MelRisk: Using the neutrophil-to-lymphocyte ratio to improve risk prediction models for metastatic cutaneous melanoma in the sentinel lymph node

Ryckie G. Wade, Samuel Bailey, Alyss V. Robinson, Michelle C. I. Lo, Howard Peach, Marc Moncrieff, James Martin

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Background: Identifying metastatic melanoma in the sentinel lymph node (SLN) is important because 80% of SLN biopsies are negative and 11% of patients develop complications. The neutrophil-to-lymphocyte ratio (NLR), a biomarker of micrometastatic disease, could improve prediction models for SLN status. We externally validated existing models and developed ‘MelRisk’ prognostic score to better predict SLN metastasis. Methods: The models were externally validated using data from a multicenter cohort study of 1,251 adults. Additionally, we developed and internally validated a new prognostic score `MelRisk’, using candidate predictors derived from the extant literature. Results: The Karakousis model had a C-statistic of 0.58 (95% CI, 0.54–0.62). The Sondak model had a C-statistic of 0.57 (95% CI 0.53–0.61). The MIA model had a C-statistic of 0.60 (95% CI. 0.56–0.64). Our ‘MelRisk’ model (which used Breslow thickness, ulceration, age, anatomical site, and the NLR) showed an adjusted C-statistic of 0.63 (95% CI, 0.56–0.64). Conclusion: Our prediction tool is freely available in the Google Play Store and Apple App Store, and we invite colleagues to externally validate its performance.

Original languageEnglish
Pages (from-to)1653-1660
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number5
Early online date1 Dec 2021
Publication statusPublished - 1 May 2022


  • Lymphocytes
  • Melanoma
  • Neutrophils
  • Risk
  • Sentinel Lymph Node

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