New data shows that the i31-SLNB genomic test can help identify melanoma patients who may safely skip sentinel lymph node biopsy.
The test is part of the DecisionDx-Melanoma and combines a 31-gene profile with clinical factors such as age and tumor thickness to predict whether cancer has spread to lymph nodes.
In a study of 912 patients across 30 U.S. centers, the results were strong. Patients classified as low risk (less than 5% chance of spread) had an actual lymph node positivity rate of just 2.6%, which supports avoiding surgery under National Comprehensive Cancer Network guidelines. In contrast, high-risk patients (over 10% predicted risk) had a 21.4% positivity rate.
Outcomes were also reassuring. Low-risk patients had a 97.8% recurrence-free survival at three years, showing that skipping the biopsy did not harm outcomes.
The test is especially useful for patients in the T1b to T2a group, where the decision to perform surgery is often unclear. In this group, high-risk patients were more than 13 times as likely to have cancer spread to lymph nodes compared to low-risk patients.
These findings suggest the test could reduce unnecessary surgeries and move melanoma care toward a more personalized approach based on tumor biology rather than a one-size-fits-all strategy.