Genetic and Molecular Testing Changing How Melanoma Is Diagnosed and Treated

“Oncologists should be aware of the Castle test because it can give prognostic data and help us to identify patients at increased risk of metastasis. This could be helpful in determining how frequently patients should be monitored and in determining which patients may benefit from enhanced imaging surveillance to detect early metastasis,” Dr Ferris told Cancer Therapy Advisor.

“In addition, as more therapeutic options for stage 3 disease become available, it may help us to better select patients who may benefit from sentinel node biopsy. In addition, the Castle test may help identify patients at high risk of metastasis despite negative sentinel node.”

She said it is important for oncologists to know the strengths and limitations of each of these individual tests. Specifically, she noted that FISH may help distinguish indolent spitz nevi from more aggressive spitzoid melanoma.

“Ultimately, these tests may help to improve mortality and morbidity, if they can identify patients who can benefit from early therapeutic intervention, particularly with newer targeted therapies,” Dr Ferris said. “Also, if these tests can limit the number of sentinel node biopsies that can limit surgical morbidity. The key is finding out how to best use these new technologies in clinical practice.”

Ali Hendi, MD, clinical assistant professor of dermatology at Georgetown University Hospital and skin cancer specialist in the Washington, DC, area, said genetic testing is on the forefront of improving prognostication of melanomas. He said although in its infancy, there is a great deal of promise with new molecular tests and they could impact morbidity and mortality in the next couple of years.

“I think it’s a promising technology that needs to be used more to be validated,” Dr Hendi told Cancer Therapy Advisor. “The management of advanced melanoma is changing rapidly with the advent of systemic treatments that have modest improvements in survival.”

References

1. Chu EY. Melanoma and the genes: optimizing patient management in the age of molecular testing. Presented at the American Academy of Dermatology 74th Annual Meeting; March 7, 2016; Washington, D.C.
2. Guy GP, Thomas CC, Thompson T, Watson M, et al. Vital signs: melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.
3. Ferris LK. FRM F128 – molecular diagnostics: what it means to our patients. Presented at the American Academy of Dermatology 74th Annual Meeting; March 7, 2016; Washington, D.C.