Recurrence of Melanoma After a Negative Sentinel Node Biopsy

Predictors and Impact of Recurrence Site on Survival

Daniel C. Thomas, Gang Han, Stanley P. Leong, Mohammed Kashani-Sabet, John Vetto, Barbara Pockaj, Richard L. White, Mark B. Faries, Schlomo Schneebaum, Nicola Mozzillo, Kim J. Charney, Vernon K. Sondak, Jane L. Messina, Jonathan S. Zager, Dale Han

Research output: Contribution to journalArticle

Abstract

Background: Factors that predict melanoma recurrence after a negative sentinel lymph node biopsy (SLNB) are not well-defined. We evaluated melanoma recurrence patterns, factors prognostic for recurrence, and the impact of recurrence on outcomes after a negative SLNB. Methods: The Sentinel Lymph Node Working Group database was evaluated from 1996 to 2016 for negative SLNB melanoma patients. Clinicopathologic characteristics were correlated with recurrence, overall survival (OS), and melanoma-specific survival (MSS). Results: Median follow-up was 32.1 months. Recurrences developed in 558 of 5351 negative SLN patients (10.4%). First-site of recurrence included a local or in-transit recurrence (LITR) in 221 cases (4.1%), nodal recurrence (NR) in 109 cases (2%), and distant recurrence (DR) in 220 cases (4.1%). On multivariable analysis, age, thickness, head/neck or lower extremity primary, and microsatellitosis significantly predicted for an LITR as first-site. Having an LITR as first-site significantly predicted for a subsequent NR and DR, and significantly predicted for worse OS and MSS. Furthermore, thickness and head/neck or lower extremity primary significantly predicted for an NR as first-site, while a prior LITR significantly predicted for a subsequent NR. Factors significantly predictive for a DR included thickness, head/neck or trunk primary, ulceration, and lymphovascular invasion. Patients with any type of locoregional recurrence were at higher risk for a DR. Conclusions: Recurrences occur in 10.4% of negative SLN patients, with LITR and DR being the most common types. Importantly, having an LITR significantly predicts for a subsequent NR and DR, and is prognostic for worse survival after a negative SLNB.

Original languageEnglish (US)
JournalAnnals of surgical oncology
DOIs
StatePublished - Jan 1 2019

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Melanoma
Biopsy
Recurrence
Survival
Sentinel Lymph Node Biopsy
cyhalothrin
Neck
Head
Lower Extremity

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Recurrence of Melanoma After a Negative Sentinel Node Biopsy : Predictors and Impact of Recurrence Site on Survival. / Thomas, Daniel C.; Han, Gang; Leong, Stanley P.; Kashani-Sabet, Mohammed; Vetto, John; Pockaj, Barbara; White, Richard L.; Faries, Mark B.; Schneebaum, Schlomo; Mozzillo, Nicola; Charney, Kim J.; Sondak, Vernon K.; Messina, Jane L.; Zager, Jonathan S.; Han, Dale.

In: Annals of surgical oncology, 01.01.2019.

Research output: Contribution to journalArticle

Thomas, DC, Han, G, Leong, SP, Kashani-Sabet, M, Vetto, J, Pockaj, B, White, RL, Faries, MB, Schneebaum, S, Mozzillo, N, Charney, KJ, Sondak, VK, Messina, JL, Zager, JS & Han, D 2019, 'Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival', Annals of surgical oncology. https://doi.org/10.1245/s10434-019-07369-w
Thomas, Daniel C. ; Han, Gang ; Leong, Stanley P. ; Kashani-Sabet, Mohammed ; Vetto, John ; Pockaj, Barbara ; White, Richard L. ; Faries, Mark B. ; Schneebaum, Schlomo ; Mozzillo, Nicola ; Charney, Kim J. ; Sondak, Vernon K. ; Messina, Jane L. ; Zager, Jonathan S. ; Han, Dale. / Recurrence of Melanoma After a Negative Sentinel Node Biopsy : Predictors and Impact of Recurrence Site on Survival. In: Annals of surgical oncology. 2019.
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title = "Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival",
abstract = "Background: Factors that predict melanoma recurrence after a negative sentinel lymph node biopsy (SLNB) are not well-defined. We evaluated melanoma recurrence patterns, factors prognostic for recurrence, and the impact of recurrence on outcomes after a negative SLNB. Methods: The Sentinel Lymph Node Working Group database was evaluated from 1996 to 2016 for negative SLNB melanoma patients. Clinicopathologic characteristics were correlated with recurrence, overall survival (OS), and melanoma-specific survival (MSS). Results: Median follow-up was 32.1 months. Recurrences developed in 558 of 5351 negative SLN patients (10.4{\%}). First-site of recurrence included a local or in-transit recurrence (LITR) in 221 cases (4.1{\%}), nodal recurrence (NR) in 109 cases (2{\%}), and distant recurrence (DR) in 220 cases (4.1{\%}). On multivariable analysis, age, thickness, head/neck or lower extremity primary, and microsatellitosis significantly predicted for an LITR as first-site. Having an LITR as first-site significantly predicted for a subsequent NR and DR, and significantly predicted for worse OS and MSS. Furthermore, thickness and head/neck or lower extremity primary significantly predicted for an NR as first-site, while a prior LITR significantly predicted for a subsequent NR. Factors significantly predictive for a DR included thickness, head/neck or trunk primary, ulceration, and lymphovascular invasion. Patients with any type of locoregional recurrence were at higher risk for a DR. Conclusions: Recurrences occur in 10.4{\%} of negative SLN patients, with LITR and DR being the most common types. Importantly, having an LITR significantly predicts for a subsequent NR and DR, and is prognostic for worse survival after a negative SLNB.",
author = "Thomas, {Daniel C.} and Gang Han and Leong, {Stanley P.} and Mohammed Kashani-Sabet and John Vetto and Barbara Pockaj and White, {Richard L.} and Faries, {Mark B.} and Schlomo Schneebaum and Nicola Mozzillo and Charney, {Kim J.} and Sondak, {Vernon K.} and Messina, {Jane L.} and Zager, {Jonathan S.} and Dale Han",
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TY - JOUR

