What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?

This is a very cool test that has a lot of potential to help us make decisions in practice (full disclosure, I advise Castle and get research support from them, but am not directly compensated by them). The data published thus far shows that it is prognostic to predict nodal or distant mets. However, a prospective trial validating this data is ongoing (we are accruing). Also, it was not designed to help make decisions about the benefit of adjuvant therapy or other applications as a predictive biomarker. Additional studies are needed before it is adopted clinically in this way. That said, I know docs that are using it as an aid to decision-making when they are on the fence, albeit without sufficient data. Stay tuned for more data, lots of po...

Currently, the DecisionDx-SCC is best understood as prognostic but not predictive. This means that there is a lot of data supporting a correlation between the test score and the risk of metastases (mainly nodal). Some of this data can be found in the following publications:

Arron et al., PMID 34076385

Arron et al., PMID 35155791

The predictive part currently missing refers to whether changing treatment based on the test will improve outcomes. In general, the benefit of an intervention such as radiation therapy is expected to be greatest when the risk is highest. As Dr. @Dr. First Last points out above, prospective data is currently being accrued. In the meantime, there is some retrospective data:

Arron et al., PMID 38810706

Gopal et al., PM...