This presentation describes sentinel node biopsy assisted by ICG-SPI. We use ICG-SPI routinely as an adjunct for sentinel node identification. Here melanoma in the ear has been injected with radiotracer preoperatively and with ICG intraoperatively. Half a cc has been injected around the primary tumor. Together, the two modalities provide an accurate way to remove the sentinel node and to clip afferent lymphatics to reduce the risk of lymphocele. Where ICG-SPI is most relevant is in salvaging situations where the preoperative radiotracer fails to migrate. In this patient with a left cheek melanoma, his technetium failed to migrate from its injection point. He was thus injected with ICG in the operating room, which is seen as the bright glow on his cheek. Encircled is the faint glow seen through his neck skin at the site of his sentinel node. This is a different patient but the same scenario. Incising over the glow in the neck skin, the sentinel node is easily seen and removed, allowing these patients to be accurately staged.

sentinel node biopsy

ICG-SPI

radiotracer

lymphocele risk

melanoma staging