Universal Risk Stratification in Stage I-III Cutaneous Melanoma Using 31-gene Expression Profiling: A Single-Center...

Area of Science:

• Oncology
• Dermatology
• Genomics

Background:

• Early-stage cutaneous melanoma (CM) patients have a low individual risk but contribute to most distant recurrences.
• The role of gene expression profiling (GEP) in risk stratification and clinical management for CM is not well-defined.

Purpose of the Study:

• To evaluate the utility of DecisionDx 31-GEP for risk stratification in early-stage cutaneous melanoma.
• To assess GEP's predictive value for recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival (MSS).

Main Methods:

• A cohort of 689 CM patients from 2015-2022 underwent GEP testing.
• Kaplan-Meier and Cox proportional hazards models analyzed RFS, DMFS, and MSS.
• Secondary outcomes included sentinel lymph node biopsy (SLNB) positivity and recurrence patterns.

Main Results:

• GEP was a significant predictor of RFS, DMFS, and MSS across different classes (Class 1B/2A and Class 2B).
• Stage IA patients showed no significant predictive value from GEP.
• Older Class 1A patients with SLNB indications had lower SLNB positivity rates.

Conclusions:

• GEP is a robust predictor of recurrence and survival in CM, but its utility varies by stage, particularly in Stage II disease.
• GEP testing is not recommended for Stage IA patients.
• Older patients with low-risk GEP may be candidates for SLNB avoidance, while Class 2B patients represent a high-risk group.