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This study explores the utility of routine imaging to detect metastases in patients with negative SLNB but high-risk 31 gene expression profile (31-GEP) scores. We retrospectively identified melanoma patients with negative SLNBs. Patients with high-risk GEP results were placed in the experimental group and patients without GEP testing were placed in the control group. Among both cohorts, recurrent melanoma groups were identified. The tumor burden at the time of recurrence and the time to recurrence were compared between experimental group patients with routine imaging and control group patients without imaging schedules. We identified 327 control patients and 307 experimental patients, of which 14.1% versus 20.5% had melanoma recurrence, respectively. Of the patients with recurrent melanoma, those in the experimental group were older (65.75 versus 59.20), had higher Breslow depths (3.72\u00a0mm versus 3.31\u00a0mm), and had advanced tumor staging (89.5% versus 71.4% of patients presenting clinical stage\u2009\u2265\u2009II) compared to the control group at primary diagnosis. However, melanoma recurrence was detected earlier (25.50\u00a0months versus 35.35\u00a0months) in the experimental group at a lower overall tumor burden (73.10\u00a0mm versus 27.60\u00a0mm). A higher percentage of experimental patients started immunotherapy when offered (76.3% and 67.9%). Patients who received routine imaging after high-risk GEP test scores had an earlier recurrence diagnosis with lower tumor burden, leading to better clinical outcomes.<\/jats:p>","DOI":"10.1007\/s00403-023-02613-6","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T16:03:22Z","timestamp":1680019402000},"page":"2295-2302","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Routine imaging guided by a 31-gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies"],"prefix":"10.1007","volume":"315","author":[{"given":"Soneet","family":"Dhillon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Duarte-Bateman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Norman Eun","family":"Hagstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Lampley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantel","family":"Olivares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica Stella","family":"Fumero-Vel\u00e1zquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Vu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Wayne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian R.","family":"Gastman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Vetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedram","family":"Gerami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"issue":"1","key":"2613_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s11864-019-0607-8","volume":"20","author":"K Namikawa","year":"2019","unstructured":"Namikawa K, Yamazaki N (2019) Targeted Therapy and Immunotherapy for Melanoma in Japan. 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Wayne, have severed as consultants for Castle Biosciences, Inc. and received honoraria for consultant work. No other authors have conflicts of interest to disclose. This study was performed independent of Castle Biosciences, Inc, and was not supported or funded by them in any manner.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was reviewed by the Institutional Review Board and given the retrospective chart review design it was determined that it involves only minimal risk to human subjects. A Waiver of HIPPA Authorization was granted to permit use of deidentified health information for research purposes.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate\/consent to publish"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial registration"}}]}}