title: Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma.
abstract: 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.
authors.affiliation: Department of Surgery, University of California/Mount Zion Medical Center, San Francisco 94143-1674, USA. leongs@surgery.ucsf.edu
authors.forename: S P
authors.initials: SP
authors.lastname: Leong
authors.forename: E
authors.initials: E
authors.lastname: Donegan
authors.forename: W
authors.initials: W
authors.lastname: Heffernon
authors.forename: S
authors.initials: S
authors.lastname: Dean
authors.forename: J A
authors.initials: JA
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012394:Rosaniline Dyes / Q000009:adverse effects*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D012394:Rosaniline Dyes; C025484:iso-sulfan blue