Integration of a 31-Gene Expression Profile Into Clinical Decision-Making in the Treatment of Cutaneous Melanoma

• Published in: The American surgeon 2020-11, Vol.86 (11), p.1561-1564
• Main Authors: Scott, Anthony M., Dale, Paul S., Conforti, Arnold, Gibbs, Jennifer N.
• Format: Article
• Language: English
• Subjects: Age; Biopsy; Cancer; Classification; Clinical decision making; Clinical Decision-Making - methods; Computed tomography; Decision making; Early experience; Emission measurements; Evaluation; Female; Females; Gene expression; Health risks; Health services; Humans; Lymph nodes; Lymphatic system; Male; Melanoma; Melanoma - genetics; Melanoma - pathology; Melanoma - surgery; Metastases; Metastasis; Middle Aged; Mortality; Patients; Positron emission; Positron emission tomography; Risk; Risk groups; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy; Skin Neoplasms - genetics; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Transcriptome; Tumors
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/0003134820939944

Background The practice of utilizing gene expression profile (GEP) for the evaluation and treatment of cutaneous melanomas has been found to predict the risk of sentinel-node metastasis and recurrence. Information obtained from this assay has been used to determine clinical decision-making, including serving as an indication for sentinel lymph node biopsy and also for the intensity of screening measures. Methods Herein we present our early experience in utilizing 31-GEP in intermediate melanomas and its effect on clinical management. A retrospective review was conducted of patients who had undergone treatment for melanoma whose tumors had been subjected to 31-GEP. Additionally, patient characteristics, attributes of the original tumor biopsied, findings on final pathology, and procedures performed were evaluated. 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. Over the study period, 31-GEP was conducted on 26 cutaneous melanoma patients. Testing and treatment data are available for 23 of these patients. Eleven patients were found to be low risk (9 as 1A, 2 as 1B), 12 were found to be high risk (4 as 2A, 8 as 2B). Decision-making was altered such that sentinel lymph node biopsy was omitted in 2 cases in which the patients were found to be low risk with age >65 years. Discussion In 8 cases of node-negative disease in genetically high-risk patients, surveillance measures were augmented with positron emission tomography/computed tomography. Utilization of 31-GEP is ongoing at our institution.