{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:37:07Z","timestamp":1785731827567,"version":"3.56.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"Importance<\/jats:title>The Melanoma Institute Australia (MIA) sentinel node (SN) metastasis risk calculator provides estimates of positivity for individual patients based on 6 standard clinicopathological parameters and the full 6-parameter model has been externally validated previously using US data. However, given its geographically widespread use, further validation is required to ensure its applicability to other populations.<\/jats:p><\/jats:sec>Objective<\/jats:title>To further externally validate the MIA SN metastasis risk calculator and increase its precision by refinement of the 95% CIs.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A retrospective multicenter cohort study was carried out using data from 4 continents, including the national Danish Melanoma Database and cancer centers in the UK (n\u2009=\u20093), US (n\u2009=\u20092), New Zealand (n\u2009=\u20091), Sweden (n\u2009=\u20091), and Brazil (n\u2009=\u20091). All patients aged 18 years or older who had an SN biopsy performed for an invasive primary cutaneous melanoma and data available on the following parameters: SN status, patient age at diagnosis, Breslow thickness, and melanoma subtype were included (n\u2009=\u200915\u202f731). Available data were also collected on ulceration status, lymphovascular invasion, and the tumor mitotic rate. Data were collected between July 2021 and December 2023, and the analysis was conducted between January 2024 and June 2024.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the area under the curve (AUC) of the receiver operating characteristics for the full (6-parameter) risk prediction model. Secondary outcomes were the AUCs for each country and for the limited models (3-5 parameters), the model calibration, and the recalculated 95% CIs for the models. Decision curve analysis was performed to assess the tool\u2019s clinical utility.<\/jats:p><\/jats:sec>Results<\/jats:title>The whole pooled cohort consisted of 15\u202f731 patients; 4989 had all 6 parameters available. The AUC was 73.0% (95% CI, 70.6%-75.3%) in the subset with all 6 parameters available, and 70.8%, 71.5%, and 70.1% when 1, 2, or 3 optional parameters were missing, respectively. Calibration was excellent, with an intercept and calibration slope of 0.01 (95% CI, \u22120.02 to 0.03) and 1.03 (95% CI, 0.90-1.16), respectively. The updated 95% CI ranges were substantially tighter, with a median reduction of more than 75%.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that the MIA SN-positivity calculator performed best with all 6 parameters and has been significantly improved (version 2), with the same risk point estimates but much tighter 95% CIs. These results demonstrated that the calculator was robust, precise, and applicable to geographically widespread melanoma populations.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2025.0318","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T15:00:34Z","timestamp":1744210834000},"page":"589","source":"Crossref","is-referenced-by-count":10,"title":["Global Applicability of a Risk Prediction Tool for Sentinel Node Positivity in Patients With Primary Cutaneous Melanoma"],"prefix":"10.1001","volume":"161","author":[{"given":"Serigne N.","family":"Lo","sequence":"first","affiliation":[{"name":"Melanoma Institute Australia, Sydney, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Gjorup","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette Hougaard","family":"Chakera","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital\u2013Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbet Rosenkrantz","family":"H\u00f6lmich","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital\u2013Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Moncrieff","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital Foundation NHS Trust, Norwich, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"MacKenzie Ross","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Cassell","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Ma","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Brinch-M\u00f8ller","family":"Weitemeyer","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital\u2013Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Olofsson Bagge","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siri","family":"Klausen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Copenhagen University Hospital\u2013Herlev and Gentofte, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius F.","family":"Calsavara","sequence":"additional","affiliation":[{"name":"A.C. Camargo Cancer Center, S\u00e3o Paulo, Brazil"},{"name":"Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o P.","family":"Duprat Neto","sequence":"additional","affiliation":[{"name":"A.C. Camargo Cancer Center, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bertolli","sequence":"additional","affiliation":[{"name":"A.C. 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C.","family":"Geh","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom"},{"name":"Skin Tumour Unit, St John\u2019s Institute of Dermatology, Guy\u2019s Hospital, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Haydu","sequence":"additional","affiliation":[{"name":"USAF, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. 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