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Risk factors and patterns of recurrence after sentinel lymph node biopsy for thin melanoma

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Abstract

While having a thin melanoma (defined as AJCC 8 T1 stage tumor ≤ 1.0 mm) with negative sentinel lymph node biopsy (SLNB) provides an excellent prognosis, some patients still develop recurrence and die. To determine risk factors for any recurrence (local/in-transit, nodal, distant) in thin melanoma patients with negative SLNB and assess survival outcomes. Retrospective review of thin melanomas with negative SLNB from 1999 to 2018 was performed. Two hundred and nine patients were identified. Clinicopathologic characteristics of the primary melanoma were collected. Patterns of recurrence for local/in-transit, nodal or distant recurrence and survival outcomes were analyzed. Eighteen patients (8.6%) developed recurrence: 3 (1.9%) local/in-transit, 4 (2.9%) regional/nodal, and 11 (5.3%) distant recurrence during a median follow-up time of 62 months. A multivariate Cox regression model showed that head and neck site (HR 3.52), ulceration (HR 10.8), and mitotic rate (HR 1.39) were significant risk factors for recurrence. Median time to first recurrence was 49 months. Patients with recurrence had a significantly worse 5 year overall survival than those without recurrence (82.2 vs 99.2%). A retrospective single center study and limited sample size. Did not factor in possible false negative SLNBs when calculating hazard ratios. For thin melanoma patients with negative SLNB, heightened surveillance is warranted for those with ulceration, primary tumor location on the head or neck, and elevated mitotic rate.

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Funding

This study was partially supported by the IDP Foundation and the Melanoma Research Foundation (SP0043559).

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Author notes

  1. Daniel Kim and Stanley Chu have contributed to this article equally.

Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Daniel Kim, Ayesha U. Khan, Elsy V. Compres, Pedram Gerami & Jeffrey D. Wayne

  2. Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA

    Stanley Chu & Jeffrey D. Wayne

  3. Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Hui Zhang

  4. Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Pedram Gerami & Jeffrey D. Wayne

Authors
  1. Daniel Kim
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Correspondence to Jeffrey D. Wayne.

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Conflict of interest

Dr. Gerami has served as a consultant for Myriad Genomics, DermTech Int., Merck and Castle Biosciences and has received honoraria for this. Dr. Wayne is on the speaker’s bureau for Novartis Pharmaceuticals and Castle Biosciences and has received honoria for this work. All other authors report no relevant conflicts of interest.

IRB approval

Reviewed and approved by Northwestern IRB, STU1127, STU00209856.

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Kim, D., Chu, S., Khan, A.U. et al. Risk factors and patterns of recurrence after sentinel lymph node biopsy for thin melanoma. Arch Dermatol Res 314, 285–292 (2022). https://doi.org/10.1007/s00403-021-02229-8

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  • DOI: https://doi.org/10.1007/s00403-021-02229-8

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