Case Study

Stage 1A (T1a) melanoma: Is a thin tumor low risk?

A 34-year-old female presented with a lesion on her arm diagnosed as malignant melanoma. The patient was believed to be low-risk due to an early-stage diagnosis.

Case details

  • Invasive malignant melanoma
  • 0.6 mm Breslow depth
  • No ulceration
  • No evidence of mitoses
  • No TILs present
  • No satellitosis
  • Clark level III

Based on AJCC staging and NCCN guidelines

Because of the patient's Breslow depth, she was considered low risk and not be eligible for a sentinel lymph node biopsy. Her recommended treatment plan was a history and physical every 6-12 months for five years, then annually.

Why DecisionDx-Melanoma?

Because of the patient's young age and Breslow depth being on the thicker end of a thin melanoma, the Moh's surgon didn't know whether to refer the patient to medical oncology or follow her themselves.

Test result and impact to care

DecisionDx-Melanoma test result of Class 2B indicated the highest risk. The patient was referred to a medical oncologist for high-intensity surveillance (CT scans every six months).

 

  • During the patient's 6-month scan, a metastatis to the lung was identified. The biopsy showed that it was a proven oligomet that was BRAF negative. 
  • The patient was treated with radiotherapy to the lung and started on combination therapy. 
  • The patient is doing well with clear scans at more than six years. 

Due to her high-risk test result, the patient's recurrence was identified earlier, while she was still asymptomatic, and was able to be managed effectively.

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