Use of the 31-Gene Expression Profile Test to Aid in the Decision of Adjuvant Treatment of Cutaneous Melanoma.

Melanoma is the fifth most common cancer in the United States, with over 7,000 deaths annually. Although most patients diagnosed with early-stage (stage I or II) disease have an excellent prognosis, two out of three patients who die from melanoma were initially diagnosed in early stages. Thus, additional methods to identify which patients are at risk of poor outcomes are needed. DecisionDx-Melanoma is a 31-gene expression profile (31-GEP) molecular risk stratification test that predicts an individual's risk of recurrence or metastasis in patients with cutaneous melanoma (CM). Here, we describe a 61-year-old man who presented with a spot on his upper scalp. A biopsy confirmed malignant melanoma measuring > 3.87 mm, with ulceration and mitotic rate 2 to 3/mm². CT, PET, and MRI scans did not reveal metastasis. Following wide local excision and sentinel lymph node biopsy, he was diagnosed with stage IIB CM. Due to the presence of high-risk features, 31-GEP testing was ordered, which revealed Class 2B (high-risk) CM. Due to the high-risk 31-GEP result, the patient was treated off-label with nivolumab for 1 year and received follow-up surveillance scans every 3 months for 3 years. At his last follow-up in April 2022, scans continued to show no recurrent or metastatic disease. The patient continues dermatologic screening every 6 months. The 31-GEP test provides valuable additional information to help clinicians make personalized, risk-based treatment and surveillance plans for patients with CM.