Lymphedema After Sentinel Lymph Node Biopsy for Cutaneous Melanoma

A Report of 5 Cases

David A. Wrone, MD; Kenneth K. Tanabe, MD; A. Benedict Cosimi, MD; Michele A. Gadd, MD; Wiley W. Souba, MD; Arthur J. Sober, MD
Arch Dermatol. 2000;136:511-514.

Background Sentinel lymph node (SLN) biopsy has rapidly become the procedure of choice for assessing the lymph node status of patients with 1992 American Joint Committee on Cancer stages I and II melanoma. The procedure was designed to be less invasive and, therefore, less likely to cause complications than a complete lymph node dissection. To our knowledge, this is the first report in the literature documenting extremity lymphedema following SLN biopsy.
Observation We report 5 cases of lymphedema after SLN biopsy in patients being routinely followed up after melanoma surgery at the Massachusetts General Hospital Melanoma Center, Boston. Three cases were mild, and 2 were moderate. Potential contributing causes of lymphedema were present in 4 patients and included the transient formation of hematomas and seromas, obesity, the possibility of occult metastatic melanoma, and the proximal extremity location of the primary melanoma excision. Four of the patients underwent an SLN biopsy at our institution. We used the total number of SLN procedures (N=235) that we have performed to calculate a 1.7% baseline incidence of lymphedema after SLN biopsy.

Conclusions Sentinel lymph node biopsy can be complicated by mild and moderate degrees of lymphedema, with an incidence of at least 1.7%. Some patients may have contributing causes for lymphedema other than the SLN biopsy, but many of these causes are difficult to modify or avoid.

From the Massachusetts General Hospital Melanoma Center (Drs Wrone, Tanabe, Cosimi, Gadd, Souba, and Sober), and the Departments of Dermatology (Drs Wrone and Sober) and Surgery (Drs Tanabe, Cosimi, Gadd, and Souba), Massachusetts General Hospital, Boston.

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