Using the Merlin assay for reducing sentinel lymph node biopsy complications in melanoma: a retrospective cohort study

Tina J. Hieken, Mariana B. Sadurní, Enrica Quattrocchi, Ajdin Kobic, Sindhuja Sominidi-Damodaran, Jvalini T. Dwarkasing, Lisette Meerstein-Kessel, Alina G. Bridges, Alexander Meves

Research output: Contribution to journalComment/debatepeer-review


Background: The assessment of the sentinel lymph node is a cornerstone of melanoma staging. However, ~80% of sentinel lymph node biopsies (SLNB) are negative and nontherapeutic, and patients are unnecessarily exposed to surgery-related complications. Here, we gauged the potential of the Merlin assay to reduce SLNB-associated complications. The Merlin assay uses clinicopathologic variables and tumor gene expression profiling to identify low-risk patients who may forgo SLNB. Methods: We utilized the Merlin test development cohort to determine SLNB complication rates for procedures performed between 2004 and 2018 at Mayo Clinic. Complications evaluated were lymphedema, seroma, infection/cellulitis, hematoma, and wound dehiscence. Patients who underwent a completion lymph node dissection were excluded. Results: A total of 558 patients were included. The overall 90-day complication rate specific to SLNB (1 year for lymphedema) was 17.4%. The most common complications were seroma (9.3%), infection/cellulitis (4.8%), and lymphedema (4.3%). All three were more common in patients with a lower extremity primary tumor location versus other locations. With Merlin test results applied, SLNB-related complications would have decreased by 59%. Conclusion: SLNB is a safe procedure but carries a significant complication rate. Merlin testing might reduce the need for SLNB and its associated complications.

Original languageEnglish (US)
Pages (from-to)848-854
Number of pages7
JournalInternational journal of dermatology
Issue number7
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Dermatology


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