Indocyanine green fluorescence imaging in the identification of sentinel lymph node in melanoma

Abstract

Sentinel lymph node biopsy is imperative in the management of melanoma and allows for accurate histological assessment of nodal basins in stage 1B disease, or greater. Indocyanine green (ICG) represents a somewhat novel localisation modality that may confer a decreased risk of anaphylaxis and reduced risk of skin discolouration. A middle childhood (6-11 years) boy with a 3-month history of a new, pigmented, right cheek lesion was referred for evaluation. Excisional biopsy revealed a pigmented epithelioid melanocytoma.After the MDM discussion, a WLE and sentinel lymph node biopsy were recommended. The sentinel node was successfully identified using intraoperative ICG fluorescence imaging. There were no adverse outcomes such as skin staining or lack of dye uptake.Although initially positive for nodal micrometastases, management consisted of clinical follow-up with 3 monthly ultrasound scans of the neck. To date, there is no evidence of recurrence.

Keywords: Paediatric Surgery; Plastic and reconstructive surgery; Skin.

Figure 1. Standard preoperative incision markings (transverse).

Figure 2. Sentinel node identified in ipsilateral submandibular lymph nodes.