Sentinel node mapping in Marjolin's ulcers: is it feasible?

Area of Science:

• Oncology
• Surgical Oncology
• Dermatology

Background:

• Marjolin's ulcers are malignant} tumors that develop in chronic wounds, often in burn scars.
• Sentinel node biopsy is a standard procedure for staging various cancers.
• Assessing the feasibility of sentinel node biopsy in Marjolin's ulcers is crucial for accurate staging and treatment planning.

Purpose of the Study:

• To evaluate the feasibility of sentinel node biopsy in Marjolin's ulcers.
• To assess the efficacy of peritumoral injection of radiotracer and blue dye for lymphatic mapping.

Main Methods:

• Ten patients with Marjolin's ulcers underwent peritumoral injection of technetium-99m antimony sulfide colloid and patent blue V.
• Lymphatic mapping was performed using a gamma probe, and sentinel nodes were identified and harvested.
• Primary lesions were excised, and wounds were grafted with split-thickness skin grafts.

Main Results:

• Sentinel nodes were identified on lymphoscintigraphy in only 2 out of 10 patients.
• Successful intraoperative sentinel node mapping was achieved in these 2 patients.
• None of the harvested sentinel nodes were blue, indicating limited dye uptake.

Conclusions:

• Lymphatic mapping and sentinel node biopsy appear to have low feasibility in Marjolin's ulcers within extensive burn scars.
• The low detection rate suggests challenges in accurately identifying sentinel nodes in these specific cases.
• Larger studies are recommended to validate these preliminary findings and explore alternative approaches.