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Methods of Detection of First Recurrence in Patients with Stage I/II Primary Cutaneous Melanoma After Sentinel Lymph Node Biopsy

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

An understanding of the methods of detection of recurrent melanoma after sentinel lymph node biopsy (SLNB) is essential for the coordination of a rational plan of follow-up.

Methods

Clinical stage I/II melanoma patients who underwent SLNB from 1991 to 2004 were identified from a prospectively maintained single-institution database. Detection of recurrence by self (awareness of symptoms or abnormal physical findings) or physician (discovered on routine physical or scheduled test) and timing of clinic visit were recorded. Postoperative follow-up included physical exam every 3–4 months for the first year, every 3–6 months for the second year, and every 6–12 months thereafter. Serum lactate dehydrogenase (LDH) and chest X-ray (CXR) were obtained annually. Computed tomography (CT) and positron emission tomography (PET) were performed selectively.

Results

Of 1062 patients who underwent SLNB, 203 (19%) experienced 230 initial sites of recurrence; 198 patients were evaluable for follow-up. Median follow-up after first recurrence was 17 months. Symptoms and self-detected physical findings were present in 109 patients (55%); 85 patients (78%) were seen earlier than their scheduled visit. Self-detected physical findings identified in-transit (n = 26; 24%) and nodal (n = 25; 23%) disease. Physician detection occurred in 89 patients (45%), nearly half by a scheduled radiographic test (CXR, 16%; CT, 29%; PET, 1%). The method of detection significantly predicted post-recurrence survival (p < 0.05).

Conclusion

More than half of melanoma recurrences are self-detected; these patients have the most favorable post-recurrence survival rates because of the type of recurrence detected. The mode of detection is a significant predictor of post-recurrence survival. This supports an aggressive program of patient education in self-examination after SLNB for melanoma.

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Authors and Affiliations

  1. Department of Surgery, David Grant United States Air Force Medical Center, Travis AFB, CA, USA

    Kimberly Moore Dalal MD

  2. Department of Surgery, University of California at San Francisco, CA, USA

    Kimberly Moore Dalal MD

  3. Department of Surgery, Memorial-Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA

    Kimberly Moore Dalal MD, Mary S. Brady MD, David P. Jaques MD & Daniel G. Coit MD

  4. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Qin Zhou MA & Katherine S. Panageas DrPH

  5. Department of Surgery, Washington University, St. Louis, MO, USA

    David P. Jaques MD

Authors
  1. Kimberly Moore Dalal MD
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  2. Qin Zhou MA
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  3. Katherine S. Panageas DrPH
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  4. Mary S. Brady MD
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  5. David P. Jaques MD
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  6. Daniel G. Coit MD
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Correspondence to Daniel G. Coit MD.

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Moore Dalal, K., Zhou, Q., Panageas, K.S. et al. Methods of Detection of First Recurrence in Patients with Stage I/II Primary Cutaneous Melanoma After Sentinel Lymph Node Biopsy. Ann Surg Oncol 15, 2206–2214 (2008). https://doi.org/10.1245/s10434-008-9985-z

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  • DOI: https://doi.org/10.1245/s10434-008-9985-z

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