Clinical Considerations for Integrating Gene Expression Profiling into Cutaneous Squamous Cell Carcinoma Management

June 2021 | Volume 20 | Issue 6 | Supplement Individual Articles | 5s | Copyright © June 2021


Published online May 11, 2021

Sarah T. Arron MD PhDa, Travis W. Blalock MDb, J. Michael Guenther MDc, David M. Hyams MDd, Sherrif F. Ibrahim MD PhDe, Shlomo A. Koyfman MDf, Ashley Wysong MD MSg

aSarah Arron Medical Professional Corporation, San Mateo, CA
bDepartment of Dermatology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Atlanta VA Health System, Decatur, GA
cSt. Elizabeth Medical Center, Edgewood, KY
dDesert Surgical Oncology, Eisenhower Medical Center, Rancho Mirage, CA
eRochester Dermatologic Surgery, Victor, NY; University of Rochester Medical Center, Rochester, NY
fCleveland Clinic, Cleveland, OH
gUniversity of Nebraska Medical Center, Omaha, NE

Abstract
Gene expression profile (GEP) testing is now commercially available for metastatic risk prediction in patients with cutaneous squamous cell carcinoma (CSCC) and one or more high-risk factors. The purpose of this article is to provide an early framework for healthcare providers looking to integrate patient-specific tumor biology into their clinical practice using GEP testing. To develop a framework for clinical use, an expert panel was convened to identify CSCC management decision points where GEP testing may be immediately incorporated into practice until the definitive results of prospective trials become available. Based on their discussion, the expert panel focused on the areas of nodal evaluation, adjuvant radiation therapy, and follow-up and surveillance. The panel emphasized that GEP prognostic test results should not currently be used as a surrogate for standard of care treatment but as an additional data point when determining individualized management for patients with high-risk CSCC. Whenever possible, decisions on management plans for these patients should be developed with multidisciplinary input.

J Drugs Dermatol. 2021;20:6(Suppl):s5-11. doi:10.36849/JDD.6068.

INTRODUCTION

As the population of the United States continues to grow and age, the number of patients being diagnosed with nonmelanoma skin cancer (NMSC) is also changing. From 2006 to 2012, the annual incidence of NMSC increased by 35% with an estimated 710,000 people diagnosed with cutaneous squamous cell carcinoma (CSCC).1 While the majority of CSCCs are curable with surgery, there is a subset of patients with tumors that have aggressive growth characteristics associated with a higher probability of metastasis, recurrence, or disease-specific death (ie, high-risk CSCC).2,3 As the overall incidence of CSCC increases, it is likely that the incidence of these high-risk tumors will also increase, adding to the burden on patients, clinicians, and the healthcare system. Ideally, the goal is to identify patients with high-risk CSCC early and create personalized management plans that will reduce the risk of CSCC-related outcomes.

CSCC management plans are often based on using clinicopathologic staging and treatment guidelines to stratify patients by risk. However, CSCC is a heterogeneous disease and tumors in the same staging category may behave differently based on variations in tumor biology. The reported rates of