Sentinel Lymph Node Detection by Indocyanine Green Fluorescence Imaging in Skin Cancer Patients: Technical Refinement

Background: Sentinel lymph node (SLN) biopsy has become the standard method for assessing the regional lymph node status of patients with skin cancers such as malignant melanoma, squamous cell carcinoma, or extramammary Paget’s disease. Recently, we reported a novel method for detection of SLN in skin cancer patients by real-time fluorescence navigation with indocyanine green (ICG). Objective: To describe our latest experience and the technical details of this method. Methods: SLN biopsy was performed with ICG navigation in 24 skin cancer patients (17 with melanoma, 4 with squamous cell carcinoma, 2 with extramammary Paget’s disease, and 1 with eccrine porocarcinoma). After ICG was injected intradermally around the primary tumor, the subcutaneous lymphatic drainage was traced and SLNs were detected by real-time fluorescence imaging. Results: Subcutaneous lymphatics and SLNs were identified in all patients with the primary tumor located in the upper extremity (4/4), lower extremity (12/12), genital region (2/2), and trunk (4/4), as well as in 1/2 patients with head and neck tumors. Conclusion: SLN biopsy guided by ICG fluorescence imaging is a simple technique with a high detection rate, especially for tumors of the extremities and genital region. This method seems to be a useful option for SLN biopsy in skin cancer patients with a primary tumor located on the upper or lower extremity or in the genital region.