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Original Article |

Long-term Follow-up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result

Edward L. Jones, MD; Teresa S. Jones, MD; Nathan W. Pearlman, MD; Dexiang Gao, PhD; Robert Stovall, MD; Csaba Gajdos, MD; Nicole Kounalakis, MD; Rene Gonzalez, MD; Karl D. Lewis, MD; William A. Robinson, MD, PhD; Martin D. McCarter, MD
JAMA Surg. 2013;148(5):456-461. doi:10.1001/jamasurg.2013.1335.
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Published online

Objective To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result.

Design Retrospective chart review of a prospectively created database of patients with cutaneous melanoma.

Setting Tertiary university hospital.

Patients A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008.

Main Outcome Measures Time to recurrence and overall survival.

Results Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001).

Conclusion Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.

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Figures

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Figure 1. Number of recurrences by month after diagnosis. The median time to recurrence was 23 months, and the mean time to recurrence was 29.2 months. Two patients experienced recurrence more than 8 years after diagnosis, which affected the mean value (1 patient at 96 months and 1 patient at 106 months).

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Figure 2. Recurrence by site of primary melanoma in 83 patients. The majority of patients with recurrences had primary lesions located in the head and neck region, followed by the trunk. Primary lesions in the upper extremity accounted for the smallest portion of the recurrences.

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Figure 3. Overall survival probability for patients with and patients without recurrence. Kaplan-Meier overall survival curves show the number of months after diagnosis of survival. Patients with a negative sentinel lymph node biopsy (SLNB) result who experienced recurrence had an overall 5-year survival probability of 68%, and patients with a negative SLNB result who did not experience recurrence had an overall 5-year survival probability of 98%. The overall 5-year survival probability for patients with a negative SLNB result is 91%.

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