title: Increased post-operative complications with methylene blue versus lymphazurin in sentinel lymph node biopsies for skin cancers.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SNLB) is the standard of care in staging of melanoma and other skin cancers. Early studies used lymphazurin (LZ) for SLNB. A national shortage of LZ promoted methylene blue (MB) as an alternate stain.
  
  
  OBJECTIVE
  This study compares complication rates between LZ and MB in SLNB patients, and the reliability dyes in locating sentinel lymph nodes.
  
  
  METHODS
  Charts were reviewed for patients who underwent SLNB for skin cancers between September 2006 and November 2008 at Penn State Hershey Medical Center. The type and quantity of dye, the presence of blue stained sentinel nodes, and any complications were recorded.
  
  
  RESULTS
  Ninety-three patients underwent SLNB (46 LZ, 47 MB). The amount of dye used was similar (avg. 0.93 ml LZ, 1.24 ml MB). The complication rate of LZ was 8.7%, and MB was 25.5%. There was significantly more (P = 0.003) skin graft complications in the MB patients (6/12) versus LZ (0/15).
  
  
  CONCLUSIONS
  There is a higher rate of complications with MB, especially with skin grafting. The reported risk of anaphylaxis with LZ has not been reported in volumes <2 ml. The sentinel lymph node identification rate is historically similar between dyes, and in this study was noted to be higher with LZ.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA. rneves@hmc.psu.edu
authors.forename: Rogerio I
authors.initials: RI
authors.lastname: Neves
authors.forename: Brandon Q
authors.initials: BQ
authors.lastname: Reynolds
authors.forename: Sprague W
authors.initials: SW
authors.lastname: Hazard
authors.forename: Brian
authors.initials: B
authors.lastname: Saunders
authors.forename: Donald R
authors.initials: DR
authors.lastname: Mackay
mesh_terms: D015266:Carcinoma, Merkel Cell / Q000175:diagnosis / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery; D004396:Coloring Agents; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D008751:Methylene Blue; D011183:Postoperative Complications; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D059039:Standard of Care
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D008751:Methylene Blue