“With traditional methods of diagnosis and prognosis, we have looked at clinical, histological, demographic and historical factors and these are the factors that we consider when looking for a model to make predictions about whether something is going to be “Good” or “Bad,” Darrell S Rigel, MD, MS, FAAD, Clinical Professor of Dermatology and Director of the Melanoma Surveillance Clinic at Mount Sinai Icahn School of Medicine in New York City and Co-Director of the Clinical Dermatology Conference fall 2022 for AMs and IPs declared Dermatology Times® in a follow-up interview highlighting key points from his presentation at the Fall 2022 Clinical Dermatology Conference for AMs and IPs.1 “The thing is, everyone’s genetics are a little different. If we can use precision techniques to refine diagnosis, prognosis, and what will be effective in treatment, we can make our use of healthcare resources more efficient. We now have other factors that were previously undetectable or undefined. If we can incorporate these factors into our models, we can make better diagnoses, prognoses and choice of therapies – that’s the idea behind precision medicine.
In diagnosis, tests such as DermTech’s 2-GEP (LINC and PRAME) and 3-GEP (LINC, PRAME and TERT) tests for melanoma can use increased sensitivity and specificity to better predict whether a lesion is benign. or malignant. “There were a few studies that were really exciting about this one that was in the skin that basically showed, the more advanced the pathway of malignancy, the higher the lesion, the higher the expression of those genes. , the larger the expression and therefore the better for the diagnosis. , which really validates the test in many ways,” Rigel said. “More importantly, if you have a negative test, the likelihood that the lesion is truly negative is now 99.6% That’s really important, because it tells you that you have the ability to say, “Okay, maybe I can pass that on,” and not do a biopsy.
With respect to prognosis, the additional information provided by tests such as the 40-GEP test for squamous cell carcinoma and the 31-GEP test for melanoma can help give a better assessment of prognosis, as well as predict whether sentinel lymph nodes will be positive.
Finally, Rigel said, a patient’s genetic makeup can provide keys to determining which biologic drug will work best for patients with psoriasis. “We’re only scratching the surface with this.”
“I think the important takeaway is that precision medicine doesn’t just come in dermatology,” Rigel said. “It’s already here, but it’s going to make a much bigger difference in the next few years and really influence the way we practice in clinical settings.”
Disclosures: Rigel is an advisory board member, lecturer, and/or has received research grants/funding from Castle Biosciences and DermTech.
1. Rigel D. What you need to know about precision dermatology. Presented at: 2022 Fall Clinical Dermatology Conference for PAs & NPs; June 3-5, 2022; Scottsdale, AZ.