In a nutshell
The authors analyzed the factors that predict the return of melanoma (recurrence) and the survival of recurrent melanoma patients following a negative diagnostic report.
Some background
One of the most important factors that predict the possibility of melanoma recurrence is the status of sentinel lymph node (SLN). SLN is the first lymph node (tiny, bean-shaped organs that help fight infection) to which the cancer cells are believed to have spread (metastasis). To determine the status of SLN, a procedure known as sentinel lymph node biopsy (SLNB) is carried out. It involves taking a tissue sample to determine whether the cancer has spread to the nearby lymph nodes. However, many patients experience a delayed melanoma recurrence, even after a negative SLNB result.
Therefore, a longer follow-up and understanding of the factors linked with the relapse of melanoma are required.
Methods & findings
The authors aimed to determine the predictive factors and the patterns of melanoma recurrence in patients with a negative SLNB result.
515 melanoma patients were included in this study. All patients had a negative SLNB result. 83 (16%) patients experienced melanoma recurrence at 23 months during an average follow-up of 61 months. Of these, 21 patients had recurrence in the lymph nodes that were examined during SLNB.
The average tumor thickness (how far the cancer reached deep into the skin) in recurrent melanoma patients was 2.7 mm compared to 1.8 mm in non-recurrent melanoma. 32.5% of recurrent melanoma tumors were ulcerated (tumor breaking through skin’s surface) compared to 13.5% in non-recurrent melanoma.
31.8% of melanoma recurrences affected the head and neck regions. The average survival time following a recurrence was 21 months. In general, diagnosis at a younger age had a lower risk of recurrence. The risk of melanoma recurrence was 9% in the female population compared to 21% in the male population.
The bottom line
The authors concluded that increasing tumor thickness, ulceration of tumor, increasing age, male sex and tumors in the head and neck regions were associated with melanoma recurrence after a negative SLNB result. They further suggested that long-term follow-up was necessary for this group of patients.
What’s next?
If your SLNB result is negative but you may have any of the risk factors mentioned, talk to your doctor about a long-term follow-up plan.
Published By :
JAMA surgery
Date :
May 01, 2013
