Case Study

Is an early-stage diagnosis low risk?

A 68-year-old female was referred by her primary care provider and presented with malignant melanoma. She was believed to be low-risk due to her early-stage diagnosis. She was not eligible for a sentinel lymph node biopsy (SLNB) based on AJCC8 and NCCN guidelines.

Case details

  • Malignant melanoma
  • 0.7 mm Breslow thickness
  • No ulceration
  • No evidence of Mitosis
  • TILs present
  • Vertical growth
  • No satellitosis
  • Clark level III

Based on AJCC staging and NCCN guidelines

The patient had a wide local excision followed by a history and physical every 6-12 months for five years, then annually.

Why DecisionDx-Melanoma?

The patient did not want to undergo surgery, therefore the clinician used DecisionDx-Melanoma to assess the risk of not having a SLNB.

Test result and impact to care

DecisionDx-Melanoma test result of Class 2B indicated the highest risk. The patient was referred to medical oncology for CT scans to the chest and pelvis every six months. The clinician also recommended follow-up appointments every three months for the first three years and then every six months after.

 

  • During one of her 6-month scans, a metastasis was found in her groin area. 
  • She was restaged as a Stage IV melanoma and started on Keytruda immediately while the disease was well within manageable parameter and the patient was asymptomatic. 

Without the high-risk DecisionDx-Melanoma test result, this patient could have been missed if looking at clinicopathologic factors alone. 

Download Case Study