Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1934–1942 | Cite as

Patterns of First-Recurrence and Post-recurrence Survival in Patients with Primary Cutaneous Melanoma After Sentinel Lymph Node Biopsy

  • Kimberly M. Dalal
  • Ami Patel
  • Mary S. Brady
  • David P. Jaques
  • Daniel G. Coit



Sentinel lymph node biopsy (SLNB) has become well accepted in management of patients with primary cutaneous melanoma. An understanding of the pattern of recurrence after SLNB is helpful in coordinating a rational plan of follow-up in these patients. We sought to determine the site and timing of initial recurrence and post-recurrence survival after SLNB.


Stage I/II melanoma patients who underwent SLNB during 1991–2004 were identified from a prospective single-institution database. Site and date of first recurrence after SLNB were recorded. Patterns of recurrence after SLNB and post-recurrence survival were analyzed.


One thousand and forty-six patients underwent SLNB. The sentinel lymph node (SLN) was positive in 164 patients (16%). Median follow-up was 36 months for survivors. Median and 3-year relapse-free survival for SLN-positive patients were 41 months and 56%, and for SLN-negative patients were not reached and 87%, respectively (P < .0001). Of the SLN-positive patients, 47% experienced recurrence, compared with 14% SLN-negative patients. The pattern of recurrence stratified by SLN status was similar between the two groups (P = NS). After recurrence, the site of recurrence was the only significant prognostic factor influencing survival (P < .0001).


Although SLN-positive patients experience recurrence far earlier and more frequently than SLN-negative patients, the pattern of recurrence is similar. After recurrence, its site is the primary determinant of survival.


Melanoma Recurrence Sentinel lymph node biopsy Post-recurrence survival 


  1. 1.
    Jemal A, Murray T, Ward E, et al. Cancer Statistics, 2006. CA Cancer J Clin 2006;56:106–30PubMedCrossRefGoogle Scholar
  2. 2.
    Stadelmann W, Rapaport D, Soong S, et al. Prognostic clinical and pathologic features. In: Balch CHA, Sober A, Soong S, ed. Cutaneous Melanoma. St. Louis, MO: Quality Medical, 1998:11–35Google Scholar
  3. 3.
    Clary BM, Brady MS, Lewis JJ, Coit DG. 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. Ann Surg 2001;233:250–8PubMedCrossRefGoogle Scholar
  4. 4.
    Gershenwald JE, Colome MI, Lee JE, et al. Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with stage I or II melanoma. J Clin Oncol 1998;16:2253–60PubMedGoogle Scholar
  5. 5.
    Gadd MA, Coit DG. Recurrence patterns and outcome in 1019 patients undergoing axillary or inguinal lymphadenectomy for melanoma. Arch Surg 1992;127:1412–6PubMedGoogle Scholar
  6. 6.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9PubMedGoogle Scholar
  7. 7.
    Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–83PubMedGoogle Scholar
  8. 8.
    Gadd MA, Cosimi AB, Yu J, et al. Outcome of patients with melanoma and histologically negative sentinel lymph nodes. Arch Surg 1999;134:381–7PubMedCrossRefGoogle Scholar
  9. 9.
    Essner R, Conforti A, Kelley MC, et al. Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999;6:442–9PubMedCrossRefGoogle Scholar
  10. 10.
    McCarthy W, Shaw H, Thompson J, et al. Time and frequency of recurrence of cutaneous stage I malignant melanoma with guidelines for follow-up study. Surg Gynecol Obstet 1988;166:497–502PubMedGoogle Scholar
  11. 11.
    Wagner JD, Gordon MS, Chuang TY, et al. Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma. Cancer 2000;89:453–62PubMedCrossRefGoogle Scholar
  12. 12.
    McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol 2001;8:192–7PubMedCrossRefGoogle Scholar
  13. 13.
    Fincher TR, McCarty TM, Fisher TL, et al. Patterns of recurrence after sentinel lymph node biopsy for cutaneous melanoma. Am J Surg 2003;186:675–81PubMedCrossRefGoogle Scholar
  14. 14.
    Chao C, Wong SL, Ross MI, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg 2002;184:520–5PubMedCrossRefGoogle Scholar
  15. 15.
    Zogakis TG, Essner R, Wang H, et al. Melanoma recurrence patterns after negative sentinel lymphadenectomy. Arch Surg 2005;140:865–72PubMedCrossRefGoogle Scholar
  16. 16.
    Jansen L, Nieweg OE, Peterse Jl, et al. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg 2000;87:484–9PubMedCrossRefGoogle Scholar
  17. 17.
    Statius Muller MG, van Leeuwen PA, van Diest PJ, et al. Pattern and incidence of first site recurrences following sentinel node procedure in melanoma patients. World J Surg 2002;26:1405–11PubMedCrossRefGoogle Scholar
  18. 18.
    Wagner JD, Ranieri J, Evdokimow DZ, et al. Patterns of initial recurrence and prognosis after sentinel lymph node biopsy and selective lymphadenectomy for melanoma. Plast Reconstr Surg 2003;112:486–97PubMedCrossRefGoogle Scholar
  19. 19.
    Balch CM, Soong S, Smith T, et al. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1–4 mm melanomas. Ann Surg Oncol 2001;8:101–108PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Kimberly M. Dalal
    • 1
  • Ami Patel
    • 1
  • Mary S. Brady
    • 1
  • David P. Jaques
    • 1
  • Daniel G. Coit
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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