Open AccessMelanoma Recurrence after Negative Sentinel Lymph Node Biopsy
Author(s) -
DavisMalesevich Melinda,
Goepfert Ryan,
Myers Jeffrey N.
Publication year - 2011
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599811416318a94
Subject(s) - medicine , sentinel lymph node , breslow thickness , perineural invasion , melanoma , biopsy , mucosal melanoma , sentinel node , metastasis , head and neck , wide local excision , surgery , radiology , cancer , breast cancer , cancer research
Objective Delineate clinico‐pathologic factors associated with recurrence of cutaneous melanoma of the head and neck region and survival after negative sentinel lymph node biopsy (SLNB). Method A retrospective review from January 2000 to June 2009 was conducted at a tertiary referral center. Characteristics and outcomes of 204 patients with head and neck melanoma who underwent negative SLNB were analyzed in a univariant and multivariant fashion. Main outcomes measured included: local, regional, distant recurrences, and survival. Results A total of 204 patients with cutaneous melanoma of the head and neck underwent successful SLNB, in which final pathology was negative for nodal metastasis. Fifty‐nine recurrences occurred in 42 patients: local/in‐transit 18, regional 17, and distant metastasis 24. Five recurrences occurred within the same nodal basin that harbored the negative SLN(s). Decreased survival was associated with Breslow thickness ( P <. 05) and ulceration ( P <. 006). Local recurrence was associated with Clark level, Breslow thickness, and perineural invasion ( P <. 05). Regional recurrence was correlated with Breslow thickness ( P <. 05). Distant metastasis was associated with Breslow thickness, ulceration, nodular histology, and negative SLN(s) located in level V ( P <. 05). Conclusion Regional recurrence in a primary echelon nodal basin after negative SLNB is rare (2‐4%) and is associated with increased Breslow thickness (>2.0mm). Thus, sentinel node biopsy is highly effective in assessing the draining nodal basin for metasatic disease and for directing further treatment leading to regional disease control.