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November 21, 2023
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Gene expression profiling may reduce unnecessary biopsies in melanoma

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Key takeaways:

  • The gene expression profiling integrated with clinicopathological features could have reduced the number of biopsies by 43.7%.
  • The test had a better sentinel lymph node positivity than a nomogram (2.7% vs. 10%).

Clinical gene expression profiling may be able to better identify melanoma patients who can safely forgo sentinel lymph node biopsy compared with current recommended conventions, according to a study.

According to the current National Comprehensive Cancer Network (NCCN) guidelines, staging and nomograms are recommended to identify patients with cutaneous melanoma that are at the highest risk of disease progression and should undergo sentinel lymph node biopsy (SLNB). However, according to a study conducted by Michael Tassavor, MD, dermatologist and Mohs surgeon at Medical Dermatology & Cosmetic Surgery, and colleagues, these tools are not always reliable and may cause many patients to get SLNBs unnecessarily.

DERM1123Tassavor_Graphic_01
 Data derived from Tassavor M, et al. Anticancer Res. 2023;doi:10.21873/anticanres.16644.

“About 88% of those who undergo the SLNB surgery test negative for disease progression,” Tassavor told Healio. “That means 88% of people could have avoided unnecessary surgery, wasting health care dollars and exposing them to the estimated 11% risk of complications.”

Michael Tassavor

Tassavor and colleagues conducted a study comparing the performance of gene expression profiling integrated with clinicopathological features (i31-GEP) with the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, which is currently recommended by NCCN guidelines, in 465 patients with T1-T2 tumors and known SLN statuses.

Their results showed the i31-GEP could have reduced the number of SLNBs by 43.7% in patients with T1 tumors. Further, for those predicted to have a less than 5% risk, the i31-GEP sustained a false-negative rate below the 5% risk threshold, according to national guidelines, whereas the MSKCC nomogram did not.

Of patients with positive SLNs, the i31-GEP identified 2.7% as low risk compared with 10% identified by the MSKCC nomogram (P = .026).

“The high sensitivity and negative predictive value of the i31-GEP for SLNB show that patients considered low risk can have higher confidence of a negative SLN compared to relying upon MSKCC nomogram results,” Tassavor said.

As a result, the researchers suggest that incorporating the i31-GEP for SLNB into clinical practice may help identify which patients can safely forgo SLNB thus guiding the management of these patients.

“This test could spare a significant number of patients from the financial costs and risks associated with SLNB,” Tassavor concluded.