Methylen blue dye related breast skin necrosis requiring mastectomy: Case report

Abstract

Sentinel lymph node (SLN) biopsy is accepted as the gold standard procedure for assessing the status of the axillary lymph node in clinically node-negative breast cancer. The intraoperative blue dye injection is commonly performed to localize the SLN. Systemic allergic complications related to blue dye injection have been well documented, but local adverse effects requiring surgical excision are extremely rare. We report an infrequent case of skin and subcutaneous tissue necrosis following subdermal injection of methylen blue (MB) dye. A 48-year-old female, diagnosed with infiltrating ductal carcinoma, was treated by her initial surgeon with lumpectomy and SLN biopsy. For identification of the SLN, periareolar subdermal injection of 4 ml of 1% MB dye was performed. The patient was seen 10 days following discharge when it was noticed that the periareolar injection sites in the left breast had become necrotic. Since the necrosis invaded the majority of breast, mastectomy had to be performed. Histopathologic examination revealed necrosis of the skin and subcutaneous tissue of the left breast. Although the use of MB dye for SLN biopsy in breast cancer has few systemic reactions, its use has been associated with a number of undesired local complications. Deep parenchymal injections are recommended in order to avoid blue dye-associated skin lesions.