title: Melanoma recurrence patterns after negative sentinel lymphadenectomy.
abstract: OBJECTIVE
  A tumor-negative sentinel node (SN) does not eliminate the chance of melanoma recurrence. Patterns of metastasis can be identified and characterized in patients with tumor-negative SNs.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Melanoma referral center.
  
  
  METHODS
  Patients who underwent lymphatic mapping and sentinel lymphadenectomy between 1995 and 2002 and whose SNs were negative for metastasis by hematoxylin-eosin and immunohistochemistry staining were included in the study. The SN specimens from patients with recurrent disease were reexamined for missed metastasis.
  
  
  METHODS
  Differences in survival related to sites of recurrence and the rate of false-negative histopathologic SN diagnosis were determined.
  
  
  RESULTS
  At a median follow-up of 36.7 months, 69 (8.9%) of 773 patients with tumor-negative SNs had recurrent disease. Three-year survival after first recurrence was 17.1% in the 37 patients with distant recurrence, 48.7% in the 19 patients with local or in-transit recurrence, and 63.5% in the 13 patients with regional basin recurrence; the difference in survival between patients with local or regional and distant recurrences was statistically significant (P<.001). Histopathologic reexamination of SNs from the 69 patients identified 9 patients with false-negative SNs; 2 of these had same-basin recurrences.
  
  
  CONCLUSIONS
  The SN is a valuable prognostic indicator because only 8.9% of patients with tumor-negative SNs will develop recurrence. The low incidence (1.7%) of regional basin recurrence in patients with negative SNs supports the accuracy of our current method of lymphatic mapping and sentinel lymphadenectomy to identify occult regional nodal basin metastasis.
authors.affiliation: Roy E. Coats Research Laboratories, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA 90404, USA.
authors.forename: Theresa G
authors.initials: TG
authors.lastname: Zogakis
authors.forename: Richard
authors.initials: R
authors.lastname: Essner
authors.forename: He-jing
authors.initials: HJ
authors.lastname: Wang
authors.forename: Roderick R
authors.initials: RR
authors.lastname: Turner
authors.forename: Yuki T
authors.initials: YT
authors.lastname: Takasumi
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gaffney
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lee
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis