Survival following melanoma recurrence after negative sentinel lymph node biopsy
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Survival following melanoma recurrence after negative sentinel lymph node biopsy

› Forums › General Melanoma Community › Survival following melanoma recurrence after negative sentinel lymph node biopsy

  • Post
    • January 31, 2013 at 8:23 pm
    lou2
    Participant

    Long-Term Follow-Up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result

     

    JAMA Surgery. 2013 Jan 16;[Epub Ahead of Print], EL Jones, TS Jones, NW Pearlman, et al

     

    Long-Term Follow-Up and Survival of Patients Following a Recurrence of Melanoma After a Negative Sentinel Lymph Node Biopsy Result

     

    JAMA Surgery. 2013 Jan 16;[Epub Ahead of Print], EL Jones, TS Jones, NW Pearlman, et al

     

    TAKE-HOME MESSAGE

    Retrospective review of 520 melanoma patients with a negative sentinel lymph node biopsy showed an overall recurrence rate of 16%, with median follow-up of 61 months. For recurrences in the sampled nodal basin, the false-negative rate was 4%. Factors that significantly predicted recurrence were increasing age, increasing Breslow thickness, the presence of ulceration, and lesions in the head and neck.

     

    SUMMARY

    OncologySTAT Editorial Team

    The status of the sentinel lymph node (SLN) is the strongest predictor of recurrence in melanoma. However, false-negative SLN biopsy (SLNB) results are possible. Because melanoma recurrences are often delayed, long follow-up is necessary to clearly define the patterns of recurrence after a negative SLNB and the factors that predict recurrence risk in these patients.

    Jones et al reviewed the charts of 515 melanoma patients who had a negative SLNB (performed by one of two investigators at the University of Colorado Hospital, Aurora) between 1996 and 2008. There were 5 patients with two separate lesions with separate SLNBs and so were counted twice for a total of 520 patients. Median follow-up was 61 months (range, 0–154 months).

    Of the 520 patients with a negative SLNB, 83 (16%) had a recurrence a median of 23 months (range, 2–106) after diagnosis. Only 21 patients had a recurrence in the sampled nodal basin for an in-basin false-negative rate of 4%.

    In univariate analysis, significant predictive factors for recurrence after a negative SLNB were male sex, older age at diagnosis, increasing Breslow thickness of the primary lesion, the presence of ulceration, and lesions located in the head and neck region. (Clark level, mitoses, lymphovascular invasion, and regression did not predict recurrence.) In multivariate analysis, all of the predictive factors remained significant except male sex.

    Of the 83 patients with a recurrence after a negative SLNB result, 40 (48.2%) died. Median survival after recurrence was 15.5 months (range, 1–73 months). The 5-year overall survival (OS) probability was significantly lower in the patients who experienced a recurrence compared with those who did not (68% vs 98%). For all patients with a negative SLNB, OS was 91%.

    When patients with unknown location of recurrence were excluded, the initial location of recurrence (local, in-transit, regional, or distant) did not significantly affect OS. This finding is contrary to the supposition that local or in-transit recurrences may be caught earlier and resected, leading to improved survival.

    Among the 26 patients with a distant recurrence, 13 died, and patients with gastrointestinal, liver, and/or multiple metastases tended to have a lower survival probability.

    The long median time to recurrence (23 months) in this study highlights the importance of long-term follow-up for these patients. The optimal time for a final postoperative visit has yet to be determined, but in the current study, a follow-up time of just 5 years would have missed 10.8% of recurrences.

    Access the article »

Viewing 8 reply threads
  • Replies
      • January 31, 2013 at 8:33 pm
      JC
      Participant

      Geez, what the heck did I have a SLNB for then?  And, why be thankful for negative results when it doesn't mean anything?

      • January 31, 2013 at 8:33 pm
      JC
      Participant

      Geez, what the heck did I have a SLNB for then?  And, why be thankful for negative results when it doesn't mean anything?

        • January 31, 2013 at 9:35 pm
        POW
        Participant

        Hey! Calm down! I think you're misinterpreting this article.

