SWEMR – app – melanoma prognostic instrument

In Sweden adjuvant systemic therapies for patients following surgical treatment of high-risk melanoma was introduced as a recommendation in the national guidelines in the end of 2018. Treatment recommendations are based on the AJCC 8th edition staging system, where unfortunately the distinction between stage II and III disease is based on lymph node status and/or presence of satellite/in-transit metastases, and not the risk per se for melanoma recurrence or death. Patients with stage IIIA disease, according to AJCC 8th , actually have a better prognosis than patients with stage IIC disease, but until last year only the former were recommended adjuvant treatment internationally. The hazard ratio for recurrence free survival (RFS) is similar across all stage groups (IIB-IIID), and adjuvant PD-1 inhibitors are now approved for stage IIB through IIID stage patients, however in Sweden only recommended to stage IIIB-IIID. A drawback of adjuvant immunotherapy recommendations is that there is still no overall survival (OS) data reported for the adjuvant PD-1 inhibitors currently used. Initially it was thought that the RFS benefits seen in the trials would automatically translate into an OS benefit with longer-term follow-up. However, with the CheckMate-238 trial, where the benefit in RFS with nivolumab compared to ipilimumab did not translate to an OS benefit, this is now being questioned. Adjuvant immunotherapy is also very costly and comes with a risk for enduring life-long adverse events, and we are hopefully looking into a new era in where adjuvant treatment recommendations are based on more personalized recommendations.

The instrument is available as an online tool via the Swedish Melanoma Registry´s website. In addition, in collaboration with students from Chalmers Teknologkonsulter, the instrument has also been launched as a mobile application, free to download for Iphone as well as Android.


It is in this setting we have to see the new prognostic instrument, based on large scale data from the Swedish Melanoma Registry (SweMR), as a possible useful tool (1). The instrument provides a quick and easy risk assessment concerning survival prognosis 1 to 10 years after diagnosis. The instrument is based on data from more than 70,000 patients with primary melanoma between 1990 and 2021 included in the national and population-based Swedish quality register for cutaneous melanoma. Through a combination of several independent risk factors, melanoma-specific survival has been analyzed for a variety of risk groups. The analyzes that form the basis of the instrument are performed on separate models for thin melanomas, <1mm and for thicker melanomas, >1mm, due to the fact that sentinel lymph node biopsy is not recommended for thin melanomas in Sweden. The melanoma prognostic instrument has been developed by Associate professor Karolin Isaksson at Lund University and Professor Roger Olofsson Bagge at the University of Gothenburg and colleagues (1). The prognostic instrument is planned to be updated regularly and hopefully also expanded with parameters about received adjuvant oncologic therapy.

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Uppdaterad: 3 juni, 2024
1 Lyth J, Mikiver R, Nielsen K, Ingvar C, Olofsson Bagge R, Isaksson K. Population-based prognostic instrument (SweMR 2.0) for melanoma-specific survival - An ideal tool for individualised treatment decisions for Swedish patients. Eur J Surg Oncol. 2023 Oct;49(10):106974.
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