Predictive Factors for False Negative Sentinel Lymph Node in Melanoma Patients VINCENZO PANASITI, MD, PhD, Ã V ALERIA DEVIRGILIIS, MD, Ã MICHELA CURZIO, MD, Ã VINCENZO ROBERTI, MD, Ã SILVIA GOBBI, Ã MARIARITA ROSSI, MD, Ã UGO BOTTONI, MD, PhD, y RITA CLERICO, MD, Ã NICOLO SCUDERI, MD, Ã AND STEFANO CALVIERI, MD Ã BACKGROUND Sentinel lymph node biopsy (SLNB) represents a useful tool for staging melanoma patients. However false-negative SLNB are reported in the literature. OBJECTIVE The aim of our study is to identify predictive factors for false-negative SLNB in melanoma patients. MATERIALS AND METHODS We conducted a retrospective analysis on 316 melanoma patients who underwent SLNB and were followed up at the Department of Dermatology and Plastic Surgery of Uni- versity of Rome ‘‘Sapienza’’ from March 1994 to June 2008. RESULTS In our patients, SLNB was positive in 35 cases (11.07%) whereas it was negative in 281 cases (88.93%); 12/316 patients (3.8%) had positive SLNB and positive therapeutic lymph node dissection (TLND); 23/316 (7.28%) patients had positive SLNB and negative TLND; 266/316 (84.18%) patients had negative SLNB but without subsequent metastases in the SLN site; 15/316 (4.74%) patients had negative SLNB, but with subsequent metastases in the same SLN site (false-negative patients). Among the different prognostic factors, only ulceration was the main predictive factor for false-negative SLNB, according to statistical analysis (p = .0420). CONCLUSION Our data confirm that SLNB is a useful technique for staging melanoma patients. How- ever, in patients with negative SLNB, a closer follow-up is recommended when ulceration is present. The authors have indicated no significant interest with commercial supporters. C utaneous melanoma represents a malignancy whose incidence is rising worldwide. 1 In the United States, the incidence has increased by more than 200%, from 7.89 to 21.14 cases per 100,000 from 1975 to 2006. 2 Survival rates change according to the stage of the disease: based on the American Joint Committee on Cancer (AJCC), 3 5-year survival rate is more than 90% at disease stage IA, but does not exceed 20% in stage IV melanoma patients. In the literature 3,4 the most significant prognostic factors are recognized to be Bre- slow thickness and regional lymph node metastases. The technique of sentinel lymph node biopsy (SLNB), originally proposed by Morton and collea- gues, 5 represents a useful tool for the staging of melanoma patients because it may identify patients with nodal micrometastases who may undergo ther- apeutic lymph node dissection (TLND). Breslow thickness and ulceration are important factors used in guiding the decision-making process when determining the usefulness of SLNB in early stage melanoma. In fact, this procedure has been advocated in stage IB and II melanoma patients under certain circumstances. 3,4 However, despite the high accuracy and minimal invasiveness of the technique, its use remains con- troversial in part because of significant rates of false- negatives, ranging from 2% to 16%. 6–9 Several definitions have been proposed to define a false-negative SLN. As illustrated by Caraco ` and & 2010 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc.  ISSN: 1076-0512  Dermatol Surg 2010;36:1521–1528  DOI: 10.1111/j.1524-4725.2010.01676.x 1521 Ã Department of Dermatology and Plastic Surgery, University of Rome ‘‘Sapienza,’’ Viale del Policlinico, Rome, Italy; y Department of Dermatology and Oncology, University of Catanzaro ‘‘Magna Graecia,’’ Cantanzaro, Italy