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

Jones EL, Jones TS, Pearlman NW, et al. — Wed, 01 May 2013 00:00:00 GMT

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.

Early Diagnosis of Metastatic Disease in Melanoma: Does It Make a Difference? Comment on “Long-term Follow-up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result” Early Diagnosis of Metastatic Disease in Melanoma

Wong JH. — Wed, 01 May 2013 00:00:00 GMT

An area of continuing controversy with regard to melanoma is the therapeutic value of a sentinel lymph node biopsy (SLNB). An interim analysis of the Multicenter Selective Lymphadenectomy Trial I failed to demonstrate an improvement in melanoma-specific survival for patients undergoing an SLNB compared with patients who were only observed. For this reason, some have questioned the role of an SLNB in an era when adjuvant therapy remains controversial.

JAMA Surgery: Dermatology Topic Collection

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

Early Diagnosis of Metastatic Disease in Melanoma: Does It Make a Difference? Comment on “Long-term Follow-up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result” Early Diagnosis of Metastatic Disease in Melanoma