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Updated: Sep 28, 2026
The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy
Published on: June 1, 2019
Adverse skin lesions after methylene blue injections for sentinel lymph node localization
Benjamin Stradling1, Gerard Aranha, Sheryl Gabram
1Chicago College of Osteopathic Medicine of Midwestern University, Chicago, IL, USA.
Background:
Methylene blue dye (MBD) is being used as an alternative to isosulfan blue dye in sentinel lymph node (SLN) biopsies for breast cancer patients. Complications using MBD for SLN localization have not previously been reported.
Methods:
A retrospective study was conducted of 24 consecutive patients who received MBD. Patients were given 3 to 5 cc of 1% MBD as peritumoral injections within the breast parenchyma and intradermally. Patients who developed local skin lesions at the injection site were queried regarding lesion appearance and when subsequent adjuvant therapy was initiated.
Results:
Five of the 24 patients (21%) developed skin lesions at the injection site. Intradermal injections were discontinued, and only deep parenchymal injections were performed. All 5 patients had improvement of their skin lesions with silver sulfadiazine cream and no patient required debridement. Each patient received adjuvant therapy after surgery without delay.
Conclusions:
Our institution has experienced patients who developed skin lesions at the MBD injection site when using combined deep parenchymal and intradermal injections. With the increased use of MBD, caution should be used to avoid intradermal injections with SLN localization.
Insights
Methylene blue dye (MBD) used for sentinel lymph node biopsies can cause skin lesions at injection sites. Avoiding intradermal injections may prevent these complications in breast cancer patients.
Area of Science:
- Oncology
- Surgical Pathology
- Dermatology
Background:
- Methylene blue dye (MBD) is an emerging alternative to isosulfan blue for sentinel lymph node (SLN) biopsies in breast cancer.
- Complications associated with MBD for SLN localization have not been previously documented.
Purpose of the Study:
- To report complications arising from MBD use in SLN biopsies.
- To evaluate the incidence and characteristics of skin lesions following MBD injection.
Main Methods:
- A retrospective review of 24 breast cancer patients who underwent SLN biopsy using MBD.
- MBD was administered via peritumoral and intradermal injections; patients with skin lesions were assessed for appearance and adjuvant therapy timing.
Main Results:
- Twenty-one percent (5/24) of patients developed injection site skin lesions.
- Lesions resolved with silver sulfadiazine cream, and no debridement was necessary.
- Adjuvant therapy was initiated without delay for all patients.
Conclusions:
- Combined deep parenchymal and intradermal MBD injections were associated with skin lesions.
- Discontinuation of intradermal injections and use of parenchymal injections alone may mitigate these complications.
- Caution is advised regarding intradermal MBD administration for SLN localization.
