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SF024/#183  Sentinel lymph node biopsy with technetium-99m and fluorescence indocyanine green for malignant vulvar melanoma
  1. Isabel Bernal1,
  2. Esther Yoon2,
  3. Mayo Hotta3,
  4. Martin Newman3 and
  5. Joel Cardenas4
  1. 1Nova Southeastern University, Osteopathic Medicine, Fort Lauderdale, USA
  2. 2Cleveland Clinic, Laboratory Medicine, Weston, USA
  3. 3Cleveland Clinic, Plastic and Reconstructive Surgery, Weston, USA
  4. 4Cleveland Clinic, Gynecololgy Oncology, Coral Springs, USA


Introduction The surgical management of vulvar cancer has been evolving. Standard inguino-femoral lymphadenectomy (IFL) is associated with significant postoperative morbidity and lymphedema. Current guidelines recommend sentinel lymph node biopsy with Technetium-99m (Tc99) and blue dye. With the introduction of fluorescence in surgery, the use of indocyanine green (ICG) appears to have a role in improving the detection rate of sentinel lymph nodes. We present a case of sentinel lymph node biopsy with Tc-99 and ICG.

Description Sixty-five yo female with a BMI of 47.50 Kg/m2 presented with vulvar biopsy that showed Stage 2b malignant vulvar melanoma. Physical exam showed two black 5-mm lesions in the mons. PET CT scan did not show abnormal groin lymph nodes or distant metastasis. Underwent radical vulvectomy with Bilateral Inguino-femoral sentinel lymph node biopsy with Tc99 and Indocyanine green (ICG). Pre-operative lymphoscintigraphy detected bilateral groin lymph node. During surgery, ICG (25 grams/diluted in 10 ml sterile water) was injected intradermally at the leading edge of the lesion.

Conclusion/Implications Pathology showed one left groin sentinel node with 7 mm metastatic disease. One out of four right groin sentinel node biopsy showed 1 mm disease. All surgical margins were negative for invasive melanoma. The final pathology was pT2a pN2. Sentinel lymph node biopsy with Tc-99 and ICG appears feasible and may increase the detection rate of micrometastasis. ICG is an alternative to blue dye.

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