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In this case, a more accurate assessment of the state of disease was attained through 40-GEP testing. Traditional staging methods, including AJCC8 and BWH, overestimated our patient’s risk profile. More research needs to be completed surrounding gene testing and metastatic risk. Our goal with this case is to contribute to the growing body of literature surrounding the use of gene expression profile testing in cutaneous cancer.
Scientific evidence
The 40-gene expression profile (40-GEP) test enhances risk-aligned guidance for surveillance imaging in high-risk cutaneous squamous cell carcinoma (cSCC)
Oct 2024
Publication: Presented at the 2024 American Society for Dermatologic Surgery (ASDS) Annual Meeting
Predicting adjuvant radiation therapy benefit in cutaneous squamous cell carcinoma with the 40-gene expression profile
Sep 2024
The 40-GEP identified patients most likely to benefit from ART (Class 2B) and those that can consider deferring treatment (Class 1).
Publication: Future Oncology
Association of a 40-gene expression profile with risk of metastatic disease progression of cutaneous squamous cell carcinoma (cSCC) and specification of benefit of adjuvant radiation therapy
Jul 2024
DecisionDx-SCC identifies patients at the highest risk of nodal/distant metastasis who may derive the greatest benefit from ART, as well as patients who may have clinical indications for ART but are at low risk of metastasis. Compared with current guidelines, 40-GEP could provide greater specificity concerning the benefit of ART in individual patients.
Publication: International Journal of Radiation Oncology, Biology, Physics
Addition of the 40-gene expression profile (40-GEP) test improves prognostic accuracy and risk stratification for high-risk cutaneous squamous cell carcinoma (HR-cSCC) of the head and neck treated with Mohs micrographic surgery (MMS)
May 2024
Assess the ability of the 40-GEP test to significantly improve metastatic risk prediction of NCCN, AJCC8, and BWH staging systems when included.
Publication: Poster, presented at the American College of Mohs Surgery 2024
Inconsistent associations between risk factor profiles and adjuvant radiation therapy (ART) treatment in patients with cutaneous squamous cell carcinoma and utility of the 40-gene expression profile to refine ART guidance
Mar 2024
ART guidance is not determined by the presence of specific clinicopathologic factors, with treated and untreated patients sharing the same risk factor profiles. cSCC risk determination based on NCCN recommendations for clinical factor assessment results in inconsistent use of ART. Including tumor biology-based prognostic information from the 40-GEP refines risk and identifies patients who are most appropriate and likely to benefit from ART, and those that can consider deferring ART
Publication: Dermatology and Therapy
Integrating the 40-gene expression profile (40-GEP) test improves metastatic risk-stratification within clinically relevant subgroups of high-risk cutaneous squamous cell carcinoma (cSCC) patients
Mar 2024
The 40-GEP test demonstrates accurate, independent, clinically actionable stratification of metastatic risk and improves predictive accuracy when integrated into risk classification systems. The improved accuracy of risk assessment when including tumor biology via the 40-GEP test ensures more risk-aligned, personalized patient management decisions.
Publication: Dermatology and Therapy
Integrating 40-GEP testing to improve clinical recommendations for adjuvant radiation for cutaneous squamous cell carcinoma: multidisciplinary consensus guidelines
Feb 2024
Combining clinicopathologic staging with the 40-GEP test allows for more accurate prognostic staging of cSCC tumors; this, in turn, improves precision in multidisciplinary treatment recommendations, including the use of ART. The utility of 40-GEP testing has been demonstrated in low-, higher-, and highest-stage cSCC tumors. Additionally, 40-GEP testing has shown greater specificity than current clinicopathologic guidelines in identifying patients at highest risk of nodal or distant metastasis who would most likely benefit from ART, as well as lower risk patients who would benefit less from such therapy. Appropriate use of 40-GEP testing involves a shared decision-making model between the multidisciplinary team and the patient with cSCC, taking into consideration many factors, such as the patient’s risk of metastasis, tumor and nontumor characteristics, and individual preferences.
Publication: Journal of Clinical Aesthetic Dermatology
The 40-gene expression profile (40-GEP) test identifies cutaneous squamous cell carcinoma (cSCC) patients at high risk of metastasis within lower-staged tumors to better guide treatment decisions
Jan 2024
Publication: Poster, presented at the 2024 Winter Clinical Dermatology Conference - Hawaii®, Honolulu, Hawaii, January 12-17, 2024
Use of the 40-gene expression profile (40-GEP) test in medicare-eligible patients diagnosed with cutaneous squamous cell carcinoma (cSCC) to guide adjuvant radiation therapy (ART) decisions leads to a significant reduction in healthcare costs
Jan 2024
Utilizing the 40-GEP test results to guide ART decision-making would result in material savings to Medicare.
Publication: Journal of Clinical and Aesthetic Dermatology
Incorporating a prognostic gene expression profile test into the mangement of cutaneous squamous cell carcinoma: An expert consensus panel report
Dec 2023
The 40-GEP test provides accurate and independent prognostic information beyond standard staging systems that only incorporate pathologic data. In this consensus paper, 8 dermatologists with significant expertise in diagnosing and managing cSCC concluded that incorporation of GEP testing into national guidelines can help further stratify patients based on risk of metastasis, and thus may improve morbidity and mortality.
Publication: Journal of Drugs in Dermatology
40-gene expression profile representative of metastatic risk of squamous cell carcinoma in a Mohs surgical patient
Oct 2023
Publication: Cureus
Incorporation of the 40-gene expression profile (40-GEP) test to improve treatment decisions in high-risk cutaneous squamous cell carcinoma (cSCC) patients: case series and algorithm
May 2023
Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient’s risk for poor outcomes.
Publication: Clinical, Cosmetic and Investigational Dermatology