Localization of the Sentinel Lymph Node in Melanoma Without Blue Dye

Hu, Yinin; Melmer, Patrick D; Slingluff, Craig L.

doi:10.1097/sla.0000000000001187

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…The 5‐year OS and DFS rates (78% and 76%, respectively) after SLNB without blue dye use were similar to or higher than those reported from Asian countries in general or from studies of patients who underwent classical SLNB, but were lower than the rates obtained in previous studies similar to ours . This may be attributed to the proportion of patients with ALM, and a mean Breslow thickness that was much higher in our study than in the others.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

“…The omission of blue dye injection can avoid both skin complications and rare but dangerous anaphylactic reactions; it may also enable SLNB under local instead of general anaesthesia, being safer and reducing time and costs. 27 Accordingly, omitting blue dye injection has become increasingly common in recent clinical practice, 6,7 and there have been several reports on the value of omitting blue dye injection during SLNB in patients with other malignancies such as breast or penile cancer. 28,29 The cohort of the present study can be considered representative of patients undergoing SLNB for melanoma in Asia, as the demographic distributions, tumour depths, Breslow thicknesses and tumour locations were consistent with data from previous studies in Korea and other Asian countries.…”

Section: Discussionmentioning

confidence: 99%

“…5 Considering these disadvantages, the necessity of using the patent blue dye for SLN identification has been questioned in recent studies. 4,6,7 Guidelines for the treatment of MM published by the American Academy of Dermatology 8 highlight the importance of complete tumour removal and SLNB. The use of Mohs micrographic surgery (MMS) for tumour removal in patients with MM is controversial, but MMS can preserve normal tissue and yields similar disease-free survival (DFS) and overall survival (OS) outcomes to wide local excision (WLE).…”

Section: Discussionmentioning

confidence: 99%

“…It is also not performed in pregnant women . Considering these disadvantages, the necessity of using the patent blue dye for SLN identification has been questioned in recent studies …”

mentioning

confidence: 99%

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Efficacy and clinical significance of omitting blue dye injection during sentinel lymph node biopsy before Mohs micrographic surgery for malignant melanoma of the lower extremities

Kim

Seo

et al. 2019

Br J Dermatol

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Summary Background Sentinel lymph node biopsy (SLNB) is usually performed using a triple technique that includes lymphoscintigraphy (LSG), which involves the injection of a radiolabelled tracer, blue dye injection, and detection of the radioisotope with a gamma probe. However, blue dye injection may cause pathological misinterpretation and obscure clinical margins, especially when combined with Mohs micrographic surgery (MMS) for cutaneous melanoma. Objectives To assess the efficacy of SLNB without blue dye injection in patients who subsequently underwent MMS for melanomas of the lower extremities. Methods We evaluated patients who underwent MMS with or without SLNB using preoperative localization of the primary melanoma via LSG and intraoperative confirmation using a gamma probe between 2010 and 2016. Results Seventy‐two patients with melanoma of mean Breslow thickness 3·03 ± 1·44 mm were evaluated. Sixty‐five of the 72 patients underwent SLNB, the success rate of which was 98%. The 5‐year overall and disease‐free survival rates were 78% and 76%, respectively. Conclusions Blue dye injection can be omitted without compromising the accuracy of standard SLNB. Omitting blue dye injection also has marked advantages in MMS for melanoma. What's already known about this topic? Sentinel lymph node biopsy (SLNB) is usually performed using a triple technique including lymphoscintigraphy, which involves the injection of a radiolabelled tracer, blue dye injection, and radioisotope detection using a gamma probe. Blue dye injection may cause pathological misinterpretation and obscure clinical margins. What does this study add? Omitting the dye does not decrease diagnostic accuracy and is particularly advantageous for Mohs micrographic surgery (MMS) in melanomas with clinically indistinct tumour borders. SLNB without blue dye injection is feasible in MMS for melanoma.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…It is also not performed in pregnant women . Considering these disadvantages, the necessity of using the patent blue dye for SLN identification has been questioned in recent studies …”

mentioning

confidence: 99%

See 3 more Smart Citations

Efficacy and clinical significance of omitting blue dye injection during sentinel lymph node biopsy before Mohs micrographic surgery for malignant melanoma of the lower extremities

Kim

Seo

et al. 2019

Br J Dermatol

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Subcostal lymph nodes: An unusual sentinel lymph node basin in cutaneous melanoma

Marsh

Lattimore

Cramer

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Lymphatic drainage from subcostal nodes, along the costal groove, have not previously been characterized as sites for melanoma drainage and metastasis. This study reports a series of patients with subcostal nodes draining primary melanomas, with characterization of the sites of primary melanomas that drain to these nodes. Methods Patients who presented to our institution between 2005 and 2020 with documented cutaneous melanoma and sentinel lymph node biopsy of a subcostal node (sentinel = S), or metastases to subcostal nodes later in clinical management (recurrent = R) were included. Patient demographics, melanoma pathology, nodal features, imaging information, surgical approaches, and outcomes data were collected. Results Six patients had subcostal sentinel nodes (SNs). Primary sites included the posterior trunk and lateral chest wall. Subcostal nodes were found under ribs 10−12. Subcostal SNs had at least one dimension measuring 3 mm or less. There were no surgical complications related to removing the subcostal SN. Conclusions Melanoma can metastasize to subcostal lymph nodes and be found at the time of SN biopsy or identified at recurrence. These small nodes are fed by lymphatic channels that run in the neurovascular bundle under the ribs. When lymphatic mapping identifies a subcostal SN, it should be excised.

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