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Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival

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

Abstract

Background

Factors that predict melanoma recurrence after a negative sentinel lymph node biopsy (SLNB) are not well-defined. We evaluated melanoma recurrence patterns, factors prognostic for recurrence, and the impact of recurrence on outcomes after a negative SLNB.

Methods

The Sentinel Lymph Node Working Group database was evaluated from 1996 to 2016 for negative SLNB melanoma patients. Clinicopathologic characteristics were correlated with recurrence, overall survival (OS), and melanoma-specific survival (MSS).

Results

Median follow-up was 32.1 months. Recurrences developed in 558 of 5351 negative SLN patients (10.4%). First-site of recurrence included a local or in-transit recurrence (LITR) in 221 cases (4.1%), nodal recurrence (NR) in 109 cases (2%), and distant recurrence (DR) in 220 cases (4.1%). On multivariable analysis, age, thickness, head/neck or lower extremity primary, and microsatellitosis significantly predicted for an LITR as first-site. Having an LITR as first-site significantly predicted for a subsequent NR and DR, and significantly predicted for worse OS and MSS. Furthermore, thickness and head/neck or lower extremity primary significantly predicted for an NR as first-site, while a prior LITR significantly predicted for a subsequent NR. Factors significantly predictive for a DR included thickness, head/neck or trunk primary, ulceration, and lymphovascular invasion. Patients with any type of locoregional recurrence were at higher risk for a DR.

Conclusions

Recurrences occur in 10.4% of negative SLN patients, with LITR and DR being the most common types. Importantly, having an LITR significantly predicts for a subsequent NR and DR, and is prognostic for worse survival after a negative SLNB.

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Funding

This work was not supported by any funding sources.

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Authors and Affiliations

  1. Yale School of Medicine, New Haven, CT, USA

    Daniel C. Thomas MD, MPH

  2. Texas A and M University, College Station, TX, USA

    Gang Han PhD

  3. California Pacific Medical Center, San Francisco, CA, USA

    Stanley P. Leong MD, MS & Mohammed Kashani-Sabet MD

  4. Oregon Health and Science University, Portland, OR, USA

    John Vetto MD & Dale Han MD

  5. Mayo Clinic, Phoenix, AZ, USA

    Barbara Pockaj MD

  6. Carolinas Medical Center, Charlotte, NC, USA

    Richard L. White MD

  7. The Angeles Clinic-Cedars Sinai, Los Angeles, CA, USA

    Mark B. Faries MD

  8. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Schlomo Schneebaum MD

  9. National Cancer Institute of Naples, Naples, Italy

    Nicola Mozzillo MD

  10. St. Joseph Hospital, Orange, CA, USA

    Kim J. Charney MD

  11. Moffitt Cancer Center, Tampa, FL, USA

    Vernon K. Sondak MD, Jane L. Messina MD & Jonathan S. Zager MD

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  1. Daniel C. Thomas MD, MPH
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Corresponding author

Correspondence to Dale Han MD.

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Disclosure

Daniel C. Thomas, Gang Han, Stanley P. Leong, Mohammed Kashani-Sabet, John Vetto, Barbara Pockaj, Richard L. White, Mark B. Faries, Schlomo Schneebaum, Nicola Mozzillo, Kim J. Charney, Vernon K. Sondak, Jane L. Messina, Jonathan S. Zager, and Dale Han have no conflicts of interest to report.

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Thomas, D.C., Han, G., Leong, S.P. et al. Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival. Ann Surg Oncol 26, 2254–2262 (2019). https://doi.org/10.1245/s10434-019-07369-w

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  • DOI: https://doi.org/10.1245/s10434-019-07369-w

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