Sentinel node mapping in Marjolin's ulcers: is it feasible?

Introduction: This study evaluated the feasibility of sentinel node biopsy in Marjolin's ulcers using peritumoral injection of the radiotracer and blue dye.

Materials And Methods: Ten patients with Marjolin's ulcers (5 male and 5 females) ranging in age from 39-65 years, and who were candidates for surgical removal of their tumors, were included in this study. The patients received 2 mCi technetium 99m (99mTc) antimony sulfide colloid in 2 divided doses subcutaneously in the peritumoral region. Immediately after anesthesia induction, 1 cc patent blue V in 2 divided doses was also injected in the same fashion as the radiotracer. Lymphatic mapping and sentinel node biopsy was performed using a gamma probe. Any hot and/or blue lymph nodes were harvested as a sentinel node. Primary lesions were then excised and wounds grafted with a splitthickness skin graft.

Results: A sentinel node could be identified on the lymphoscintigraphy images in only 2 patients. Sentinel node mapping was successful during surgery in these 2 patients. None of the harvested sentinel nodes were blue.

Conclusion: Lymphatic mapping and sentinel node biopsy do not seem feasible in Marjolin's ulcers located in areas of extensive burn scarring due to a low detection rate. Larger studies are needed to validate the results of this study.