        This article says that if your SLNB is negative you have an 86% chance of NEVER having a recurrence! Them's pretty good odds to me.

        Furthermore, the article goes on to state: "The overall 5-year survival probability for patients with a negative SLNB result is 91%." What that means to me is that most people who have negative SNLBs are closely monitored for years afterward and if there IS a recurrence, it is found and treated quickly. 

        What this study is doing is trying to figure out, in those cases where there IS a recurrence, why did that happen? What should the surgeons and pathologists be looking for to alert them to be extra vigilant with this patient? The answer they came up with is: deep lesions (median 2.8 mm), ulcerated lesions, location in head or neck, and age and gender of patient. All of which I think we already knew. Interestingly, Clark level, number of mitoses, lymphovascular invasion, and regression did not predict recurrence. So we can relax about those.

        So if I had a melanoma with a negative SNLB, I'd be vastly relieved. But I'd be sure to continue regular check-ups with a melanoma specialist for at least 5 years. Again, I think we already knew that. It's just to see the solid data.

        • January 31, 2013 at 9:35 pm
        POW
        Participant

        Hey! Calm down! I think you're misinterpreting this article.

        This article says that if your SLNB is negative you have an 86% chance of NEVER having a recurrence! Them's pretty good odds to me.

        Furthermore, the article goes on to state: "The overall 5-year survival probability for patients with a negative SLNB result is 91%." What that means to me is that most people who have negative SNLBs are closely monitored for years afterward and if there IS a recurrence, it is found and treated quickly. 

        What this study is doing is trying to figure out, in those cases where there IS a recurrence, why did that happen? What should the surgeons and pathologists be looking for to alert them to be extra vigilant with this patient? The answer they came up with is: deep lesions (median 2.8 mm), ulcerated lesions, location in head or neck, and age and gender of patient. All of which I think we already knew. Interestingly, Clark level, number of mitoses, lymphovascular invasion, and regression did not predict recurrence. So we can relax about those.

        So if I had a melanoma with a negative SNLB, I'd be vastly relieved. But I'd be sure to continue regular check-ups with a melanoma specialist for at least 5 years. Again, I think we already knew that. It's just to see the solid data.

        • February 1, 2013 at 1:24 am
        lou2
        Participant

        What I would rather know is how many people who did not have this biopsy had a recurrence.  Then you might know if it was worthwhile doing.

        • February 1, 2013 at 1:24 am
        lou2
        Participant

        What I would rather know is how many people who did not have this biopsy had a recurrence.  Then you might know if it was worthwhile doing.

        • February 1, 2013 at 2:05 am
        POW
        Participant

        Did you have an SNLB? And all the lymph nodes were negative for melanoma? If so, what are you so angry about? Are you wishing you did not have an SNLB? 

        • February 1, 2013 at 2:05 am
        POW
        Participant

        Did you have an SNLB? And all the lymph nodes were negative for melanoma? If so, what are you so angry about? Are you wishing you did not have an SNLB? 

        • February 1, 2013 at 9:40 pm
        qtkitycat
        Participant

        My fiance had a 2 SNLB 6/2012 that were both negative.

        Now, 7 months later, the melanoma is widespread to several organs.  There is definately something that was missed.  This needs to be addressed.  Being sent home with a confident feeling that the cancer is gone, only to find out months later it was there the whole time eating away at every organ it could find is devastating.

        • February 1, 2013 at 9:40 pm
        qtkitycat
        Participant

        My fiance had a 2 SNLB 6/2012 that were both negative.

        Now, 7 months later, the melanoma is widespread to several organs.  There is definately something that was missed.  This needs to be addressed.  Being sent home with a confident feeling that the cancer is gone, only to find out months later it was there the whole time eating away at every organ it could find is devastating.

        • February 1, 2013 at 10:04 pm
        TAC
        Participant

        Did she also have a PET scan prior to her SNLB's? Sorry to hear that it has spread. If she did have a scan and it was clear, it is hard to reconcile this with her current state. Best wishes to you both.

