Gene Expression Profiling as an Emerging Tool in Skin Cancer Management

At the 10th Annual Fall Clinical PA/NP Conference in Orlando, Florida, Darrell Rigel, MD, MS, clinical professor at New York University, adjunct clinical professor at UT Southwestern, and consultant dermatologist at Cooper Clinic in Dallas, delivered a seminar on the evolving role of gene expression profiling (GEP) in managing skin cancers, particularly melanoma and squamous cell carcinoma. In his session, “Seminar-in-Depth: The Clinician’s Case-Based Guide to Gene Expression Profiling in Skin Cancer Management,” Rigel educated attendees on GEP testing’s growing role in modern skin cancer care for precise, personalized, and evidence-based disease management.

Rigel emphasized the alarming rise in melanoma incidence in the U.S., with over 100,000 new cases of invasive melanoma expected this year alone. Traditional prognostic tools such as tumor thickness, ulceration, and sentinel lymph node status remain important, but Rigel highlighted the need for more precise and individualized risk assessment through GEP testing.

The 31-GEP test analyzes the expression of 31 genes to provide a prognosis and the likelihood of sentinel lymph node positivity. This allows clinicians to tailor follow-up intensity and consider advanced treatments earlier for higher-risk patients. Conversely, patients with better-than-expected prognoses may avoid unnecessary interventions. Currently, about 20,000 patients receive the 31-GEP test annually, prescribed by over 4,000 dermatology healthcare providers nationwide.

GEP also plays a pivotal role in guiding sentinel node biopsy decisions. For patients with low-risk (Class 1A) profiles, the test can spare them from undergoing unnecessary biopsies. Higher-risk (Class 2B) patients, on the other hand, can be confidently advised to proceed with the biopsy.

Rigel also highlighted expanding use of GEP testing in squamous cell carcinoma cases with higher-risk features. Rigel mentioned a recent study, which showed that patients with Class 2B results will benefit from adjuvant radiation therapy, while those with lower-risk profiles do not, offering a practical framework for therapy decisions.

“We're just scratching the surface with GEP testing. It's making a real difference in my management of skin cancer, especially for melanoma and squamous cell carcinomas,” Rigel concluded. “I think the use is really becoming broad-based to the point that to me, it's almost the best practices at this point to integrate this kind of approach in managing these patients.”

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