title: Sentinel lymph node biopsy for conjunctival malignant melanoma: surgical techniques.
abstract: BACKGROUND
  The purpose of this report is to examine the viability and safety of preoperative lymphoscintigraphy and radio guided sentinel lymph node (SLN) biopsy for conjunctival melanoma, and to identify the best technique to perform this procedure.
  
  
  METHODS
  Three patients diagnosed with malignant melanoma of the conjunctiva underwent lymphoscintigraphy and SLN biopsy using a dual technique comprising isosulfan blue dye and technetium Tc 99m sulfur colloid. Each patient was anesthetized and the conjunctival melanoma was excised. SLNs were localized by a gamma probe, identified according to radioactivity and sentinel blue printing, and dissected, along with drainage of the associated lymphatic basins. The SLNs were evaluated by a pathologist using hematoxylin-eosin staining following serial sectioning and immunohistochemistry using a triple melanoma cocktail (S-100, Melan-A, and HMB-45 antigens).
  
  
  RESULTS
  Two SLNs were stained in the jugular chain during preoperative lymphoscintigraphy in the first patient, two SLNs were identified in the preauricular and submandibular areas in the second patient, and two SLNs were identified in the submandibular and parotid areas in the third patient. All lymph nodes identified by lymphoscintigraphy were dissected and identified at surgery with 100% accuracy in all three patients. All SLNs were histologically and immunohistochemically negative. Patients had good cosmetic and functional results, and maintained their visual acuity and ocular motility.
  
  
  CONCLUSIONS
  Patients with conjunctival melanoma can undergo preoperative lymphoscintigraphy and SLN biopsy safely using radioactive technetium and isosulfan blue dye.
authors.affiliation: Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil ; Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Alberto Ja
authors.initials: AJ
authors.lastname: Wainstein
authors.affiliation: Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Drummond-Lage
authors.affiliation: Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Milhem Jm
authors.initials: MJ
authors.lastname: Kansaon
authors.affiliation: Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Gustavo O
authors.initials: GO
authors.lastname: Bretas
authors.affiliation: Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Rodrigo F
authors.initials: RF
authors.lastname: Almeida
authors.affiliation: Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ana Lf
authors.initials: AL
authors.lastname: Gloria
authors.affiliation: Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ana Rp
authors.initials: AR
authors.lastname: Figueiredo
keywords: conjunctival melanoma; lymphoscintigraphy; ocular melanoma; sentinel lymph node biopsy