Sentinel lymph node biopsy in the management of patients with primary cutaneous melanoma: Review of a large single-institutional experience with an emphasis on recurrence

Objective To analyze the authors' experience with sentinel lymph node biops y (SLNB) and the subsequent incidence and pattern of recurrence in patients with positive and negative nodes. Summary Background Data Lymphatic mapping with SLNB has become widely accep ted in the management of patients with melanoma who are at risk for occult regional lymph node metastases. Because this procedure is relatively new, t he pattern of recurrence after SLNB is not yet clear. Methods All patients with primary cutaneous melanoma who underwent SLNB fro m 1991 through 1998 were identified from a prospective single-institution m elanoma database. Results Three hundred fifty-seven consecutive patients with localized prima ry cutaneous melanoma who underwent SLNB were identified. The sentinel node was identified in 332 patients (93%) and was positive in 56 (17%). Fourtee n percent of patients had developed a recurrence at a median follow-up of 2 4 months. The median time to recurrence was 13 months. The 3-year relapse-f ree survival rates for patients with positive and negative nodes were 56% a nd 75%, respectively. SLN status was the most important predictor of diseas e recurrence. The site of first recurrence in patients with negative and po sitive nodes was more commonly locoregional than distant. Reexamination of the SLN in 11 patients with negative nodes with initial nodal and in-transi t recurrence showed evidence of metastases in 7 (64%). Conclusions Patients with positive sentinel nodes have a significantly incr eased risk for recurrence. The early pattern of first recurrence for patien ts with negative and positive results is characterized by a preponderance o f locoregional sites, similar to that reported in previous series of electi ve lymph node dissection. These data underscore the need for careful pathol ogic analysis of the SLN as well as a careful, directed locoregional physic al examination in the follow-up of these patients.