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Original Article |
1 Sydney Melanoma Unit and Melanoma and Skin Cancer Research Institute, Sydney Cancer Centre, Gloucester House, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, New South WalesAustralia
2 Discipline of Surgery, Faculty of Medicine, University of Sydney, Sydney, 2006, New South WalesAustralia
3 Department of Surgery, University of Calgary, 1331 29th Street NW, Calgary, Alberta T2N9 4N2Canada
4 Department of Anatomical Pathology, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, New South WalesAustralia
5 Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, 100 Carillon Avenue, Newtown, 2042, New South WalesAustralia
6 Discipline of Medicine, University of Sydney, Sydney, 2006, New South WalesAustralia
Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD Sydney Melanoma Unit and Skin Cancer Research Institute, Sydney Cancer Centre, Gloucester House, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, New South Wales, Australia; E-mail: thompson{at}smu.org.au.
Background: A negative sentinel node biopsy (SNB) implies a good prognosis for mela-noma patients. The purpose of this study was to determine the long-term outcome for mel-anoma patients with a negative SNB.
Methods: Survival and prognostic factors were analyzed for 836 SNB-negative patients. All patients with a node field recurrence were reviewed, and sentinel node (SN) tissue was reexamined.
Results: The median tumor thickness was 1.7 mm, and 23.8% were ulcerated. The median follow-up was 42.1 months. Melanoma specific survival at 5 years was 90%, compared with 56% for SN-positive patients (P < .001). On multivariate analysis, only thickness and ulceration retained significance for disease-free and disease-specific survival. Five-year survival for patients with nonulcerated lesions was 94% vs. 78% with ulceration. Eighty-three patients (9.9%) had a recurrence. Twenty-seven patients developed recurrence in the regional node field, and in 22 of these, it was the first recurrence site. Six developed local recurrence, 17 an intransit metastasis, and 58 distant disease. The false-negative rate was 13.2%. SN slides and tissue blocks were further examined in 18 patients with recurrence in the node field, and metastatic disease was found in 3 of them.
Conclusions: This large, single-center study confirms that patients with a negative SNB have a significantly better prognosis than those with positive SNs. In those with a negative SNB, primary tumor thickness and ulceration are independent predictors of survival. Incorrect pathologic diagnosis contributed to only a minority of the false-negative results in this study.
Key Words: Melanoma • Sentinel lymph node • Metastasis • Survival
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