Management Decisions Made by Physician Assistants and Nurse Practitioners in Cutaneous Malignant Melanoma Patients: Impact of a 31-Gene Expression Profile Test

November 2018 | Volume 17 | Issue 11 | Original Article | 1220 | Copyright © November 2018

Rachel S. Mirsky BA,a Giselle Prado MD,b Ryan M. Svoboda MD MS,c Alex M. Glazer MD,d Darrell S. Rigel MD MSe

aMedical Student, Albert Einstein College of Medicine, Bronx, NY bClinical Research Fellow, National Society for Cutaneous Medicine, New York, NY cClinical Research Fellow, Department of Dermatology, Duke University School of Medicine, Durham, NC dResident, Division of Dermatology, University of Arizona, Tucson, AZ eClinical Professor, Department of Dermatology, NYU School of Medicine, New York, NY

dents in 5 of 6 vignettes. For all vignettes with a higher risk 31-GEP test result, there was a statistically significant increase in SLNBx recommendations.Impact of 31-GEP Test Results on Decision to Recommend X-Ray or Ultrasound A lower risk 31-GEP test result led to a statistically significant decrease in recommended imaging with x-ray or ultrasound in 5 of 6 vignettes. For all vignettes, a higher risk 31-GEP test result led to a statistically significant increase in the proportion who would recommend x-ray or ultrasound imaging.Impact of 31-GEP Test Results on the Decision to Recommend CT, MRI, or PET Scan A lower risk 31-GEP test result led to a statistically significant decrease in recommended imaging with CT, MRI, or PET scans in 5 of 6 vignettes. For all vignettes with a higher risk 31-GEP test result, there was a statistically significant increase in CT, MRI, or PET scan recommendations.Impact of 31-GEP Test Results on Recommended Follow-up Interval A lower risk 31-GEP result led to a statistically significant increase in the number of respondents who would recommend a longer follow-up interval in 4 of 6 vignettes. Similarly, a higher risk result was associated with a statistically significant increase in the proportion who would recommend shorter follow-up interval for all vignettes.

DISCUSSION

In order to be clinically useful, a new technology or test must impact management.Previous studies have demonstrated the impact and clinical utility of a 31-GEP assay on management decisions made by dermatologists and residents.11,12 The present study produced similar results in another group, dermatology PA/NPs, who may have less experience in pigmented lesion assessment and thus may gain even greater benefit from this adjunctive technology.Table1