Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma

Background: Selective sentinel lymph node (SLN) dissection can spare about 80% of patients with primary melanoma from radical lymph node dissection. T his procedure identifies the SLN either visually by injecting isosulfan blu e dye around the primary melanoma site or by handheld gamma probe after rad iocolloid injection. Methods: During selective SLN mapping, 1 to 5 ml of isosulfan blue was inje cted intradermally around the primary melanoma. From November 1993, to Augu st 1998, 406 patients underwent intraoperative lymphatic mapping with the u se of both isosulfan blue and radiocolloid injection. Three cases of select ive SLN dissection, in which adverse reactions to isosulfan blue occurred, were reviewed. Results: We report three cases of anaphylaxis after intradermal injection w ith isosulfan blue of 406 patients who underwent intraoperative lymphatic m apping 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 treate d rapidly. Operating room personnel who participate in intraoperative lymph atic mapping where isosulfan blue is used must be aware of the potential co nsequences and be prepared to treat anaphylaxis.