Pattern and incidence of first site recurrences following sentinel node procedure in melanoma patients

• Published in: World journal of surgery 2002-12, Vol.26 (12), p.1405-1411
• Main Authors: Muller, Markwin G. Statius, van Leeuwen, Paul A. M., van Diest, Paul J., Pijpers, Rik, Nijveldt, Robert J., Vuylsteke, Ronald J. C. L. M., Meijer, Sybren
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; Breslow Thickness; Cohort Studies; Confidence Intervals; Female; Follow-Up Studies; Humans; Incidence; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Invasion; Lymphatic Metastasis; Male; Medical sciences; Melanoma; Melanoma - epidemiology; Melanoma - pathology; Melanoma - secondary; Melanoma - surgery; Melanoma Patient; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Positive Sentinel Node; Predictive Value of Tests; Probability; Prospective Studies; Risk Assessment; Sentinel Lymph Node Biopsy - statistics & numerical data; Sex Distribution; Skin Neoplasms - epidemiology; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Tumors
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-002-6197-8

Studies of large series of melanoma patients indicated that the average incidence of developing a recurrence during follow‐up was 40%. The most frequent first sites of these recurrences were the regional lymph nodes. We hypothesized that the sentinel node (SN) procedure may change the pattern of recurrence by reducing the number of first recurrences in the regional lymph node basin during follow‐up to a negligible number, and that locoregional cutaneous and distance metastases are the major future sites of recurrence. We further studied the influence of SN status together with different influential factors on prognosis. An SN procedure with a triple technique was performed in 250 consecutive patients with proven AJCC stages I and II cutaneous melanoma. The median follow‐up was 38 months. So far, 44 patients (18%) have developed a recurrence of the disease. The distribution of localization of the first metastases was as follows: 23 patients (52%) with a locoregional cutaneous recurrence; 4 (9%) with recurrence in the regional lymph node basin; 2 (5%) with recurrence in an interval node; and 15 (34%) with distant recurrence. The relative risk of developing recurrence for SN‐positive patients is 4.2; for Breslow thickness of 1.51 to 4.00 mm it is 5.5, and thicker than 4.0 mm it is 6.2; for lymphatic invasion 7.6; and for ulceration 3.8. We conclude that the SN procedure changes the pattern of recurrences during follow‐up by reducing the number of first recurrences within the regional lymph node basin to a negligible number. High Breslow thickness, lymphatic invasion, and ulceration of the primary melanoma are strong risk factors for recurrence. Résumé L’incidence de récidive de mélanome dans les grandes séries est de l’ordre de 40%. Ces récidives intéressent le plus souvent les ganglions lymphatiques régionaux. Notre hypothèse est que la technique de ganglion sentinelle (GS) réduit le nombre de récidives initiales dans le territoire de drainage direct alors que les récidives sont alors cutanées, locorégionales et à distance. Si cela était vrai, le nombre total de récidives pourrait être diminué. Nous avons étudié l’influence du GS et d’autres facteurs pronostiques. Chez 250 patients atteints de mélanome cutané stades I et II selon la classification AJCC, on a réalisé la technique de GS par la technique triple. La médiane de suivi a été de 38 mois. Jusqu’à présent, 44 patients (18%) ont développé une récidive. La distribution du site de la première métastase a