David Cotter, MD, PhD

An expert discusses whether the 31-gene expression profile (GEP) risk classification would change treatment guidelines and how the patient’s GEP risk level would influence the approach to surveillance and follow-up.

An expert discusses when gene expression profile (GEP) testing is recommended for melanoma and squamous cell carcinoma (SCC) patients, including cases where it may not be necessary, and provides final thoughts on the utility of GEP testing in risk stratification and making treatment decisions.

An expert discusses their impressions of the case, classifying the patient’s risk based on the clinical presentation of the lesion, and outlines treatment recommendations without knowing the 40-gene expression profile (GEP) information, including whether adjuvant therapy (ART) would be recommended. The expert also shares how to discuss 40-GEP testing with patients and reassure them that accurate risk levels are crucial for receiving optimal treatment.

An expert discusses initial thoughts on the case, including the risk category the patient would fall into based on the characteristics of their lesion, outlines the treatment guidelines for melanoma based on their risk, and suggests the frequency of surveillance visits solely based on their traditional risk classification.

An expert discusses the detection of circulating tumor DNA (ctDNA) prior to surgery, noting higher detection rates in stage III patients compared with stage IIB/C patients, and its significant association with a greater number of involved lymph nodes, extracapsular extension, and clinically evident disease, while also highlighting that all 6 patients with ctDNA detected during the surveillance period developed recurrent melanoma. The expert also provides an overview of the 40-gene expression profile (GEP) test for squamous cell carcinoma (SCC) risk stratification and discusses its utility.

An expert discusses the qualities of genetic tests that are most important to clinicians seeking precise and reliable results for melanoma diagnosis and prognosis, and reviews the 31-gene expression profile (GEP) test, highlighting its ability to classify melanoma risk into 1A, 1B, 2A, and 2B, with 1A patients showing higher melanoma-specific survival (MSS) and overall survival (OS), while 1B/2A and 2B classifications serve as independent predictors of MSS and OS, noting that patients who underwent 31-GEP testing had lower mortality compared with untested patients.

An expert discusses the patient demographics and clinical features used in traditional staging and risk classification of melanoma and squamous cell carcinoma (SCC), examining how staging systems from organizations like the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) align in risk classification, the challenges of relying solely on clinical features for prognosis, and the importance of accurate risk staging in guiding treatment decisions for these cancers.