trunk cases) that finding it in this case is unusual but not extraordinary — the extraordinary part of our case is specifically the prior ipsilateral SLNB and the multi-decade latency, not the contralateral drainage per se.