Factors Affecting Dermatologists’ Use of a 31-Gene Expression Profiling Test as an Adjunct for Predicting Metastatic Risk in Cutaneous Melanoma
May 2018 | Volume 17 | Issue 5 | Original Article | 544 | Copyright © May 2018
Ryan M. Svoboda MD MS,a Alex M. Glazer MD,b Aaron S. Farberg MD,c and Darrell S. Rigel MD MSd
aNational Society for Cutaneous Medicine, New York, NY bUniversity of Arizona, Tucson, AZ cIcahn School of Medicine at Mount Sinai, New York, NY dNYU School of Medicine, New York, NY
study was to determine which factors significantly impact clinicians’ decisions to utilize the 31-GEP test to predict metastatic risk in patients with cutaneous malignant melanoma.
Attendees at a national dermatology conference were sequentially presented with four patient vignettes, each a case of cutaneous malignant melanoma with a different Breslow thickness (Table 1). For each vignette, respondents were asked, via an anonymous audience response system, whether they would recommend the 31-GEP test for the patient. They were then asked to consider whether they would recommend the test for the same patient under two specific situations: 1) if the lesion were ulcerated and 2) if the patient had a negative sentinel lymph node biopsy. Respondents were also asked whether 31-GEP test results would affect their decision to recommend sentinel lymph node biopsy (SLNBx) in patients with 0.76-1.0 mm thick tumorsAdditional questions were asked about years of clinical experience and previous familiarity with the 31-GEP test. Summary statistics were calculated for demographic variables. Chi-squared tests were used for comparison, with a P-value of P<0.05 considered significant. All analyses were performed using STATA statistical software (Version 15, College Station, TX). This study was Institutional Review Board exempt.
A total of 181 of 187 individuals completed the survey (96.8% response rate). The sample consisted of mostly practicing dermatologists with relatively few trainees; roughly 50% of the sample had been in practice for more than 20 years. Two-thirds of respondents were previously familiar with the 31-GEP test.
Factors Impacting Clinicians’ Decision to Order 31-GEP Test
For all vignettes with tumors with thickness of 0.5 mm or greater, the majority of respondents would recommend the 31-GEP test (Table 2). Only for the vignette with 0.26 mm tumor did a minority (22%) of subjects say they would recommend the