title: Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result.
abstract: OBJECTIVE
  To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result.
  
  
  METHODS
  Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital.
  
  
  METHODS
  A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008.
  
  
  METHODS
  Time to recurrence and overall survival.
  
  
  RESULTS
  Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001).
  
  
  CONCLUSIONS
  Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.
authors: Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA.
authors: Edward L
authors: EL
authors: Jones
authors: Teresa S
authors: TS
authors: Jones
authors: Nathan W
authors: NW
authors: Pearlman
authors: Dexiang
authors: D
authors: Gao
authors: Robert
authors: R
authors: Stovall
authors: Csaba
authors: C
authors: Gajdos
authors: Nicole
authors: N
authors: Kounalakis
authors: Rene
authors: R
authors: Gonzalez
authors: Karl D
authors: KD
authors: Lewis
authors: William A
authors: WA
authors: Robinson
authors: Martin D
authors: MD
authors: McCarter
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors