Annals of Surgical Oncology

, Volume 7, Issue 5, pp 361–366 | Cite as

Adverse Reactions to Isosulfan Blue During Selective Sentinel Lymph Node Dissection in Melanoma

  • Stanley P. L. Leong
  • Elizabeth Donegan
  • Wanda Heffernon
  • Susan Dean
  • Jeffrey A. Katz
Original Article


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.


Anaphylaxis Isosulfan blue Melanoma SLN 


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Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Stanley P. L. Leong
    • 1
    • 4
  • Elizabeth Donegan
    • 2
  • Wanda Heffernon
    • 2
  • Susan Dean
    • 3
  • Jeffrey A. Katz
    • 2
  1. 1.Departments of SurgeryUniversity of California/Mount Zion Medical CenterSan Francisco
  2. 2.AnesthesiologyUniversity of California/Mount Zion Medical CenterSan Francisco
  3. 3.NursingUniversity of California/Mount Zion Medical CenterSan Francisco
  4. 4.Professor of SurgeryUniversity of California at San Francisco/Mount Zion Cancer CenterSan Francisco

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