New online calculator launched to determine risk of spread of melanoma
15 June 2020
Clinicians around the world now have access to a new online calculator that predicts the risk that a patient’s primary melanoma has spread to nearby lymph nodes.
For patients recently diagnosed with melanoma, one of the first hurdles is to find out whether the melanoma cells have spread. To do this, clinicians will biopsy the first lymph node (known as the “sentinel” node) to see if melanoma cells are present, indicating that spread to it has occurred. If it has, it greatly increases the likelihood that it has spread further. This information in turn, helps determine the patient’s best treatment plan.
Dr Alexander Varey and Associate Professor Serigne Lo from Melanoma Institute Australia, whose team developed the calculator based on research published today in the Journal of Clinical Oncology, said it has the potential to better identify melanoma patients who are most likely to benefit from a sentinel node biopsy, as well as those least likely to benefit.
‘For us, one of the big questions was, can we better predict which patients will be at significant risk of having their cancer spread to their lymph nodes?’ said Dr Varey. ‘That’s what this calculator aims to do.
‘The calculator takes into account five pieces of basic information about the melanoma and the patient’s age to determine the patient’s individual risk of the cancer having spread to their lymph nodes.
‘This means that patients deemed at low risk of disease spread can potentially avoid having a sentinel node biopsy, which sometimes has complications and usually requires a general anaesthetic.’
Current treatment guidelines recommend that if a patient has a tumour with a particular set of parameters – mainly tumours that are slightly thicker or ulcerated – then removal and examination of the sentinel node should be considered. However, these guidelines are not tailored to individual patients and don’t take into account important information including the age of the patient. Younger age is known to be one of the most important risk factors for melanoma spreading to lymph nodes.
Supported by a Sydney Health Partners grant, the MIA team used established international calculators as a starting point. The research team tailored them to Australian demographics using patient data from Melanoma Institute Australia’s extensive database, which has been built up over a 50-year period. The team then built a new calculator to include additional patient parameters that increased its reliability and showed it provided considerably more accurate predictions than were previously available.
The calculator has been trialed at sites including Royal Prince Alfred, Royal North Shore and Westmead Hospitals with enthusiastic responses from clinicians and their patients.
‘The calculator enables clinicians to have better informed discussions with their patients based on each individual’s percentage risk, rather than a few simplistic criteria that only approximate the risk of disease spread to the lymph nodes,’ said MIA Co-Medical Directors, Professor Richard Scolyer and Professor Georgina Long AO.
‘The main benefit of the calculator is likely to be for those deemed to be at low risk of disease spread, who can safely forgo a sentinel node biopsy. This is of benefit particularly to older patients who are less likely to have melanoma spread to their lymph nodes, but who are at increased risk of complications from extra surgery and general anaesthesia.’
The Sentinel Node Biopsy Risk Calculator is available for clinician use here: www.melanomarisk.org.au
An improved risk-prediction calculator for sentinel node positivity in melanoma patients: the MIA nomogram.
Serigne N Lo, Jiawen Ma, Richard A Scolyer, Lauren E Haydu, Jonathan R Stretch, Robyn PM Saw, Omgo E Nieweg, Kerwin F Shannon, Andrew J Spillane, Sydney Ch’ng, Graham J Mann, Jeffrey E Gershenwald, John F Thompson, Alexander HR Varey.
Published in: Journal of Clinical Oncology
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