Incorporating a Prognostic Gene Expression Profile Test into the Management of Cutaneous Squamous Cell Carcinoma: An Expert Consensus Panel Report
February 2024 | Volume 23 | Issue 2 | 54 | Copyright © February 2024
Published online November 16, 2023
Danny Zakria MD MBAa, Nicholas Brownstone MDb, Brian Berman MDc, Roger Ceilley MDd, Terrence A. Cronin Jr. MDc, James Q. Del Rosso DOe, Laura K. Ferris MD PhDf, Gary Goldenberg MDa, Daniel Siegel MDg
aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bDepartment of Dermatology, Temple University Health, Philadelphia, PA
cDepartment of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
dDepartment of Dermatology, The University of Iowa, Iowa City, IA
eDepartment of Dermatology, Touro University, Henderson, NV
fDepartment of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA
gDepartment of Dermatology, SUNY Downstate, Brooklyn, NY
Abstract
Background: Cutaneous squamous cell carcinoma (cSCC) is a growing health concern with a rapidly increasing incidence. Disease-specific mortality is typically preceded by a metastasis, but current staging systems have significant limitations in predicting this event. The 40-gene expression profile (40-GEP) test is a validated method of further stratifying patients based on the risk of regional or distant metastasis, but limited guidelines exist for incorporating this test into clinical practice.
Objective: To review the available literature on the use of gene expression profile (GEP) testing to assess prognosis in cSCC and create consensus statements to guide dermatology clinicians on its use.
Methods: A comprehensive literature search of PubMed, EMBASE, and Scopus was completed for English-language original research articles on the use of GEP testing to assess cSCC prognosis. A panel of 8 dermatologists with significant expertise in diagnosing and managing cSCC gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using the Strength of Recommendation Taxonomy (SORT) criteria.
Results: The literature search produced 157 articles that met the search criteria. A thorough screening of the studies for relevance to the research question resulted in 21 articles that were distributed to the panelists for review prior to the roundtable discussion. The panel unanimously voted to adopt 7 consensus statements and recommendations, 6 of which were given a strength of "A" and 1 of which was given a strength of "C".
Conclusion: The 40-GEP test provides accurate and independent prognostic information beyond standard staging systems that only incorporate pathologic data. Incorporation of GEP testing into national guidelines can help further stratify patients based on risk of metastasis and thus may improve morbidity and mortality.
J Drugs Dermatol. 2023;22(12):54-60. doi:10.36849/JDD.7691
INTRODUCTION
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, occurring in 1.8 million people in the United States (US) annually.1-4 Its incidence is on the rise, likely due to an aging population and possibly an increased emphasis on skin cancer screening.1-5 Although typically found at a 1:4 ratio to basal cell carcinoma (BCC), the most common skin cancer in the general US population, one study identified a 1:1 ratio between cSCC and BCC in a Medicare fee-for-service population in 2012.5 While cSCC typically carries an excellent prognosis, with 5-year cure rates greater than 90%, a subset of these tumors exhibit aggressive behavior such as local recurrence and metastasis.6-9 The frequency of regional and distant metastasis may be underreported due to a lack of nonmelanoma skin cancer (NMSC) registries.1,8 As a result,
