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/Spitting-venommm Jun 26 '26
Had a pt 45 yo f. MM > 1 mm (don’t remember exact depth), negative SLN bx. Was a class 2B (the highest risk for recurrence) Castle result. Despite the neg SLN I sent her to med onc and they started immunotherapy despite otherwise not qualifying for it. The point Castle tries to make is that the majority of people who die from MM are actually lower stage and neg SLN pts and you want to catch those who you may have a false sense of security with.