The understanding of human dermal lymphatic anatomy has rested for nearly 120 years on the original work of Sappey. Subsequently, others have added significantly to our knowledge with anatomic studies. Copious lymphoscintigraphical data have accumulated in recent years in the evaluation of cutaneous melanomas. These data suggest that the old anatomic picture of lymphatic anatomy is functionally inaccurate. Analysis of these cumulative data reveals an extensive network of feeding lymphatic connections to major nodal basins far more expansive than previously recognized. These nodal basins overlap to a significant extent, rendering drainage prediction based on location nearly impossible. Therapeutic implications are remarkable.
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