Unpacking the Role of Gene Expression Profiling in Melanoma

At the DERM 2025 NP PA CME Conference in Las Vegas, Nevada, David Cotter, MD, PhD, discussed the dual role of cutting-edge technology in dermatology: artificial intelligence and molecular testing. His focus for attendees this year was on gene expression profiling (GEP), a molecular technique that evaluates which genes are "turned on or off" in skin cells, providing powerful insights into cellular behavior.¹ This technology allows clinicians to analyze gene activity at various levels—from single cells to entire tumor environments—enabling a more nuanced understanding of skin pathology.

In clinical practice, Cotter emphasized the utility of GEP testing, particularly in melanoma management. He highlighted the 31-GEP test, a widely used diagnostic tool that stratifies melanoma patients by risk, guiding decisions around sentinel lymph node biopsy, likelihood of recurrence, and overall prognosis. He underscored the importance of patient communication, carefully explaining to them that this test does not analyze genetic mutations but rather gene activity (RNA), helping to alleviate concerns surrounding traditional genetic testing and its implications for family members or insurance.

“I tell them that I need to know everything that there is potentially to know about their melanoma so we can help answer any questions that come up [and] give them the best and highest level of care,” Cotter said in an interview with Dermatology Times.

Cotter also shared his enthusiasm for the future of dermatologic therapeutics, especially for atopic dermatitis (AD). While psoriasis has seen transformative treatments over the last decade, similar breakthroughs for AD are still emerging. He expressed optimism about the evolving drug pipeline, with new molecules on the horizon that may offer comparable efficacy and safety.

On a local level, Cotter spoke about the expansion of research initiatives in his Las Vegas practice, including ongoing head-to-head clinical trials that offer patients early access to innovative therapies. These efforts also serve an educational purpose, providing research opportunities to medical students and residents from the University of Nevada. He noted that 7 of his mentees have matched into dermatology in recent years, reinforcing his commitment to nurturing the next generation of clinicians and researchers.

Reference

1. Cotter D. Dark Waters: Navigating the Diagnosis of Melanoma and Gene Expression Profiling of Skin Cancer. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.