title: Patterns of early recurrence after sentinel lymph node biopsy for melanoma.
abstract: BACKGROUND
  Patterns of early recurrence after sentinel lymph node (SLN) biopsy for melanoma was determined from the Sunbelt Melanoma Trial, which includes patients with Breslow thickness > or =1.0 mm and nonpalpable regional lymph nodes.
  
  
  METHODS
  SLN were evaluated by routine histology and S-100 protein stain. Overall, there were 1,183 patients with a median follow-up of 16 months.
  
  
  RESULTS
  SLN were positive in 233 of 1,183 patients (20%). The recurrence rate was greater among patients with histologically positive SLN than those with negative SLN (15.5% versus 6.0%, respectively, P <0.05). Patients with positive SLN were more likely to have distant metastases (as opposed to locoregional recurrence) than those with negative SLN (67% versus 46%, respectively, P <0.05). By multivariate analysis, SLN status, Breslow thickness, Clark level, and ulceration were significant independent factors associated with early recurrence. Of patients with negative SLN, 14 of 950 (1.5%) experienced metastatic disease in lymph node basins which were staged as negative for tumor by SLN biopsy initially.
  
  
  CONCLUSIONS
  Early regional lymph node recurrence was very uncommon after positive SLN biopsy and completion lymphadenectomy. Patients with positive SLN are more likely than those with negative SLN to develop both local/in-transit recurrence and distant metastases within a short follow-up period.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville, 315 East Broadway, Suite 309, KY 40202, USA.
authors.forename: Celia
authors.initials: C
authors.lastname: Chao
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Reintgen
authors.forename: R Dirk
authors.initials: RD
authors.lastname: Noyes
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Cerrito
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors