Tumescent anesthesia use for cutaneous malignancies does not impact sentinel node identification but decreases estimated blood loss

Abstract

Sentinel node biopsy is performed to stage clinically and radiographically occult regional disease in cases of malignancy, including cutaneous cancer such as melanoma. The use of tumescent anesthesia with sentinel node biopsy for cutaneous malignancies has not been well studied. Therefore, we aimed to compare the rate of successful sentinel node identification and estimated blood loss between patients who underwent sentinel node biopsy with and without the use of tumescent anesthesia. A retrospective review was conducted of a prospectively maintained single-institution database of all patients who underwent reconstruction after the extirpation of a cutaneous malignancy over an 18-month period. Patient demographics, tumor histology, and characteristics, indication for and success of sentinel node biopsy, use of tumescent anesthesia, and total estimated blood loss were examined. Sentinel node biopsy was performed in 15 of 39 patients (38.5%) receiving tumescent anesthesia compared with 6 of 26 patients (23.1%) not receiving it (p=0.19). Sentinel node biopsy had a success rate of 100% in the tumescent and nontumescent anesthesia groups. The mean estimated blood loss in the tumescent anesthesia group was 36.7mL versus 59.6mL in the nontumescent anesthesia group (p<0.001). Complication rates were comparable between the tumescent anesthesia (12.8%) and nontumescent anesthesia (19.2%) groups (p=0.48). The use of tumescent anesthesia in cutaneous malignancy extirpation and immediate reconstruction was not associated with a decreased sentinel node identification rate or change in complication rates. However, tumescent anesthesia was associated with a decrease in the estimated blood loss.