Sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green in cutaneous head and neck/lip mucosa melanomas.

Abstract

The triple technique (lymphoscintigraphy, patent-blue staining, and a gamma probe) constitutes a reliable method for the sentinel lymph node (SLN) biopsy. However, in head and neck melanomas, a shine-through phenomenon, which occurs because these SLNs are close to the primary focus, is irreversibly problematic. To get around the shine-through phenomenon, this study uses the fluorescence navigation with indocyanine green (ICG) as well as the triple technique. ICG is a green dye and can be used as a marker with infrared fluorescence. ICG solution is intradermally injected around the tumor. By using Photodynamic Eye (PDE) intraoperatively, it is possible to observe the injected ICG as SLNs in the fluorescence images. By use of the fluorescence imaging with ICG, clear identification of the SLN of the case became possible. We think the fluorescence navigation with ICG will be a useful option for the SLN biopsy in head and neck melanomas.