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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
    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
        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?

          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?

              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.

                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.

                  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.

                    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.

                      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? 

                        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? 

                          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.

                            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.

                              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.

                                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.

                                  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.

                                    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.

                                      JC
                                      Participant

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

                                        JC
                                        Participant

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

                                          JC
                                          Participant

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

                                            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.

                                              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.

                                                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

                                                  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

                                                    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

                                                      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.

                                                        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.

                                                          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.

                                                            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.

                                                              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? 

                                                                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.

                                                                  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.

                                                                  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?

                                                                    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.

                                                                      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.

                                                                          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 πŸ™‚

                                                                             

                                                                            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

                                                                            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 πŸ™‚

                                                                               

                                                                              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

                                                                              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 πŸ™‚

                                                                                 

                                                                                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

                                                                                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 πŸ™‚

                                                                                   

                                                                                  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

                                                                                  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 πŸ™‚

                                                                                     

                                                                                    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

                                                                                    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 πŸ™‚

                                                                                       

                                                                                      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

                                                                                      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

                                                                                        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

                                                                                          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

                                                                                          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.

                                                                                            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.

                                                                                              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.

                                                                                                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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