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

Wade, Ryckie G., Bailey, Samuel, Robinson, Alyss V., Lo, Michelle C. I., Peach, Howard, Moncrieff, Marc and Martin, James (2022) MelRisk: Using the neutrophil-to-lymphocyte ratio to improve risk prediction models for metastatic cutaneous melanoma in the sentinel lymph node. Journal of Plastic, Reconstructive and Aesthetic Surgery, 75 (5). pp. 1653-1660. ISSN 1748-6815

[thumbnail of Accepted_Manuscript]
PDF (Accepted_Manuscript) - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (1MB) | Preview


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.

Item Type: Article
Additional Information: Funding Information: Ryckie Wade is a Doctoral Research Fellow funded by the National Institute for Health Research (NIHR, DRF-2018-11-ST2-028). The views expressed are those of the author(s) and not necessarily those of the United Kingdom's National Health Service, NIHR or Department of Health. Further information: The authors thank James Smith, Donald J Dewar and Jenny Goodenough for testing the app at the alpha and beta stages. Ethical approval was gained from the local (reference PL15/368) and United Kingdom National Health Research Authority (HRA, IRAS ID: 234565). There was no requirement to take consent from patients for this study, as determined by the UK HRA given that the study used historical data that was already captured and there was no need to interface with patients.
Uncontrolled Keywords: lymphocytes,melanoma,neutrophils,risk,sentinel lymph node,surgery ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 08 Dec 2021 09:31
Last Modified: 01 Dec 2022 01:38
DOI: 10.1016/j.bjps.2021.11.088


Downloads per month over past year

Actions (login required)

View Item View Item