How should the use of the DecisionDx-Melanoma test be integrated into clinical practice to potentially avoid sentinel lymph node biopsy?

At this time, DecisionDx should be used as an extra piece of molecular information, not for clinical decision-making. The study done on DecisionDx was mainly retrospective, not prospective, so it has limited value in guiding patient care at this time. I would base your decision on SLBx on the curren...

We don't recommend using DecisionDx-Melanoma testing for deciding on sentinel node biopsy due to the lack of properly designed prospective studies. The Breslow depth is the best indicator for conducting SLNB.

DecisionDx-Melanoma can be used to inform sentinel lymph node biopsy decision-making. This test performs well in T1b melanomas. It also has utility in T1a high-risk (HR) melanomas, such as transected melanomas. Additionally, I like to use it for thinner T2a melanomas. The test helps risk-stratify pa...

This remains an area of research. Unfortunately, very few diagnostic tests are studied properly. These new genomic tests are usually more expensive. It is important to show that these tests modify the long-term outcome while avoiding a lead-time bias. This is very important in order not to overtreat...

The latest NCCN guidelines now recognize the Mayo Clinic Merlin-GEP as part of the workup for stage T1b, T2a melanoma patients. Does this change opinions about the test?

There are definitely cases that teeter on the border of choosing a sentinel node dissection, where genetic information may sway my or the patient's decision-making one way or another. In these cases, the test provides a reasonably valuable data point. In the end, known nodal status is usually more i...

DecisionDx is not appropriate for patients with significant, life-limiting medical issues, such as end-stage dementia, dialysis dependence, home oxygen use, or those who are near the end of life.
It is appropriate for patients with invasive primary melanoma, particularly clinical stage I or II diseas...