Topic: D. Clinical Cancer
Regional Recurrence After Negative Sentinel Lymph Node Biopsy for Melanoma
Grant W Carlson, Andrew J. Page, Douglas R. Murray, Anya J. Li, Keith A. Delman, Andrea Hestley, Douglas C. Parker, Cynthia Cohen
Emory University, Atlanta, GA
OBJECTIVE(S): Sentinel lymph node biopsy (SLN) biopsy has shown great utility in the management of melanoma. An analysis of regional recurrence in previously mapped negative SLN basins is performed.
METHODS: A retrospective query of a prospective melanoma database from 1994-2006 identified 1283 patients who underwent successful SLN biopsy. One thousand fifty-six patients (82.3%) were SLN- and 227 patients SLN+ (17.7%). Clinical variables were examined for the impact on regional recurrence by multivariate analysis.
RESULTS: The mean follow-up for the entire group was 41.3 months. Thirty-two patients (3.1%) presented with an isolated regional recurrence in a previously mapped negative nodal basin. Pathological review of the SLNs harvested from these basins found 7 (21.9%) samples positive for metastatic melanoma. The 5-year survival was: SLN- 90.2%, false-SLN 31.6%, and SLN+ 50.0% (p<0.001). Multivariate analysis of risk factors for regional recurrence after negative SLN biopsy is depicted in the Table.
CONCLUSIONS: Head and neck tumor site is the strongest predictor of a false-negative SLN biopsy. Mechanisms other than SLN sampling error may contribute to the failure of the SLN biopsy in some patients. Patients with regional recurrence after negative SLN biopsy have a decreased 5-year survival compared to patients who presented with initially positive SLNs.
| Risk factors | P value | Odds ratio | Confidence interval (95%) |
| Female | 0.30 | 1.23 | 0.83-1.84 |
| Age > 53 | 0.60 | 0.99 | 0.97-1.01 |
| Breslow depth > 2.5mm | <0.001 | 1.23 | 1.14-1.33 |
| Ulceration | 0.004 | 1.81 | 1.20-2.73 |
| Head and neck site | <0.001 | 2.57 | 1.69-3.91 |