A consensus statement published in JAMA Dermatology by an international group of melanoma researchers evaluated the use of prognostic gene-expression profile testing to guide clinical management of melanoma.1 The group cautioned against the routine use of currently available gene-expression profiling tests for patients with cutaneous melanoma.
For melanoma, such tests are designed to predict whether a patient’s tumor is likely to be aggressive and metastasize. Although routine gene-expression profile testing is not endorsed by national melanoma care guidelines, its use is increasing among clinicians who care for patients with melanoma to guide decisions on treatment and surveillance imaging.
Gene-expression profiling may have limitations, however, particularly in early-stage tumors, where a “low-risk” result could give patients a false sense of security or a “high-risk” result could subject them to more aggressive treatments or monitoring that may be unnecessary. Further, there are no national standards for which type of test should be used, when it should be used, or how accurate these tests should be.
The Melanoma Prevention Working Group ought to advance conversations around how and when gene-expression profiling should be used by clinicians caring for patients with melanoma. Through a series of meetings, surveys, and literature reviews, they authored this statement to review the current data and make recommendations for the use of gene-expression profile testing in melanoma. Their goal is to assist clinicians in determining when and how gene-expression profiling should be adopted in clinical practice and to outline the criteria by which tests should be evaluated and incorporated into clinical care guidelines.
Roadmap for Testing
The group included approximately 200 dermatologists, medical oncologists, surgical oncologists, and laboratory researchers who specialize in melanoma. “We are optimistic about the future use of gene-expression profiling in melanoma patients and are hopeful that this consensus statement can be a resource to clinicians in understanding the limitations of [gene-expression profile] testing and guiding the evaluation and use of new tests as they become available,” said Doug Grossman, MD, PhD, Melanoma Center Leader at Huntsman Cancer Institute and Professor of Dermatology at the University of Utah. Dr. Grossman convened the working group and is lead author of this consensus statement.
Doug Grossman, MD, PhD
The researchers hope the statement will provide a roadmap to help understand how gene-expression profile testing should be used when caring for patients with melanoma and what further evaluation is needed for its adoption in this field.
DISCLOSURE: The evaluation was funded by the National Institutes of Health/National Cancer Institute including P30 CA042014, the University of Utah Department of Dermatology, Huntsman Cancer Foundation, the Medical Research Council of Australia, the American Skin Association, and the Sydney Medical School Foundation. Dr. Grossman has financial relationships with Orlucent outside the submitted work. For full disclosures of the other authors, visit jamanetwork.com.
1. Grossman D, Okwundu N, Bartlett, EK, et al: Prognostic gene expression profiling in cutaneous melanoma. JAMA Dermatol. July 29, 2020 (early release online).