Early recurrence after lymphatic mapping and sentinel node biopsy in patients with primary extremity melanoma: A comparison with elective lymph node dissection

Introduction: Although sentinel node biopsy with completion lymphadenectomy in node-positive patients (SLND) has been widely adopted in the management of patients with early stage melanoma, reports detailing the outcome of pa tients after SLND are limited. To address this issue, we analyzed our exper ience with SLND and provided a comparison to patients treated with elective lymph node dissection (ELND). Methods: All patients who underwent SLND (1991-1998) and ELND (1974-1994) w ere identified from single institution melanoma databases. Results: A total of 152 and 329 patients with early-stage melanoma of the e xtremity underwent SLND and ELND. respectively. Nodal metastases were prese nt in 44 of 329 ELND patients (13%) and in 31 of 152 SLND patients (20%). E arly relapse-free and disease-specific survivals were similar for the entir e population, although in patients at higher risk for recurrence (age > 50 years, thickness >3.0 mm). there was an increased rate of relapse in the SL ND group (P = .04). Among all sites of early recurrences, locoregional site s were more common in patients undergoing SLND (72%) compared with ELND (39 %, P < .01). SLN-negative patients with nodal recurrence had evidence of me tastases on retrospective enhanced pathologic analysis in four of seven cas es. Conclusions: Although overall relapse-free and disease-specific survivals a re similar, there is a higher rate of relapse in a subset of SLND node-nega tive patients who are at high risk for nodal metastases. ELND and SLNB shou ld not be thought of as equivalent approaches until studies with longer fol low-up are available.