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Benefits & Pitfalls of Gene Expression Profiling in Treating Cutaneous Malignancies

Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic and Surgical Conference, interviewed Dr. Vishal A. Patel (fellowship trained Mohs micrographic surgeon who serves as Director of Cutaneous Oncology at the GW Cancer Center and Director of Dermatologic Surgery at the GW Department of Dermatology) about the pros and cons of gene expression profiling. Watch him describe how this technology can potentially identify patients needing more care. And also why he recommends proceeding with caution when using it.

Further Reading

If you would like to read more about gene expression profiling in dermatology, check out the following 3 articles recently published in the Journal of Drugs in Dermatology.

Clinical Considerations for Integrating Gene Expression Profiling into Cutaneous Squamous Cell Carcinoma Management


Gene expression profile (GEP) testing is now commercially available for metastatic risk prediction in patients with cutaneous squamous cell carcinoma (CSCC) and one or more high-risk factors. The purpose of this article is to provide an early framework for healthcare providers looking to integrate patient-specific tumor biology into their clinical practice using GEP testing. To develop a framework for clinical use, an expert panel was convened to identify CSCC management decision points where GEP testing may be immediately incorporated into practice until the definitive results of prospective trials become available. Based on their discussion, the expert panel focused on the areas of nodal evaluation, adjuvant radiation therapy, and follow-up and surveillance. The panel emphasized that GEP prognostic test results should not currently be used as a surrogate for standard of care treatment but as an additional data point when determining individualized management for patients with high-risk CSCC. Whenever possible, decisions on management plans for these patients should be developed with multidisciplinary input. Read the full article here.

Bridging the Gap: Integrating Gene Expression Profiling into Clinical Practice

Clinicians who treat patients with cutaneous squamous cell carcinoma (CSCC) face a unique set of management challenges. While the aim is to identify biologically aggressive tumors at earlier stages of progression and tumors that may be more advanced but pose lower than predicted risk, prognostication is not always accurate. Furthermore, even after careful clinical and histopathologic risk stratification, there remains significant variability in managing patients with high-risk CSCC. To address this challenge, experts are evaluating tools designed to improve risk stratification of these patients as discussed by the authors of this article.

Gene expression profile (GEP) testing has been shown, in combination with established clinical and histologic factors, to refine risk prediction for outcomes of interest for multiple diseases.1 The recently developed and validated 40-GEP test for CSCC is the first clinically available GEP test used to predict the risk of nodal and distant metastasis and should only be considered for use in tumors with one or more high-risk factors.2 The probability of nodal or distant CSCC metastasis varies based on established clinicopathologic risk factors, which current management algorithms use to provide recommendations appropriate for each individual patient. GEP testing for CSCC has the ability to provide clinicians with objective data from the primary tumor that can augment existing risk stratification, which could be an important and beneficial advance in patient care. Read the full article here.

Using 31-Gene Expression Profile in Melanoma Risk Prognosis

Cutaneous melanoma (CM) is one of the most dangerous and fastest growing types of cancer. According to the Center for Disease Control, the incidence of melanoma skin cancer has increased by 2% per year.1 A majority of CM related deaths are from melanomas initially classified as lowrisk subtypes.2 The prognostic and metastatic risk for CM is therefore underestimated according to current staging criteria.3

Current diagnostic recommendations exist based on the American Joint Committee on Cancer’s (AJCC) staging system, while current therapeutic recommendations are based on the National Comprehensive Cancer Network (NCCN) guidelines. AJCC staging takes into account several factors like Breslow Depth, ulceration status, nodal involvement, and presence of distant metastasis, which provide important prognostic information and indicate overall and disease-free survival.4,5 Because the AJCC guidelines are based on pathology alone, there is controversy surrounding this staging and how accurate it is at predicting mortality and morbidity in patients diagnosed with primary CM.6  Read the full article here.

About Dr. Vishal A. Patel

Dr. Vishal A. Patel is a board-certified dermatologist and fellowship trained Mohs micrographic surgeon who specializes in cutaneous oncology and reconstructive surgery. He is an Assistant Professor of Dermatology and Oncology at the George Washington University School of Medicine & Health Sciences. He serves as the Director of Cutaneous Oncology at the GW Cancer Center and the Director of Dermatologic Surgery at the GW Department of Dermatology. He is a fellow of the American Society of Dermatologic Surgery, the American College of Mohs Surgery, and the American Academy of Dermatology. Dr. Patel is an expert in cutaneous oncology include Mohs micrographic surgery for melanoma, high risk squamous cell and basal cell carcinomas, Merkel cell carcinoma, complex reconstructive surgery, and the medical management of high-risk skin cancers in immunocompromised patients. His research interests focus on the medical and surgical management of high-risk squamous cell carcinoma.

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