        • February 1, 2013 at 10:04 pm
        TAC
        Participant

        Did she also have a PET scan prior to her SNLB's? Sorry to hear that it has spread. If she did have a scan and it was clear, it is hard to reconcile this with her current state. Best wishes to you both.

        • February 1, 2013 at 10:13 pm
        qtkitycat
        Participant

        No, there were no scans done.  They did the mapping for SLNB, then the surgery to remove them along with a wide excision where the original mole was located.

        • February 1, 2013 at 10:13 pm
        qtkitycat
        Participant

        No, there were no scans done.  They did the mapping for SLNB, then the surgery to remove them along with a wide excision where the original mole was located.

        • February 1, 2013 at 11:36 pm
        JC
        Participant

        your profile says initial Stage I, but over 4.00mm?  Is that Stage I?

        • February 1, 2013 at 11:36 pm
        JC
        Participant

        your profile says initial Stage I, but over 4.00mm?  Is that Stage I?

        • February 1, 2013 at 11:36 pm
        JC
        Participant

        your profile says initial Stage I, but over 4.00mm?  Is that Stage I?

        • February 1, 2013 at 11:58 pm
        TAC
        Participant

        Hindsight….there should have been a scan done no matter that a SNB was done. It is just one other test to see if anything suspicious shows up. I know that scans are frowned upon by some oncologists   just wait until there are symptoms. If I encounter one of these oncologists, I'll run as fast as possible away from them. There are idiots even in the doctor ranks. Just my opinion but seems like common sense to me to get a valid baseline which would include a scan plus a SNLB.

        • February 1, 2013 at 11:58 pm
        TAC
        Participant

        Hindsight….there should have been a scan done no matter that a SNB was done. It is just one other test to see if anything suspicious shows up. I know that scans are frowned upon by some oncologists   just wait until there are symptoms. If I encounter one of these oncologists, I'll run as fast as possible away from them. There are idiots even in the doctor ranks. Just my opinion but seems like common sense to me to get a valid baseline which would include a scan plus a SNLB.

        • February 2, 2013 at 12:03 am
        JC
        Participant

        i don't think that makes a doctor an idiot. . scans are routinely not done, not clinically recommended for Stage I asymptomatic patients

        • February 2, 2013 at 12:03 am
        JC
        Participant

        i don't think that makes a doctor an idiot. . scans are routinely not done, not clinically recommended for Stage I asymptomatic patients

        • February 2, 2013 at 12:03 am
        JC
        Participant

        i don't think that makes a doctor an idiot. . scans are routinely not done, not clinically recommended for Stage I asymptomatic patients

        • February 1, 2013 at 11:58 pm
        TAC
        Participant

        Hindsight….there should have been a scan done no matter that a SNB was done. It is just one other test to see if anything suspicious shows up. I know that scans are frowned upon by some oncologists   just wait until there are symptoms. If I encounter one of these oncologists, I'll run as fast as possible away from them. There are idiots even in the doctor ranks. Just my opinion but seems like common sense to me to get a valid baseline which would include a scan plus a SNLB.

        • February 1, 2013 at 10:13 pm
        qtkitycat
        Participant

        No, there were no scans done.  They did the mapping for SLNB, then the surgery to remove them along with a wide excision where the original mole was located.

        • February 1, 2013 at 10:04 pm
        TAC
        Participant

        Did she also have a PET scan prior to her SNLB's? Sorry to hear that it has spread. If she did have a scan and it was clear, it is hard to reconcile this with her current state. Best wishes to you both.

        • February 1, 2013 at 9:40 pm
        qtkitycat
        Participant

        My fiance had a 2 SNLB 6/2012 that were both negative.

        Now, 7 months later, the melanoma is widespread to several organs.  There is definately something that was missed.  This needs to be addressed.  Being sent home with a confident feeling that the cancer is gone, only to find out months later it was there the whole time eating away at every organ it could find is devastating.

        • February 1, 2013 at 2:05 am
        POW
        Participant

        Did you have an SNLB? And all the lymph nodes were negative for melanoma? If so, what are you so angry about? Are you wishing you did not have an SNLB? 

