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Article History

Accepted: 2 September 2026

First Online: 19 September 2026

Declarations

Conflict of Interest: The authors declare the following competing interests: CMC has received grants or contracts from the Chen Institute, Dermatology Foundation, and DeepX Health C and support for attending meetings and/or travel from Melanoma Research Alliance, American Academy of Dermatology, and Chen Institute. EMG has received grants or contracts from Regeneron Pharmaceuticals, Immunocore Holdings, Iovance Biotherapeutics, and Bristol Myers Squibb and support for attending meetings and/or travel from Regeneron and Iovance Biotherapeutics. MLW has received grants or contracts from the Department of Defense and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Catamount Medical Education. AS declares a leadership role in the Society of Interventional Radiology Medical Student Committee (unpaid). AG, JI, and XZ declare no competing interests (other than funding provided to their institutions for completion of the study—see Funding section above). JM, KG, CR, AD, RB, and NQ are employed by OXON Epidemiology. In addition, NQ declares stock or stock options in OXON Epidemiology and has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from OXON Epidemiology. MFK, IS, and XLT are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and declare stock or stock options in Merck & Co., Inc., Rahway, NJ, USA.

Availability of Data and Material: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval: The study was performed in accordance with the standards of ethics outlined in the Declaration of Helsinki. The Ethics Committees that reviewed this retrospective observational study and granted approval were University of Virginia Institutional Review Board for Health Sciences Research (no. 2483; approval granted on 13 November 2023), Human Research Protection Program UCSF (no. 386135; 10 September 2023), Mayo Clinic IRB (no. 23-006555; 03 October 2023), and Cleveland Clinic Institutional Review Board (IRB) (no. DATA3423; 2 January 2024).

Consent to Participate: This study has been granted a waiver for Health Insurance Portability and Accountability Act (HIPAA) authorization, in accordance with applicable HIPAA regulations.

Consent for Publication: Not applicable.

Code Availability: Not applicable.

Author Contributions: Conceptualization: XLT, IS, and NQ; methodology: XLT, IS, MFK, and NQ; data collection: CMC, EMG, JI, MLW, AS, XZ, and AG; software, validation, and formal analysis: CR; writing—original draft: JM, KG, RB, and XLT; writing—review and editing: all authors; visualization: JM and KG; supervision: AD, JM, KG, and NQ; and project administration: AD. All authors have read and approved the final manuscript.