T1 - Recurrence of Melanoma After a Negative Sentinel Node Biopsy

T2 - Predictors and Impact of Recurrence Site on Survival

AU - Thomas, Daniel C.

AU - Han, Gang

AU - Leong, Stanley P.

AU - Kashani-Sabet, Mohammed

AU - Vetto, John

AU - Pockaj, Barbara

AU - White, Richard L.

AU - Faries, Mark B.

AU - Schneebaum, Schlomo

AU - Mozzillo, Nicola

AU - Charney, Kim J.

AU - Sondak, Vernon K.

AU - Messina, Jane L.

AU - Zager, Jonathan S.

AU - Han, Dale

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Factors that predict melanoma recurrence after a negative sentinel lymph node biopsy (SLNB) are not well-defined. We evaluated melanoma recurrence patterns, factors prognostic for recurrence, and the impact of recurrence on outcomes after a negative SLNB. Methods: The Sentinel Lymph Node Working Group database was evaluated from 1996 to 2016 for negative SLNB melanoma patients. Clinicopathologic characteristics were correlated with recurrence, overall survival (OS), and melanoma-specific survival (MSS). Results: Median follow-up was 32.1 months. Recurrences developed in 558 of 5351 negative SLN patients (10.4%). First-site of recurrence included a local or in-transit recurrence (LITR) in 221 cases (4.1%), nodal recurrence (NR) in 109 cases (2%), and distant recurrence (DR) in 220 cases (4.1%). On multivariable analysis, age, thickness, head/neck or lower extremity primary, and microsatellitosis significantly predicted for an LITR as first-site. Having an LITR as first-site significantly predicted for a subsequent NR and DR, and significantly predicted for worse OS and MSS. Furthermore, thickness and head/neck or lower extremity primary significantly predicted for an NR as first-site, while a prior LITR significantly predicted for a subsequent NR. Factors significantly predictive for a DR included thickness, head/neck or trunk primary, ulceration, and lymphovascular invasion. Patients with any type of locoregional recurrence were at higher risk for a DR. Conclusions: Recurrences occur in 10.4% of negative SLN patients, with LITR and DR being the most common types. Importantly, having an LITR significantly predicts for a subsequent NR and DR, and is prognostic for worse survival after a negative SLNB.

AB - Background: Factors that predict melanoma recurrence after a negative sentinel lymph node biopsy (SLNB) are not well-defined. We evaluated melanoma recurrence patterns, factors prognostic for recurrence, and the impact of recurrence on outcomes after a negative SLNB. Methods: The Sentinel Lymph Node Working Group database was evaluated from 1996 to 2016 for negative SLNB melanoma patients. Clinicopathologic characteristics were correlated with recurrence, overall survival (OS), and melanoma-specific survival (MSS). Results: Median follow-up was 32.1 months. Recurrences developed in 558 of 5351 negative SLN patients (10.4%). First-site of recurrence included a local or in-transit recurrence (LITR) in 221 cases (4.1%), nodal recurrence (NR) in 109 cases (2%), and distant recurrence (DR) in 220 cases (4.1%). On multivariable analysis, age, thickness, head/neck or lower extremity primary, and microsatellitosis significantly predicted for an LITR as first-site. Having an LITR as first-site significantly predicted for a subsequent NR and DR, and significantly predicted for worse OS and MSS. Furthermore, thickness and head/neck or lower extremity primary significantly predicted for an NR as first-site, while a prior LITR significantly predicted for a subsequent NR. Factors significantly predictive for a DR included thickness, head/neck or trunk primary, ulceration, and lymphovascular invasion. Patients with any type of locoregional recurrence were at higher risk for a DR. Conclusions: Recurrences occur in 10.4% of negative SLN patients, with LITR and DR being the most common types. Importantly, having an LITR significantly predicts for a subsequent NR and DR, and is prognostic for worse survival after a negative SLNB.

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U2 - 10.1245/s10434-019-07369-w

DO - 10.1245/s10434-019-07369-w

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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