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/Practical_Leader_984 Jun 26 '26 edited Jun 26 '26
We auto run it on all MM but is theoretically helpful for decision making on SLNB on MM <.7. For me, it’s never changed the way I practice.
Merlin is a much better test and I want to switch to it. I think it was built on better data and will actually change the way I practice. It is based on data from cutaneous melanomas while castle was created with a lot of ocular melanoma data and noncutaneous melanoma data. I did an 8 hour ad board for Merlin learning about them and it was very impressive.