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European Journal of Plastic Surgery

, Volume 34, Issue 3, pp 201–204 | Cite as

Adverse reactions to Patent Blue V dye used in sentinel lymph node biopsy for Melanoma

  • Milap G. Rughani
  • Marc C. Swan
  • Titus S. Adams
  • Mark R. Middleton
  • Oliver C. Cassell
Original Paper

Abstract

Sentinel lymph node biopsy (SLNB) is an established investigation used in the management of melanoma, and contributes to disease staging. In the UK, Patent Blue V is injected intra-operatively to help identify the sentinel node. However little is known about the adverse effects associated with Patent Blue V in this technique. We performed a targeted survey of UK surgeons conducting SLNB for melanoma to establish variations in technique and to establish an incidence for adverse reactions. Two cases of adverse reactions were noted from 5,527 SLNB reported in the UK generating an incidence of 0.04%. All surgeons used 2.5% Patent Blue V, injecting between 0.5 and 2 ml, intra-dermally into the biopsy scar. No cases of anaphylaxis or mortality were reported. There are well-documented adverse reactions from Patent Blue V and Isosulfan Blue in breast cancer sentinel node techniques. The risk of a severe adverse reaction to Patent Blue V for SLNB in melanoma is rare in the UK. Nonetheless it is important for clinicians to be aware of the potential adverse reactions in order that it can be recognised promptly and managed effectively.

Keywords

Sentinel lymph node biopsy Melanoma Adverse reactions Patent Blue V 

Notes

Acknowledgments

MR and MM are supported by National Institute for Health Research Oxford Biomedical Research Centre

References

  1. 1.
    Morton DL, Wen DR, Wong JH et al (1992) Technical details of intra-operative lymphatic mapping for early stage melanoma. Acrh Surg 127:392–399Google Scholar
  2. 2.
    Bass SS, Cox CE, Ku NN et al (1998) The role of sentinel node biopsy in breast cancr. J Am Cancer Soc 186:423–427Google Scholar
  3. 3.
    Scherer K, Bircher AJ, Figueiredo V (2006) Blue dyes in medicine—a confusing terminology. Contact Dermatitits 54:231–232CrossRefGoogle Scholar
  4. 4.
    SurveyMonkey™. Internet Resource. Available at: www.surveymonkey.com. Accessed August 2009
  5. 5.
    1st UK Melanoma Consensus Meeting. St Thomas’ Hospital, London, June 4th 2009.Google Scholar
  6. 6.
    McArthur GJ, Banwell ME, Powell B (2006) A case of blue dermographia during sentinel lymph node biopsy. J Plast Reconstr Aesthet Surg 59(8):891–893. doi: 10.1016/j.bjps.11.007 PubMedCrossRefGoogle Scholar
  7. 7.
    Martin E (2007) The Oxford Medical Dictionary. Oxford University Press, London, UKGoogle Scholar
  8. 8.
    Albo D, Wayne J, Hunt K et al (2001) Anaphylactic reactions to isosulfan blue dye during sentinel lymph node biopsy for breast cancer. Am J Surg 182:393–398PubMedCrossRefGoogle Scholar
  9. 9.
    Simmons RM, Thevarajah S, Brennan MB et al (2003) Methylene blue dye as an alternative to isosulfan blue dye for sentinel node localisation. Ann Surg Oncol 10:242–247PubMedCrossRefGoogle Scholar
  10. 10.
    Longnecker S, Guzzardo M, Van Voris L (1985) Life-threatening anaphylaxis following subcutaneous adminsistration of isosulfan blue 1%. Clin Pharm 4:219–221PubMedGoogle Scholar
  11. 11.
    Efron P, Knudsen E, Hirshorn S et al (2002) Anaphylactic reaction to isosulfan blue used doe sentinel node biopsy; case report and literature review. Breast J 8:396–399PubMedCrossRefGoogle Scholar
  12. 12.
    Thevarajah S, Huston T, Simmons R (2005) A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast cancer. Am J Surg 189:236–239PubMedCrossRefGoogle Scholar
  13. 13.
    Mertes PM et al (2008) Anaphylaxsis to dyes during the perioperative period: reports of 14 clinical cases. J Allergy Clin Immunol 122(2):348–352PubMedCrossRefGoogle Scholar
  14. 14.
    Beenen E, de Roy Van Zuidewijn DBW (2005) Patients blue on patent blue: an adverse reaction during four sentinel node procedures. Surg Oncol 14:151–154PubMedCrossRefGoogle Scholar
  15. 15.
    Wrightson W, Wong S, Edwards M (2003) Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol 10(6):676–680PubMedCrossRefGoogle Scholar
  16. 16.
    Keller B, Yawalkar N, Pichler C, Braathen L, Hunger R (2007) hypersensitivity reaction against patent blue during sentinel lymph node removal in three melanoma patients. Am J Surg 193:122–124PubMedCrossRefGoogle Scholar
  17. 17.
    Hadar T, Gimmon Z, Prodansky D, Shalit M (2006) Giant blue urticaria following injection of patent blue dye for sentinel lymph node biopsy. Plast Reconstr Surg 117(5):1657–1658PubMedCrossRefGoogle Scholar
  18. 18.
    Wohrl S, Focke M, Hinterhuber G, Stingl G, Binder M (2004) Near-fatal anaphylaxis to Patent Blue V. Br J Dermatol 150:1037PubMedCrossRefGoogle Scholar
  19. 19.
    Leong S, Donegan E, Heffernon W, Dean A, Katz J (2000) Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma. Ann Surg Oncol 7(5):361–366PubMedCrossRefGoogle Scholar
  20. 20.
    Morton D, Cochran A, Thompson J et al (2005) Sentinel node biopsy for early-stage melanoma accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 242(3):302–313PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Milap G. Rughani
    • 1
  • Marc C. Swan
    • 1
  • Titus S. Adams
    • 1
  • Mark R. Middleton
    • 2
  • Oliver C. Cassell
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryJohn Radcliffe HospitalOxfordUK
  2. 2.Department of OncologyThe Curchill HospitalOxfordUK

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