A hybrid machine learning approach for the personalized prognostication of aggressive skin cancers.

Accurate prognostication guides optimal clinical management in skin cancer. Merkel cell carcinoma (MCC) is the most aggressive form of skin cancer that often presents in advanced stages and is associated with poor survival rates. There are no personalized prognostic tools in use in MCC. We employed explainability analysis to reveal new insights into mortality risk factors for this highly aggressive cancer. We then combined deep learning feature selection with a modified XGBoost framework, to develop a web-based prognostic tool for MCC termed 'DeepMerkel'. DeepMerkel can make accurate personalised, time-dependent survival predictions for MCC from readily available clinical information. It demonstrated generalizability through high predictive performance in an international clinical cohort, out-performing current population-based prognostic staging systems. MCC and DeepMerkel provide the exemplar model of personalised machine learning prognostic tools in aggressive skin cancers.