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OBJECTIVE(S): Sentinel lymph node biopsy (SLN) biopsy has shown great utility in the management of melanoma. An analysis of regional recurrence in previously mapped negative SLN basins is performed.
METHODS: A retrospective query of a prospective melanoma database from 1994-2006 identified 1283 patients who underwent successful SLN biopsy. One thousand fifty-six patients (82.3%) were SLN- and 227 patients SLN+ (17.7%). Clinical variables were examined for the impact on regional recurrence by multivariate analysis.
RESULTS: The mean follow-up for the entire group was 41.3 months. Thirty-two patients (3.1%) presented with an isolated regional recurrence in a previously mapped negative nodal basin. Pathological review of the SLNs harvested from these basins found 7 (21.9%) samples positive for metastatic melanoma. The 5-year survival was: SLN- 90.2%, false-SLN 31.6%, and SLN+ 50.0% (p<0.001). Multivariate analysis of risk factors for regional recurrence after negative SLN biopsy is depicted in the Table.
CONCLUSIONS: Head and neck tumor site is the strongest predictor of a false-negative SLN biopsy. Mechanisms other than SLN sampling error may contribute to the failure of the SLN biopsy in some patients. Patients with regional recurrence after negative SLN biopsy have a decreased 5-year survival compared to patients who presented with initially positive SLNs.

Risk factors for regional recurrence

Risk factors	P value	Odds ratio	Confidence interval (95%)
Female	0.30	1.23	0.83-1.84
Age > 53	0.60	0.99	0.97-1.01
Breslow depth > 2.5mm	<0.001	1.23	1.14-1.33
Ulceration	0.004	1.81	1.20-2.73
Head and neck site	<0.001	2.57	1.69-3.91

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