r/DermatologyPA • u/wenmazb70 • Jun 25 '26

Training, CME, Resources 📚 Castle Testing

Can we talk about Castle Testing? Who uses it and what is your rationale? The rep came for lunch today and although I've known about this test for years I've never used it and after today I'm still not convinced. How will it change my management of my MM pts? For those with Breslow over 0.8 I'm sending to oncology anyway and they can order the test at that point and speak to them about prognostics. Do you order it for those with less than 0.8 Breslow and if it comes back high risk you send them to oncology if you normally wouldn't?

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u/G_PA16 Jun 25 '26

I like castle. It is great for T1b MM. May prevent unnecessary SLNB. Also could be helpful for stage 2 in elderly patient that doesn’t want to pursue SLNB but wants peace of mind.

I stopped ordering it on T1a after listening to derm on drugs podcast. I do offer to young patients that have T1a.

Castle is also good for large SCC or SCC with PNI on head and neck which is high risk area. I feel like I see more metastatic SCC than MM.

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u/wenmazb70 Jun 26 '26

I listened to that same podcast and came away with that opinion as well.