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Outcome in 846 Cutaneous Melanoma Patients From a Single Center After a Negative Sentinel Node Biopsy

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Abstract

Background

A negative sentinel node biopsy (SNB) implies a good prognosis for melanoma patients. The purpose of this study was to determine the long-term outcome for melanoma patients with a negative SNB.

Methods

Survival and prognostic factors were analyzed for 836 SNB-negative patients. All patients with a node field recurrence were reviewed, and sentinel node (SN) tissue was reexamined.

Results

The median tumor thickness was 1.7 mm, and 23.8% were ulcerated. The median follow-up was 42.1 months. Melanoma specific survival at 5 years was 90%, compared with 56% for SN-positive patients (P < .001). On multivariate analysis, only thickness and ulceration retained significance for disease-free and disease-specific survival. Five-year survival for patients with nonulcerated lesions was 94% vs. 78% with ulceration. Eighty-three patients (9.9%) had a recurrence. Twenty-seven patients developed recurrence in the regional node field, and in 22 of these, it was the first recurrence site. Six developed local recurrence, 17 an in-transit metastasis, and 58 distant disease. The false-negative rate was 13.2%. SN slides and tissue blocks were further examined in 18 patients with recurrence in the node field, and metastatic disease was found in 3 of them.

Conclusions

This large, single-center study confirms that patients with a negative SNB have a significantly better prognosis than those with positive SNs. In those with a negative SNB, primary tumor thickness and ulceration are independent predictors of survival. Incorrect pathologic diagnosis contributed to only a minority of the false-negative results in this study.

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Acknowledgments

The authors thank Marjorie Colman for invaluable assistance in managing and analyzing the SMU database. The assistance of Helen Shaw in the preparation of the manuscript is also gratefully acknowledged. Supported in part by the Melanoma Foundation of the University of Sydney. Vivian S. K. Yee was the recipient of a Fulbright Scholarship and was supported by the Fulbright Foundation. J. Gregory McKinnon was the recipient of the Walter C. Mackenzie Scotiabank Fellowship.

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Authors and Affiliations

  1. Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute, Sydney Cancer Centre, Gloucester House, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, New South Wales, Australia

    Vivian S.K. Yee MD, John F. Thompson MD, J. Gregory McKinnon MD, Richard A. Scolyer MB, BS, Ling-Xi L. Li PhD, William H. McCarthy MB, BS, Michael J. Quinn MB, BS, Robyn P.M. Saw MB, MS, Kerwin F. Shannon MB, BS & Jonathan R. Stretch MB, BS, DPhil

  2. Discipline of Surgery, Faculty of Medicine, University of Sydney, Sydney, 2006, New South Wales, Australia

    John F. Thompson MD, William H. McCarthy MB, BS, Christopher J. O’Brien MB, MS, Robyn P.M. Saw MB, MS & Jonathan R. Stretch MB, BS, DPhil

  3. Department of Surgery, University of Calgary, 1331 29th Street NW, Calgary, Alberta T2N9 4N2, Canada

    J. Gregory McKinnon MD

  4. Department of Anatomical Pathology, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, New South Wales, Australia

    Richard A. Scolyer MB, BS

  5. Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, 100 Carillon Avenue, Newtown, 2042, New South Wales, Australia

    Roger F. Uren MD

  6. Discipline of Medicine, University of Sydney, Sydney, 2006, New South Wales, Australia

    Roger F. Uren MD

Authors
  1. Vivian S.K. Yee MD
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  2. John F. Thompson MD
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  3. J. Gregory McKinnon MD
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  4. Richard A. Scolyer MB, BS
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  5. Ling-Xi L. Li PhD
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  6. William H. McCarthy MB, BS
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  7. Christopher J. O’Brien MB, MS
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  8. Michael J. Quinn MB, BS
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  9. Robyn P.M. Saw MB, MS
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  10. Kerwin F. Shannon MB, BS
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  11. Jonathan R. Stretch MB, BS, DPhil
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  12. Roger F. Uren MD
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Corresponding author

Correspondence to John F. Thompson MD.

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Yee, V.S., Thompson, J.F., McKinnon, J.G. et al. Outcome in 846 Cutaneous Melanoma Patients From a Single Center After a Negative Sentinel Node Biopsy. Ann Surg Oncol 12, 429–439 (2005). https://doi.org/10.1245/ASO.2005.03.074

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  • DOI: https://doi.org/10.1245/ASO.2005.03.074

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