Multimodal AI and tumour microenvironment integration predicts metastasis in cutaneous melanoma
- Tom W. Andrew
- Marc Combalia
- Carlos Hernandez
- Sydney Grant
- Gyorgy Paragh
- Susanna Puig
- Grant Mc Arthur
- Grant Richardson
- Phil Sloan
- Sophia Z. Shalhout
- Ruth Plummer
- Penny E. Lovat
2025-11-18
Accurate prognostication is essential to guide clinical management in localised cutaneous melanoma (CM), the form of skin cancer with the highest mortality. While the tumour microenvironment (TME) plays a key role in disease progression, current staging systems rely on limited tumour features and exclude key clinicopathological prognostic features. Here we show that MelanoMAP, a multimodal AI model integrating TME-derived digital biomarkers and clinicopathological features from over 3,500 histology slides, improves prognostication of localised CM. MelanoMAP achieved a C-index of 0.82, a 24% improvement over traditional AJCC staging (0.66) and consistently outperformed clinicopathological-only models across six international patient cohorts. SHAP analysis identified TME-derived digital biomarkers, alongside traditional clinicopathological factors including age, mitotic count, and Breslow depth, were critical determinants of metastatic risk. MelanoMAP establishes a potential foundation for precision oncology in CM, demonstrating how AI-driven digital biomarkers can advance personalised prognostication and inform clinical-decision making.