Predictive accuracy of risk prediction models for recurrence, metastasis and survival for early-stage cutaneous melanoma: a systematic review

Tafadzwa Patience Kunonga*, R. P.W. Kenny, Margaret Astin, Andrew Bryant, Vasileios Kontogiannis, Diarmuid Coughlan, Catherine Richmond, Claire H. Eastaugh, Fiona R. Beyer, Fiona Pearson, Dawn Craig, Penny Lovat, Luke Vale, Robert Ellis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To identify prognostic models for melanoma survival, recurrence and metastasis among American Joint Committee on Cancer stage I and II patients postsurgery; and evaluate model performance, including overall survival (OS) prediction.

DESIGN: Systematic review and narrative synthesis.

DATA SOURCES: Searched MEDLINE, Embase, CINAHL, Cochrane Library, Science Citation Index and grey literature sources including cancer and guideline websites from 2000 to September 2021.

ELIGIBILITY CRITERIA: Included studies on risk prediction models for stage I and II melanoma in adults ≥18 years. Outcomes included OS, recurrence, metastases and model performance. No language or country of publication restrictions were applied.

DATA EXTRACTION AND SYNTHESIS: Two pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist and the Prediction study Risk of Bias Assessment Tool. Heterogeneous predictors prevented statistical synthesis.

RESULTS: From 28 967 records, 15 studies reporting 20 models were included; 8 (stage I), 2 (stage II), 7 (stages I-II) and 7 (stages not reported), but were clearly applicable to early stages. Clinicopathological predictors per model ranged from 3-10. The most common were: ulceration, Breslow thickness/depth, sociodemographic status and site. Where reported, discriminatory values were ≥0.7. Calibration measures showed good matches between predicted and observed rates. None of the studies assessed clinical usefulness of the models. Risk of bias was high in eight models, unclear in nine and low in three. Seven models were internally and externally cross-validated, six models were externally validated and eight models were internally validated.

CONCLUSIONS: All models are effective in their predictive performance, however the low quality of the evidence raises concern as to whether current follow-up recommendations following surgical treatment is adequate. Future models should incorporate biomarkers for improved accuracy.


Original languageEnglish
Article numbere073306
Number of pages10
JournalBMJ Open
Issue number9
Publication statusPublished - 28 Sept 2023

Bibliographical note

Funding Information:
This work was supported by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, grant number 16/166/05 and the NIHR Invention for Innovation (i4i) Innovative Prognostic Test for Early-Stage Cutaneous Melanoma, grant number 20993.

Publisher Copyright:
© Author(s) (or their employer(s)) 2023.


  • Adult oncology
  • Dermatological tumours
  • Epidemiology
  • Systematic Review

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