How do gene expression profiling results impact your decisions regarding adjuvant therapy in node-negative or borderline-risk melanoma patients?

Node-negative patients comprise a majority of bad outcomes from melanoma deaths. These are the patients that I worry about the most, and 90% or so of lymph node biopsies are negative. High-risk DecisionDx-Melanoma (DDx-M) scores allow for routine serial imaging despite a negative lymph node biopsy. ...

At this time, gene expression profiling is not indicated for stage II (node-negative) melanoma patients. There is only one U.S. FDA-approved adjuvant immunotherapy indication for high-risk stage IIB/C patients, so next-generation sequencing (NGS) would not make a difference in management. Circulatin...

We are more likely to do more for GEP high-risk node-negative patients. If a patient already qualifies for adjuvant immune checkpoint inhibitor (ICI) therapy, meaning they have an AJCC Stage 2B or 2C melanoma, and have a high-risk GEP score, I am more likely to refer for and recommend adjuvant ICI t...