Top

Published in:

01-06-2005

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

Authors: 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, Christopher J. O’Brien, MB, MS, Michael J. Quinn, MB, BS, Robyn P.M. Saw, MB, MS, Kerwin F. Shannon, MB, BS, Jonathan R. Stretch, MB, BS, DPhil, Roger F. Uren, MD

Published in: Annals of Surgical Oncology | Issue 6/2005

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.

Uren, RF, Howman-Giles, R, Thompson, JF, et al. 1994Lymphoscintigraphy to identify sentinel lymph nodes in patients with melanomaMelanoma Res43959PubMed

Thompson, JF 2001The Sydney Melanoma Unit experience of sentinel lymphadenectomy for melanomaAnn Surg Oncol844S47SPubMed

Morton, DL, Wen, DR, Wong, JH, et al. 1992Technical details of intraoperative lymphatic mapping for early stage melanomaArch Surg1273929PubMed

Reintgen, D, Cruse, CW, Wells, K, et al. 1994The orderly progression of melanoma nodal metastasesAnn Surg22075967PubMed

Thompson, JF, McCarthy, WH, Bosch, CM, et al. 1995Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodesMelanoma Res525560PubMed

Krag, DN 1998Minimal access surgery for staging regional lymph nodes: the sentinel-node conceptCurr Probl Surg359511016PubMed

Harlow, SP, Krag, DN, Ashikaga, T, et al. 2001Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre studyMelanoma Res114555CrossRefPubMed

Jansen, L, Nieweg, OE, Peterse, JL, Hoefnagel, CA, Olmos, RA, Kroon, BB 2000Reliability of sentinel lymph node biopsy for staging melanomaBr J Surg874849CrossRefPubMed

Statius Muller, MG, Leeuwen, PA, Lange-de Klerk, ES, et al. 2001The sentinel lymph node status is an important factor for predicting clinical outcome in patients with stage I or II cutaneous melanomaCancer9124018CrossRefPubMed

10.

Cascinelli, N, Belli, F, Santinami, M, et al. 2000Sentinel lymph node biopsy in cutaneous melanoma; the WHO Melanoma Program experienceAnn Surg Oncol746974CrossRefPubMed

11.

Clary, BM, Brady, MS, Lewis, JJ, Coit, DG 2001Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: review of a large single-institutional experience with an emphasis on recurrenceAnn Surg2332508CrossRefPubMed

12.

Gadd, MA, Cosimi, AB, Yu, J, et al. 1999Outcome of patients with melanoma and histologically negative sentinel lymph nodesArch Surg1343817CrossRefPubMed

13.

Essner, R, Conforti, A, Kelley, MC, et al. 1999Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanomaAnn Surg Oncol64429CrossRefPubMed

14.

Gershenwald, JE, Colome, MI, Lee, JE, et al. 1998Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanomaJ Clin Oncol16225360

15.

Vidal-Sicart, S, Pons, F, Puig, S, et al. 2003Identification of the sentinel lymph node in patients with malignant melanoma: what are the reasons for mistakes?Eur J Nucl Med Mol Imaging303626PubMed

16.

Doting, MH, Hoekstra, HJ, Plukker, JT, et al. 2002Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanomaEur J Surg Oncol286738CrossRefPubMed

17.

Chao, C, Wong, SL, Ross, MI, et al. 2002Patterns of early recurrence after sentinel lymph node biopsy for melanomaAm J Surg1845204; discussion 525CrossRefPubMed

18.

Nowecki, ZI, Rutkowski, P, Nasierowska-Guttmejer, A, Ruka, W 2003Sentinel lymph node biopsy in melanoma patients with clinically negative regional lymph nodes—one institution’s experienceMelanoma Res133543CrossRefPubMed

19.

Morton, DL, Hoon, DS, Cochran, AJ, et al. 2003Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma; therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastasesAnn Surg23853849; discussion 549–50PubMed

20.

Thompson, JF, Niewind, P, Uren, RF, Bosch, CM, Howman-Giles, R, Vrouenraets, BC 1997Single-dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patientsMelanoma Res75006PubMed

21.

Morton, DL, Thompson, JF, Essner, R, et al. 1999Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial GroupAnn Surg23045363discussion 463–5CrossRefPubMed

22.

Balch, CM Soong, SJ Gershenwald et al. 2001Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging systemJ Clin Oncol19362234

23.

Balch, CM, Buzaid, AC, Soong, SJ, et al. 2001Final version of the American Joint Committee on Cancer staging system for cutaneous melanomaJ Clin Oncol19363548

24.

McCarthy, WH 2002Melanoma: Margins for error—another viewAust N Z J Surg723046CrossRef

25.

Gershenwald, JE, Balch, CM, Soong, S-J, Thompson, JF 2003Prognostic factors and natural historyBalch, CMHoughton, ANSober, AJSoong, S-J eds. Cutaneous MelanomaSt. LouisQuality Medical Publishing2534

26.

Clary, BM, Mann, B, Brady, MS, Lewis, JJ, Coit, DG 2001Early recurrence after lymphatic mapping and sentinel node biopsy in patients with primary extremity melanoma; a comparison with elective lymph node dissectionAnn Surg Oncol832837PubMed

27.

Shivers, SC, Wang, X, Li, W, et al. 1998Molecular staging of malignant melanoma: correlation with clinical outcomeJAMA28014105CrossRefPubMed

28.

Balch, CM, Soong, S-J, Ross, MI, et al. 2000Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4,0 mm). Intergroup Melanoma Surgical TrialAnn Surg Oncol78797CrossRefPubMed

29.

McMasters, KM 2001The Sunbelt Melanoma TrialAnn Surg Oncol841S43SPubMed

30.

Li, LX, Scolyer, RA, Ka, VS, et al. 2003Pathologic review of negative sentinel lymph nodes in melanoma patients with regional recurrence: a clinicopathologic study of 1152 patients undergoing sentinel lymph node biopsyAm J Surg Pathol271197202PubMed

31.

Scolyer, RA, Thompson, JF, Li, LX, et al. 2004Failure to remove true sentinel nodes can cause failure of the sentinel node technique: evidence from antimony concentrations in false-negative sentinel nodes from melanoma patientsAnn Surg Oncol11174S178SCrossRefPubMed

Title: Outcome in 846 Cutaneous Melanoma Patients From a Single Center After a Negative Sentinel Node Biopsy
Authors: 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
Christopher J. O’Brien, MB, MS
Michael J. Quinn, MB, BS
Robyn P.M. Saw, MB, MS
Kerwin F. Shannon, MB, BS
Jonathan R. Stretch, MB, BS, DPhil
Roger F. Uren, MD
Publication date: 01-06-2005
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2005
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2005.03.074

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2005

Correlation Between Concordance of Tracers, Order of Harvest, and Presence of Metastases in Sentinel Lymph Nodes With Breast Cancer

Breast Conservation After Neoadjuvant Chemotherapy

A Motion for Cautious Optimism in the Treatment of Patients With Ocular Melanoma: The Ayes Have It

Quality of Life and Functional Long-Term Outcome After Partial Pancreatoduodenectomy: Pancreatogastrostomy Versus Pancreatojejunostomy

The Role of Liver Resections for Noncolorectal, Nonneuroendocrine Metastases: Experience With 142 Observed Cases

Treatment of Liver Metastases From Uveal Melanoma