Related Experiment Video
Updated: Aug 13, 2026
The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy
Published on: June 1, 2019
Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma
S P Leong1, E Donegan, W Heffernon
1Department of Surgery, University of California/Mount Zion Medical Center, San Francisco 94143-1674, USA. leongs@surgery.ucsf.edu
Background:
Selective sentinel lymph node (SLN) dissection can spare about 80% of patients with primary melanoma from radical lymph node dissection. This procedure identifies the SLN either visually by injecting isosulfan blue dye around the primary melanoma site or by handheld gamma probe after radiocolloid injection.
Methods:
During selective SLN mapping, 1 to 5 ml of isosulfan blue was injected intradermally around the primary melanoma. From November 1993, to August 1998, 406 patients underwent intraoperative lymphatic mapping with the use of both isosulfan blue and radiocolloid injection. Three cases of selective SLN dissection, in which adverse reactions to isosulfan blue occurred, were reviewed.
Results:
We report three cases of anaphylaxis after intradermal injection with isosulfan blue of 406 patients who underwent intraoperative lymphatic mapping by using the procedure as described above. The three cases we report vary in severity from treatable hypotension with urticaria and erythema to severe cardiovascular collapse with or without bronchospasm or urticaria.
Conclusions:
In our series, the incidence of anaphylaxis to isosulfan blue was approximately 1%. Anaphylaxis can be fatal if not recognized and treated rapidly. Operating room personnel who participate in intraoperative lymphatic mapping where isosulfan blue is used must be aware of the potential consequences and be prepared to treat anaphylaxis.
Insights
Adverse reactions to isosulfan blue dye during melanoma surgery are rare but serious. This study highlights three cases of anaphylaxis, emphasizing the need for prompt recognition and treatment in operating rooms.
Area of Science:
- Oncology
- Surgical Pathology
- Clinical Immunology
Background:
- Selective sentinel lymph node (SLN) dissection spares patients from extensive surgery.
- SLN identification uses isosulfan blue dye or radiocolloid injection.
- Melanoma staging relies on accurate SLN assessment.
Observation:
- Three cases of anaphylaxis occurred in 406 patients undergoing SLN mapping.
- Isosulfan blue dye was administered intradermally around the primary melanoma.
- Reactions ranged from hypotension to cardiovascular collapse.
Findings:
- The incidence of anaphylaxis to isosulfan blue was approximately 1%.
- Anaphylaxis symptoms included urticaria, erythema, hypotension, and bronchospasm.
- Severity of anaphylaxis varied significantly among affected patients.
Implications:
- Awareness of isosulfan blue's anaphylactic potential is crucial for surgical teams.
- Rapid recognition and treatment of anaphylaxis are vital to prevent fatalities.
- Standardized protocols for managing isosulfan blue-induced anaphylaxis should be implemented.
