Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result

JAMA Surg. 2013 May;148(5):456-61. doi: 10.1001/jamasurg.2013.1335.


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.

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Melanoma / mortality*
  • Melanoma / pathology*
  • Melanoma / therapy
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Recurrence, Local / therapy
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy*
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / therapy
  • Survival Rate
  • Time Factors