title: Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients.
abstract: BACKGROUND
  Since its introduction, the sentinel lymph node biopsy (SLNB) has become the standard staging procedure in clinical node-negative melanoma patients. A negative SLNB, however, does not guarantee a recurrence-free survival. Insight into metastatic patterns and risk factors for recurrence in SLNB negative melanoma patients can provide patient tailored guidelines.
  
  
  METHODS
  Data concerning melanoma patients who underwent SLNB between 1996 and 2015 in a single center were prospectively collected. Cox regression analyses were used to determine variables associated with overall recurrence and distant first site of recurrence in SLNB-negative patients.
  
  
  RESULTS
  In 668 patients, SLNBs were performed between 1996 and 2015. Of these patients, 50.4 % were male and 49.6 % female with a median age of 55.2 (range 5.7-88.8) years. Median Breslow thickness was 2.2 (range 0.3-20) mm. The SLNB was positive in 27.8 % of patients. Recurrence rates were 53.2 % in SLNB-positive and 17.9 % in SLNB-negative patients (p < 0.001). For SLNB-negative patients, the site of first recurrence was distant in 58.5 %. Melanoma located in the head and neck region (hazard ratio 4.88, p = 0.003) and increasing Breslow thickness (hazard ratio 1.15, p = 0.013) were predictive for distant first site of recurrence in SLNB-negative patients. SLNB-negative patients with a nodular melanoma and ulceration had a recurrence rate of 43.1 %; the site of recurrence was distant in 64 % of these patients.
  
  
  CONCLUSIONS
  The recurrence rates of SLNB-negative nodular ulcerative melanoma patients approach those of SLNB-positive patients. Stringent follow-up is recommended in this subset of patients.
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Faut
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Wevers
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Ginkel
authors.affiliation: Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Gilles F H
authors.initials: GF
authors.lastname: Diercks
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Schelto
authors.initials: S
authors.lastname: Kruijff
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Lukas B
authors.initials: LB
authors.lastname: Been
authors.affiliation: Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. b.l.van.leeuwen@umcg.nl.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: van Leeuwen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*