title: Long-term follow-up reveals that ulceration and sentinel lymph node status are the strongest predictors for survival in patients with primary cutaneous melanoma.
abstract: OBJECTIVE
  To assess the long-term outcome after sentinel lymph node biopsy (SLNB) in melanoma patients.
  
  
  METHODS
  Between 1995-2009 450 melanoma patients underwent SLNB in a single center. Survival and prognostic factors were analyzed for 429 patients.
  
  
  RESULTS
  Median age was 53 (range 11-84) years. Median Breslow thickness was 2.4 (range 1-20) mm and 36% were ulcerated melanomas. Median follow-up time was 64.8 (range 2-174) months. A tumor-positive SLN was present in 140 patients (31%). Completion lymph node dissection (CLND) was performed in 119 patients and these patients were analyzed for recurrence and survival. 124 Patients (29%) relapsed during follow-up; 55 in the node-positive group who underwent CLND (55/119; 46%) and 69 in the node-negative group (69/310; 22%; p < 0.001). In the node-negative group 17 patients developed recurrence in the regional node field; false-negative rate 11%. On multivariate analysis strongest prognostic factors for disease free survival (DFS) were primary melanoma ulceration and SLN positivity (Hazard Ratio (HR) of 2.2 and 2.3; p < 0.001). For disease specific survival (DSS) the same was found to be true with an HR of 2.1 for ulceration and 2.0 for SLN positivity (p = 0.001 and p = 0.002 respectively). 10-Year DFS was 71% for node-negative patients compared with 48% for node-positive patients (p < 0.001). 10-Year DSS was 77% for node-negative patients compared to 60% for node-positive patients (p < 0.001).
  
  
  CONCLUSIONS
  This study shows a remarkably high percentage of tumor-positive SLN. The long-term follow-up data confirm that tumor-positive SLN patients have a worse DFS and DSS than tumor-negative SLN patients. Ulceration and SLN status proved to be the strongest prognostic factors for long-term DFS and DSS.
authors.affiliation: Department of Surgical Oncology, University Medical Center, Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Vries
authors.forename: M J
authors.initials: MJ
authors.lastname: Speijers
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: J Th M
authors.initials: JT
authors.lastname: Plukker
authors.forename: A H
authors.initials: AH
authors.lastname: Brouwers
authors.forename: R J
authors.initials: RJ
authors.lastname: van Ginkel
authors.forename: A J H
authors.initials: AJ
authors.lastname: Suurmeijer
authors.forename: H J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000401:mortality; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D012883:Skin Ulcer / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis; D047368:Tumor Burden; D055815:Young Adult