Covid-19 vaccine mimics lymph node metastases in patients undergoing skin cancer follow-up - a monocenter study

Placke, J.-M.; Reis, H.; Hadaschik, E.; Roesch, A.; Schadendorf, D.; Stoffels, I.; Klode, J.

INTRODUCTION: The Covid-19 pandemic has changed the lives of people around the world. Fortunately, sufficient vaccines are now available. Local reactions with ipsilateral lymphadenopathy are among the most common side effects. We investigated the impact of lymphadenopathy after Covid-19 vaccination on the value of ultrasound in tumor patients. PATIENTS AND METHODS: Patients with melanoma or merkel cell carcinoma were included who underwent lymph node excision and received Covid-19 vaccination within 6 weeks before surgery. The consistency of the preoperative ultrasound findings with the histopathologic findings was investigated. RESULTS: Eight patients were included (two Merkel cell carcinoma and six melanoma patients) who underwent lymph node excision between April 16, 2021, and May 19, 2021, and had previously received Covid-19 vaccination. In three of the eight patients (one Merkel cell carcinoma and two melanoma patients), lymph node metastases were erroneously diagnosed preoperatively during tumor follow-up with physical examination, ultrasound, and or FDG PET/CT. In these three patients, the suspected lymph node metastases were located in the left axilla after Covid19 vaccination in the left upper arm, which resulted in selective lymph node removal in two patients and complete lymphadenectomy in one patient. CONCLUSION: Covid-19 vaccine-associated lymphadenopathy is expected to be observed much more frequently in the near future due to increasing vaccination rates. This cause of lymphadenopathy, which may in ultrasound as well as in FDG PET/CT resemble lymph node metastases, must be considered, especially in oncologic patients undergoing tumor follow-up. In addition, Covid-19 vaccination should be given as far away as possible from an underlying primary on the contralateral side to avoid oncologic misdiagnosis followed by malpractice.