Clinical Summary

Archives of Dermatological Research

March 2023

Routine imaging guided by a 31‑gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies

REFERENCE

Dhillon S, Duarte-Bateman D, Fowler G, et al. Routine imaging guided by a 31‑gene expression profile assay results
in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without
surveillance imaging studies. Archives of Dermatological Research. 2023. https://doi.org/10.1007/s00403-023-
02613-6

  • background

    Patients with early-stage disease typically have a good prognosis, but still have a risk of recurrence, even with negative sentinel lymph node biopsy (SLNB). Routine imaging can effectively detect early relapse when there is a lower tumor burden. For patients with stage IIB disease or greater, the National Comprehensive Cancer Network® (NCCN®)  recommends chest radiography, CT, brain magnetic resonance imaging, and positron emission tomography and CT every 3–12 months for 3 years at the discretion of the physician. However, routine imaging is not a standard protocol for clinical stage 1 and 2 patients, and the guidelines for surveillance remain controversial.

  • objective

    This study explores the utility of routine imaging to detect metastases in patients with negative SLNB but high-risk 31 gene expression profile (31-GEP) scores.

  • methods

    SLNB negative patients with high-risk GEP results (Class 2A/2B) were placed in the experimental group and SLNB negative patients without GEP testing were placed in the control group. Among both cohorts, recurrent melanoma groups were identified. The tumor burden at the time of recurrence, treatment outcomes, and survival outcomes were all measured and compared between patient groups.

  • results
    • The average tumor burden among recurrent melanoma patients in the experimental group was 27.60 mm compared to 73.10 mm in recurrent melanoma patients from the control group.
    • Melanoma recurrence was detected an average of 9.85 months earlier with the experimental high-risk group average detection at 25.50 months versus 35.35 months for the control group.
    • Patients with high-risk 31-GEP results who received routine imaging also showed a statistically significant improved overall survival 76.3% versus 50.0%, p-value= 0.027.

Patients receiving DecisionDx-Melanoma testing and routine imaging follow-up showed:

  • 1

    Approximately 10 months' earlier detection of recurrence

  • 2

    62% lower tumor burden at recurrence detection

  • 3

    At study end, patients tested had better overall survival than those not tested (76% vs 50%, p-value= 0.027)

Patients who received routine imaging after high-risk GEP test scores had an eariler recurrence diagnosis with lower tumor burden, leading to better clinical outcomes

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