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Increased post-operative complications with methylene blue versus lymphazurin in sentinel lymph node biopsies for skin cancers

Authors

  • Rogerio I. Neves MD, PhD,

    Corresponding author
    1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
    • Associate Professor of Surgery, Dermatology and Pharmacology and Medicine, Division of Plastic Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. Fax: 717-531-4339.===

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  • Brandon Q. Reynolds MD,

    1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Sprague W. Hazard MD,

    1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Brian Saunders MD,

    1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Donald R. Mackay MD

    1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Abstract

Background

Sentinel lymph node biopsy (SNLB) is the standard of care in staging of melanoma and other skin cancers. Early studies used lymphazurin (LZ) for SLNB. A national shortage of LZ promoted methylene blue (MB) as an alternate stain.

Objective

This study compares complication rates between LZ and MB in SLNB patients, and the reliability dyes in locating sentinel lymph nodes.

Methods

Charts were reviewed for patients who underwent SLNB for skin cancers between September 2006 and November 2008 at Penn State Hershey Medical Center. The type and quantity of dye, the presence of blue stained sentinel nodes, and any complications were recorded.

Results

Ninety-three patients underwent SLNB (46 LZ, 47 MB). The amount of dye used was similar (avg. 0.93 ml LZ, 1.24 ml MB). The complication rate of LZ was 8.7%, and MB was 25.5%. There was significantly more (P = 0.003) skin graft complications in the MB patients (6/12) versus LZ (0/15).

Conclusions

There is a higher rate of complications with MB, especially with skin grafting. The reported risk of anaphylaxis with LZ has not been reported in volumes <2 ml. The sentinel lymph node identification rate is historically similar between dyes, and in this study was noted to be higher with LZ. J. Surg. Oncol. 2011; 103:421–425. © 2010 Wiley-Liss, Inc.

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