{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:57:07Z","timestamp":1769601427256,"version":"3.49.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T00:00:00Z","timestamp":1591056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Two RCTs found no survival benefit for completion lymphadenectomy after positive sentinel lymph node biopsy compared with observation with ultrasound in patients with melanoma. Recurrence patterns and regional control are not well described for patients undergoing observation alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients with a positive sentinel node biopsy who did not have immediate completion lymphadenectomy were identified from a single-institution database (1995\u20132018). First recurrences were classified as node only, local and in-transit (LCIT) only, LCIT and nodal, or systemic. Regional control and factors associated with recurrence survival were analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Median follow-up was 33 months. Of 370 patients, 158 (42\u00b77 per cent) had a recurrence. The sites of first recurrence were node only (13\u00b72 per cent), LCIT only (11\u00b79 per cent), LCIT and nodal (3\u00b75 per cent), and systemic (13\u00b78 per cent). The 3-year postrecurrence melanoma-specific survival rate was 73 (95 per cent c.i. 54 to 86) per cent for patients with node-only first recurrence, and 51 (31 to 68) per cent for those with initial systemic recurrence. In multivariable analysis, ulceration in the primary lesion (hazard ratio (HR) 2\u00b753, 95 per cent c.i. 1\u00b727 to 5\u00b704), disease-free interval 12 months or less (HR 2\u00b738, 1\u00b728 to 4\u00b735), and systemic (HR 2\u00b757, 1\u00b716 to 5\u00b765) or LCIT and nodal (HR 2\u00b794, 1\u00b711 to 7\u00b779) first recurrence were associated significantly with decreased postrecurrence survival. Maintenance of regional control required therapeutic lymphadenectomy in 13\u00b70 per cent of patients during follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Observation after a positive sentinel lymph node biopsy is associated with good regional control, permits assessment of the time to and pattern of recurrence, and spares lymphadenectomy-related morbidity in patients with melanoma.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.11621","type":"journal-article","created":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T11:03:26Z","timestamp":1591095806000},"page":"1480-1488","source":"Crossref","is-referenced-by-count":17,"title":["Nodal and systemic recurrence following observation of a positive sentinel lymph node in melanoma"],"prefix":"10.1093","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-153X","authenticated-orcid":false,"given":"E K","family":"Bartlett","sequence":"first","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A Y","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Langone Health , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P M","family":"Spanheimer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D M","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M S","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C E","family":"Ariyan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D G","family":"Coit","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"key":"2022100812582832300_bjs11621-bib-0001","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMoa060992","article-title":"Sentinel-node biopsy or nodal observation in melanoma","volume":"355","author":"Morton","year":"2006","journal-title":"N Engl J 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