Fluorescent Lymphangiography: Sentinel Node Navigation Surgery in Melanoma

Sentinel lymph node biopsy (SLNB) and overall sentinel node navigational surgery (SNNS) of melanoma lymphatics is considered standard of care for the staging of regional lymph nodes (LN) in patients with melanoma according to the American Joint Committee of Cancer (AJCC). Currently, both radiolabeled colloids and blue dye are used for the localization of said nodularity, and its combination gives optimal accuracy. However, several drawbacks of these techniques exist. In fact, the blue dye often requires significant dissection in order to be accurately visualized. The radiolabeled colloid injection is more cumbersome and requires significant clinical coordination. Additionally, it exposes patient and care givers to small, but cumulative, doses of radiation. An alternative tracer has been recently introduced to clinical practice, indocyanine green (ICG). This agent is nontoxic, does not stain the tissues, and thanks to its property of becoming fluorescent in the near infrared light spectrum, can be easily visualized by using special filtered light. Herein, we present the applicability and implications of fluorescence-guided surgery of sentinel lymph node (SLN) in patients with melanoma.