Clinical Utility of Dermoscopy and 31-Gene Expression Profiling by Dermatology Providers in Melanoma Management Care
December 2022 | Volume 21 | Issue 12 | 1347 | Copyright © December 2022
Published online December 1, 2022
Alexander Witkowski MD PhDa*, Claudia Lee BSb*, Emile Latour PhDa, John Vetto MDa, Joanna Ludzik MD PhDa,c
aDepartment of Dermatology, Oregon Health and Sciences University, Portland, OR
bSchool of Medicine, University of California Riverside, Riverside, CA
cDepartment of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland
*co-first authors
Abstract
Objective: A 31-gene expression profile (31-GEP) test that predicts metastatic risk in patients with cutaneous malignant melanoma (CMM) has previously been validated and is available for clinical use. The test dichotomizes patients into lower risk and higher risk groups based on differences that correspond to unique genetic expression patterns. Although the impact of such a test on dermatology providers' clinical decision-making has been studied, little is known about whether there exists an association between certain clinical features, such as dermoscopy, and 31-GEP results.
Methods: In this retrospective analysis of 31-GEP test results ordered by dermatologists, we evaluated the frequency of dermoscopic features, using a modified dermoscopy three-point checklist, in 17 cases (n=17) and compared these findings to other key clinicopathologic features including tumor thickness, ulceration, and mitotic rate to 31-GEP results. Additionally, we evaluated the dermatologist's perspective and incorporation of GEP testing as part of patient discussion on melanoma management.
Results: 31-GEP stratified patients into 4 groups; groups 1A and 1B are considered low risk of metastasis or recurrence, while 2A and 2B are considered high risk. Of the 17 cases, we had fifteen group 1A (88.23%), one 1B (5.88%), and one 2B (5.88%) result. Overall frequency of dermoscopic features is as follows; 100% of lesions presented with asymmetry, 47% with round structures, and 70.6% with blue-white color. The average time providers spent explaining and ordering the test was 15 minutes, with a range of 10 to 20 minutes.
Conclusions: This study represents our experience and understanding of the dermatologist’s role ordering 31-GEP in the care pathway of melanoma patients and we recommend that dermatology providers consider ordering the test for newly diagnosed CMM patients.
J Drugs Dermatol. 2022;21(12): doi:10.36849/JDD.6889
INTRODUCTION
Providers continue to face significant challenges in determining appropriate prognosis and post-diagnosis management for patients with newly diagnosed cutaneous malignant melanoma (CMM). There exists a gap in understanding the true risk of recurrence for CMM patients, especially in those initially diagnosed with early-stage disease, which translates into significant consequences to patient outcomes. This is demonstrated by the fact that roughly two-thirds of all melanoma related deaths occur in sentinel-lymph node (SLN) negative patients who were initially diagnosed as having Stage I or Stage II disease.1 The false sense of security provided by an early-stage diagnosis results in lower intensity follow-up plans including reduced frequency of visitation and imaging, and limited consideration for systemic adjuvant therapy and clinical trial enrollment.2 This is due to the shortcomings of traditional staging systems, like those derived from the American Joint Committee on Cancer (AJCC), which fail to provide enough granularity to distinguish groups of patients with significantly different outcomes.3-4 However, given the magnitude of CMM patients who are SLN negative but still develop metastases, there is a need to utilize additional stratification tools to accurately group melanoma patients into prognostic categories. As such, there has been increasing interest in utilizing prognostic molecular tests to better classify melanoma patients in terms of metastatic potential.5-7
A commercially available 31 gene-expression profiling (31-GEP) test has been shown to be an accurate tool in identifying CMM
