A Dermatologist's Guide to Implementation of Gene Expression Profiling in the Management of Melanoma

Shawn G Kwatra; Howard Hines; Yevgeniy R Semenov; Shannon C Trotter; Elizabeth Holland; Sancy Leachman

A Dermatologist's Guide to Implementation of Gene Expression Profiling in the Management of Melanoma

J Clin Aesthet Dermatol. 2020 Nov;13(11 Suppl 1):s3-s14. Epub 2020 Nov 1.

Authors

Shawn G Kwatra^{1

2

3

4

5}, Howard Hines^{1

2

3

4

5}, Yevgeniy R Semenov^{1

2

3

4

5}, Shannon C Trotter^{1

2

3

4

5}, Elizabeth Holland^{1

2

3

4

5}, Sancy Leachman^{1

2

3

4

5}

Affiliations

¹ Dr. Kwatra is Assistant Professor of Dermatology at the Johns Hopkins University School of Medicine in Baltimore, Maryland.
² Dr. Hines is Assistant Professor of Dermatology at Johns Hopkins University School of Medicine in Baltimore, Maryland.
³ Dr. Semenov is a board-certified dermatologist and instructor in Dermatology at Harvard Medical School in Boston, Massachusetts.
⁴ Dr. Trotter is Clinical Assistant Professor of Dermatology at Ohio University and past Director of the Pigmented Lesion Clinic at the Arthur G. James Center Hospital in Columbus, Ohio. Ms. Holland is a Senior Medical Science Liaison at Castle Biosciences.
⁵ Dr. Leachman is Professor and Chair of the Department of Dermatology and Director of the Melanoma Research Program at the Knight Cancer Institute at Oregon Health and Sciences University in Oregon.

PMID: 33349788
PMCID: PMC7725505

Abstract

BACKGROUND. With the advent of effective therapeutics, melanoma mortality rates have decreased, yet incidence rates are continuing to rise, making accurate prognostication for risk of recurrence increasingly important. Gene expression profiling (GEP) is a clinically available, objective metric that can be used in conjunction with traditional clinicopathological staging to help physicians stratify risk in melanoma patients. There is a gap in guidance from the American Joint Committee on Cancer (AJCC) and the National Comprehensive Cancer Network (NCCN) regarding how to utilize GEP in melanoma care. OBJECTIVE. An expert panel of 31-GEP test users sought to provide clarification of use options and a rational clinical workflow to guide appropriate application of the 31- GEP test in everyday practice. METHODS. The authors participated in an in-depth review of the literature and panel discussion regarding current limitations of melanoma risk assessment and opportunities for improvement with GEP. The panel reviewed 1) validation and clinical impact data supporting the use of sentinel lymph node biopsy (SLNB), 2) existing primary data and meta-analyses for 31-GEP testing in melanoma risk assessment, 3) AJCC, NCCN, and Melanoma Prevention Working Group (MPWG) data and guidelines for GEP use in melanoma risk assessment, and 4) experiences, rationales, and scenarios in which 31-GEP testing may be helpful for risk assessment. RESULTS. The 31-GEP test is useful and actionable for patient care when applied in accordance with current NCCN guidelines. Stratification of patients into low (Class 1a), intermediate (Class 1b or 2a), or high (Class 2b) risk categories can inform multidisciplinary conference discussion and can assist with determining the intensity of imaging, surveillance, and follow-up care. Patient-specific features of the disease and individual circumstances should be considered in the decision to use 31-GEP testing. CONCLUSION. The authors suggest a clinical workflow that integrates 31-GEP testing under the umbrella of current national guidelines. Application of the test in appropriate patient populations can improve risk assessment and inform clinical decision-making.

Keywords: 31-GEP; Melanoma; NCCN; gene expression profiling; prognosis; prognostic algorithm; risk stratification.