(ChemotherapyAdvisor) – Melanoma recurred in 16% of patients following a negative sentinel lymph node biopsy (SLNB) without evidence of metastatic disease, a study reported in JAMA Surgery online January 17, 2013.
“Because this is such an important prognostic factor, the reliability of the SLNB is key in determining prognosis and treatment, and it warrants further study, particularly for those who have a recurrence of melanoma after a negative SLNB result,” noted Edward L. Jones, MD, of the Department of Surgery, University of Colorado, Denver, Aurora CO, and colleagues.
The retrospective chart review of a prospectively created database of patients with cutaneous melanoma identified 515 patients between 1996 and 2008. Predictors and patterns of melanoma recurrence in patients with a negative SLN biopsy result were analyzed. Median follow-up was 61 months (range, 1-154 months).
Melanoma recurred at a median of 23 months in 83 patients, 21 of whom had melanoma that “metastasized in the studied nodal basin, for an in-basin false-negative rate of 4.0%,” Dr. Jones stated, results similar to those in previously reported studies.
“Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs. 1.8 mm; P<0.001) that were more likely to be ulcerated (32.5% vs. 13.5%, P<0.001) than those without recurrence,” the investigators reported.
Compared with all other locations combined, the primary melanoma of patients with recurrence was more likely to be located in the head and neck region, 31.8% versus 11.7% (P<0.001).
An invited critique noted that the therapeutic value of SLNB is “an area of continuing controversy,” especially with respect to the role of positive nodes and whether early intervention may prevent the progression of disease beyond the SLN and possibly improve survival.
“Although the answer to this question is being addressed in the Multicenter Selective Lymphadenectomy Trial II, the maturation of those results, once accrual is completed, remains years away. Until then, reports such as this add to the increasing body of literature that supports the continued use of an SLNB for prognosis and possibly therapy.”