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Dermbits

MD, PhD

Can you discuss your thoughts on the NEJM article on melanoma overdiagnosis and how GEP may fit into this?

Skin Cancer

So highlights of this New England journal article were that we are potentially experiencing an overdiagnosis epidemic within melanoma. And so over diagnosis was kind of defined several ways. One, was we biopsy too many things, particularly too many benign lesions. Two, we are more likely, when is biopsied, if it has some histologic atypia, to actually call it melanoma, whereas in the past, a similar lesion maybe would have just been called an atypical nevis. Three, we are more likely to have these more, what would be called indolent melanoma. So, lesions that are melanoma, they're treated as melanoma, but they didn't have the same potential for metastasis as what we would maybe have thought of as melanoma, for example, 50 years ago. So how can GEP help with this? I think what GEP can do is provide objective data. So, one, in terms of what we biopsy, we're not just saying this mole has a little bit of an irregular border. We're saying we can actually measure some degree of genetic atypia. Two, in terms of, do we call an equivocal lesion linoma or benign? Again, you can use some genetic information, not just the histologic features. And then three, one of really the bad outcomes of over diagnosis is over treatment. So by getting genetic information on a lesion's behavior, then we have the potential to actually dentensify treatment for some patients.