Diffuse skin staining after using isosulfan blue for sentinel lymph node biopsies

A 69-year-old female diagnosed with bilateral invasive lobular breast carcinoma presented to our facility to undergo a bilateral mastectomy with bilateral sentinel lymph node biopsies (SLNB). Pre-operatively, five mL of isosulfan blue dye was injected to the sub-areolar tissue bilaterally and massaged for five minutes just prior to incision. Mild blue staining of the sentinel lymph nodes was noted during the surgery. After completion of the procedure, the patient’s facial skin was greenish in hue (Figure 1A,B). We predict that the dye may have been injected into a collapsible vein within the breast which would have then allowed it to disperse systemically. Also, a smaller volume of blue dye may be injected for sentinel node identification, especially given the need for bilateral SNLB. The color change was transient, and the patient returned to normal within 24 hours. She was discharged on post-operative day one in good condition.

Figure 1 Diffuse skin staining secondary to isosulfan blue injection demonstrated at oblique (A) and lateral (B) angles of the face.

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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/abs.2019.08.03). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the Declaration of Helsinki (as revised in 2013). Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.

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