Sentinel lymph node (SLN) biopsy was introduced in the 1990´s for melanoma staging. It provides a pathological lymph node staging in patients with clinical stage I/II melanoma. Studies have shown that the evaluation of sentinel node improves the prognostic accuracy of these patients, although it is debated whether it has any therapeutic value. We present a case of anthracosis mimicking, macroscopically and microscopically, a positive melanoma sentinel lymph node.
Our patient is a 75 year old woman, nonsmoker, who had always lived in Madrid, Spain. She had on her left arm a nodular melanoma, with ulceration, Clark IV, Breslow 2.2 mm, without evidence of a prior nevus. After technetium 99 scan and gamma camera, we were able to identify drainage area and SLN. There were two adenopathies in the left axilla and one in the left supraclavicular area. During the surgery, the left supraclavicular node was macroscopically black, but not enlarged (size less than 1 cm diameter).