False-negative sentinel lymph node biopsy for melanoma: a single-surgeon experience

The status of the regional lymph node basin is of prognostic importance in patients with melanoma, making the performance of sentinel lymph node biopsies (SLNBs) a key component of patient care management, particularly with the advent of immunotherapy for adjuvant treatment. The primary goal of our study was to assess the false-negative rate of SLNBs among patients with melanoma.

We conducted a retrospective review of patients with melanoma undergoing SLNB by a single surgeon between Jan. 1, 2005, and Dec. 31, 2020. We extracted and cross-referenced patient demographic and pathologic information.

During the study period, 501 patients underwent an SLNB. Of these, 97 (19.4%) patients had pathologically positive sentinel lymph nodes and 404 (80.6%) patients had negative results. The latter were subject to further review; 84 (20.8%) patients subsequently developed recurrence, with 25 (6.2%) recurrences within the primary nodal basin. Isolated regional recurrence occurred in 11 (2.7%) patients and conjunction with a false-negative rate was 10.2%. Unadjusted recurrence rates were similar across each lymph node basin, including the axilla (2.7%), groin (3.6%), and neck (1.4%).

The false-negative SLNB rate was 10.2% for isolated regional recurrences. These findings need to be considered in the era of using adjuvant systemic therapy for patients with melanoma.