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Clinical Outcome of Stage I/II Melanoma Patients After Selective Sentinel Lymph Node Dissection: Long-Term Follow-Up Results

R.J.C.L.M. Vuylsteke, P.A.M. van Leeuwen, M.G. Statius Muller, H.A. Gietema, D.R. Kragt, S. Meijer

From the Department of Surgical Oncology, VU University Medical Center, Amsterdam, the Netherlands.

Address reprint requests to S. Meijer, MD, PhD, VU University Medical Center, Department of Surgical Oncology, PO Box 7057, 1007 MB Amsterdam, the Netherlands; email: s.meijer{at}vumc.nl.

Purpose: Although sentinel lymph node (SLN) status is part of the new American Joint Committee on Cancer staging system, there is no final proof that the SLN procedure in melanoma patients influences outcome of disease. This study investigated the accuracy of the SLN procedure and clinical outcome in melanoma patients after at least 60 months of follow-up.

Patients and Methods: Between 1993 and 1996, 209 patients with stage I/II cutaneous melanoma underwent selective SLN dissection by the triple technique. If the SLN contained metastatic disease, a completion lymphadenectomy was performed. Survival analyses were performed using the Kaplan-Meier approach. Factors associated with survival were analyzed using the Cox proportional hazards regression model.

Results: The success rate was 99.5%. Median follow-up was 72 months. Forty patients (19%) had a positive SLN. The false-negative rate was 9%. Five-year overall survival was 87% for the entire group and 92% and 67% for SLN-negative and SLN-positive patients (P < .0001), respectively. All patients with a positive SLN and a Breslow thickness 1.00 mm survived, and SLN-positive patients with a Breslow thickness less than 2.00 mm tend to have a better prognosis compared with SLN-negative patients with a Breslow thickness greater than 2.00 mm. SLN status (P = .002), Breslow thickness (P = .002), and lymphatic invasion (P = .0009) were all found to be independent prognostic factors for overall survival.

Conclusion: With a success rate of 99.5% and a false-negative rate of 9% after long-term follow-up, the triple-technique SLN procedure is a reliable and accurate method. Survival data seem promising, although a therapeutic effect is still questionable. As shown in this study, not all SLN-positive patients have a poor prognosis.

Supported by a grant from the Fritz Ahlqvist Foundation, Aerdenhout, The Netherlands.

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