Background: A 51-year-old male who presents a 2.9 mm biopsy proven melanoma in left upper back. PET scan showed no metastatic disease. Preoperative lymphoscintigram revealed two suspected sentinel lymph nodes (SLNs) in the left axilla. Methods: Preoperative injection of Technetium-99 was performed on the morning of surgery, and lymphoscintigram identified 2 SLNs in the left axilla. Under general anesthesia, 0.1 cc of indocyanine green (ICG) was injected intradermally into the melanoma. The wide local excision of the melanoma was performed with cold knife and reconstructed with a rhomboid flap. Near-infrared light was activated and ICG was observed tracing towards the left axilla. A gamma probe confirmed a strong signal there, as well. The left axilla was opened, and near-infrared light identified 2 "hot-spots" indicating where the lymph nodes were. Gamma probe confirmed this. As dissection proceeded ICG clearly identified two lymph nodes with remarkable clarity and definition. This was consistent with the preoperative lymphoscintigram and the gamma probe findings. Both LNs were excised and sent to pathology. Results: Patient had an uncomplicated recovery and was discharged home the same day. Pathology demonstrated benign LN findings. Conclusions: SLN identification using near-infrared fluorescence guided imaging provides unparallel visualization of SLNs in melanoma patients. As more studies are performed ICG may prove to be a viable alternative to T99 for SLN identification in melanoma patients, especially in facilities with limited access to radiotracer lymphoscintigraphy or in patients with contraindication to Technetium.