title: Regional recurrence after negative sentinel lymph node biopsy for melanoma.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy has shown great utility in the management of melanoma. An analysis of regional recurrence in previously mapped negative SLN basins as the first site of relapse is performed.
  
  
  METHODS
  A retrospective query of a prospective melanoma database from 1994 to 2006 identified 1287 patients who underwent successful SLN biopsy. One thousand sixty patients (82.4%) were SLN negative and 227 (17.6%) patients SLN positive. Clinical variables were examined for the impact on regional recurrence by multivariate analysis.
  
  
  RESULTS
  Mean follow-up was 44.3 months (range 3-155 months). Thirty-five patients (3.3%) presented with false-negative (FN) SLN biopsy. Pathologic review of the SLNs harvested from these basins found 7 (20.0%) samples positive for metastatic melanoma. Multivariate analysis found head and neck site [hazard ratio 3.67; 95% confidence interval (CI), 1.77-7.60, P < 0.001] and tumor thickness (hazard ratio 1.16; 95% CI, 1.04-1.30, P = 0.01) to be predictive of FN SLN biopsy. The 5-year melanoma specific survival calculated from the date of the SLN biopsy was 57.6% (95%CI, 35.7-41.9) in the FN group, which was not statistically different than the SLN positive group 60.0% (95% CI, 29.6-40.1; P = 0.14).
  
  
  CONCLUSIONS
  Head and neck tumor site and tumor thickness are predictors of a FN SLN biopsy. Mechanisms other than pathologic 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 similar 5-year survival compared with patients with positive SLNs.
authors.affiliation: Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365C Clifton Road, Atlanta, Georgia 30322, USA. grant_carlson@emory.org
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Page
authors.forename: Cynthia
authors.initials: C
authors.lastname: Cohen
authors.forename: Douglas
authors.initials: D
authors.lastname: Parker
authors.forename: Ron
authors.initials: R
authors.lastname: Yaar
authors.forename: Anya
authors.initials: A
authors.lastname: Li
authors.forename: Andrea
authors.initials: A
authors.lastname: Hestley
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
mesh_terms: D015984:Causality; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis