{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T03:27:31Z","timestamp":1778902051212,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The neutrophil\u2010to\u2010lymphocyte ratio (NLR) is a critical biomarker of the immune system that plays an important role in predicting the outcome of various malignant tumors, including skin cancer. This study aimed to evaluate an NLR cutoff that could help better predict the prognosis of patients with localized melanoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We designed a\u00a0retrospective, longitudinal, observational study of 988 patients with localized melanoma for whom NLR levels were collected at baseline. To evaluate the prognostic value of NLR, the patients were divided into two groups: &gt;\u20094.8 vs. \u2264\u20094.8. We analyzed the association between increased NLR levels and clinical and pathological variables using Pearson's chi\u2010squared test and Fisher's exact test. Univariate and multivariate Cox proportional hazards models were built using stepwise backward selection to evaluate the association between NLR values and melanoma\u2010specific survival (MSS); NLR values and distant metastasis\u2010free survival (DMFS). Kaplan\u2013Meier survival curves were used to illustrate the difference in survival outcomes between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      An NLR level of &gt;\u20094.8 was associated with male sex, melanoma located on the head or neck, a mitotic index of &gt;\u20095 mitoses\/mm\n                      <jats:sup>2<\/jats:sup>\n                      , ulceration, worse MSS (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.8\u20135.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and a higher probability of developing distant metastasis (HR 2.0, 95% CI 1.1\u20133.7;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified an NLR level of 4.8 as the best cutoff to distinguish patients with localized melanoma (stages I and II) who are at an increased risk of death due to melanoma (MSS) and of developing distant metastasis (DMFS).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijd.17920","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:44:22Z","timestamp":1752065062000},"page":"1855-1861","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Neutrophil\u2010to\u2010Lymphocyte Ratio Associated With Worse Melanoma Specific\u2010Survival and Distant Metastasis Free Survival in Localized (Stage I and\n                    <scp>II<\/scp>\n                    ) Cutaneous Melanoma: An Observational Retrospective Study on 988 Patients"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7198-4273","authenticated-orcid":false,"given":"Irina","family":"Ciobotariu","sequence":"first","affiliation":[{"name":"Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"},{"name":"UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Fondazione Policlinico Universitario A. Gemelli\u2014IRCCS  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Acacio","family":"Ortega\u2010Berbel","sequence":"additional","affiliation":[{"name":"Hospital Quir\u00f3n Infanta Luisa  Sevilla Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Calder\u00f3n\u2010Mollinedo","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maider","family":"Aguerralde\u2010Martin","sequence":"additional","affiliation":[{"name":"Universidad Polit\u00e9cnica de Valencia  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Requena","sequence":"additional","affiliation":[{"name":"Department of Dermatology Instituto Valenciano de Oncolog\u00eda  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruggero","family":"Moro","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"},{"name":"Doctorate School Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esperanza","family":"Manrique\u2010Silva","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"},{"name":"Doctorate School Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Traves","sequence":"additional","affiliation":[{"name":"Department of Pathology Instituto Valenciano de Oncolog\u00eda  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Nagore","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad Cat\u00f3lica de Valencia San Vicente M\u00e1rtir  Valencia Spain"},{"name":"Department of Dermatology Instituto Valenciano de Oncolog\u00eda  Valencia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2015.03.007"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26511"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","unstructured":"M.Marzagalli N. 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