        • February 1, 2013 at 1:24 am
        lou2
        Participant

        What I would rather know is how many people who did not have this biopsy had a recurrence.  Then you might know if it was worthwhile doing.

        • January 31, 2013 at 9:35 pm
        POW
        Participant

        Hey! Calm down! I think you're misinterpreting this article.

        This article says that if your SLNB is negative you have an 86% chance of NEVER having a recurrence! Them's pretty good odds to me.

        Furthermore, the article goes on to state: "The overall 5-year survival probability for patients with a negative SLNB result is 91%." What that means to me is that most people who have negative SNLBs are closely monitored for years afterward and if there IS a recurrence, it is found and treated quickly. 

        What this study is doing is trying to figure out, in those cases where there IS a recurrence, why did that happen? What should the surgeons and pathologists be looking for to alert them to be extra vigilant with this patient? The answer they came up with is: deep lesions (median 2.8 mm), ulcerated lesions, location in head or neck, and age and gender of patient. All of which I think we already knew. Interestingly, Clark level, number of mitoses, lymphovascular invasion, and regression did not predict recurrence. So we can relax about those.

        So if I had a melanoma with a negative SNLB, I'd be vastly relieved. But I'd be sure to continue regular check-ups with a melanoma specialist for at least 5 years. Again, I think we already knew that. It's just to see the solid data.

      • January 31, 2013 at 8:33 pm
      JC
      Participant

      Geez, what the heck did I have a SLNB for then?  And, why be thankful for negative results when it doesn't mean anything?

      • February 1, 2013 at 2:16 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

      • February 1, 2013 at 2:16 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • March 7, 2013 at 3:16 pm
        ruby
        Participant

        I am glad to have read your post today It has given me hope that my negative SLNB after recurrence will not progress also thank you 🙂

         

        I am currently trying to decide whether interferon is a good option I am supposed to start a week on monday any advise would be wonderful… my story is:

        ….

        I first had a 0.9mm melanoma remove from my skin in 2008 31/12/2012 I was diagnosed with a 3 mm local recurrent in the scar line this has been removed and I have been lucky enough to be told negative node after SLNB.

         

        I have now bee told to take interferon for 4 weeks high dose and then 12 months delf administered… I have a 8 month old baby to look after a 13 year old daughter and am scared I will not cope whilsy on the course I also live in ireland away from all my family I am put off my the bad side effects but also dont want to regret not taking this chance to see off the monster your thoughts advice anythink welcomed as this is the hardest of decisions..

        x

        • December 4, 2015 at 3:22 pm
        jenny22
        Participant

        Hi Tac-

        I read through your entire history…WOW….Wondered how you are doing….

        I hope things are still "controlled" for you….

        Best,

        jenny

        • December 4, 2015 at 3:22 pm
        jenny22
        Participant

        Hi Tac-

        I read through your entire history…WOW….Wondered how you are doing….

        I hope things are still "controlled" for you….

        Best,

        jenny

        • December 4, 2015 at 3:22 pm
        jenny22
        Participant

        Hi Tac-

        I read through your entire history…WOW….Wondered how you are doing….

        I hope things are still "controlled" for you….

        Best,

        jenny

      • February 1, 2013 at 2:16 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

      • February 1, 2013 at 2:18 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

      • February 1, 2013 at 2:18 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

      • February 1, 2013 at 2:18 pm
      TAC
      Participant

      I am Stage IIIb and have been so for over 11 years in spite of 6 recurrences after 2 sentinel node biopsies were all clear with 11 lymph nodes being removed. I have tried interferon, radiation, a vaccine and Leukine…recurrences happened during each of them. All of my recurrences were within 1 – 2 inches of my original lesion on the left side of my face in my hairline. I discovered all of the recurrences. They were surgically removed. Had 4 skin grafts. Fortunately they did not metastasize into an organ.

      The sentinel node biopsy is just a way to know if the mel has made it into the sentinel node. In my case it was not a predictor of recurrences. I would do the sentinle node biopsies over again. 

       

      The obvious part of this is to be vigilant….know your body well, know the area around the original lesion if possible, do your own lymph basin checks. Best of luck.

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