BACKGROUND
Following a diagnosis of cutaneous malignant melanoma (CMM), patients are often guided for subsequent management by their dermatologist and national guideline recommendations.1,2 Based upon staging classification for CMM, guidelines recommend diagnostic tests and additional evaluation which may provide defined treatment protocols, surveillance, and follow-up. Unfortunately, these recommendations are often similar across several tumor stages in part because of the inability to precisely stratify different risk groups that may have markedly different outcomes. The push for personalized medicine has led to considerable advances in the guidelines and staging of CMM, including the recognition of the prognostic value of unique patient characteristics such as mitotic rate, ulceration presence, and sentinel lymph node biopsy (SLNBx) status.3 Technology has already been demonstrated to augment dermatologists’ clinical decision making for this tumor.4 Molecular-based techniques have been shown to provide additional information for CMM as has been noted in many other tumors. A 31-gene expression profile (GEP) test (DecisionDx-Melanoma, Castle Biosciences Inc., Friendswood, TX) was developed to predict whether a patient is at low-risk (Class 1) or high-risk (Class 2) for metastasis based on their primary CMM tumor biology.5,6 The prognostic accuracy of the 31-GEP was previously reported in several prospectively planned multicenter studies and contributes significant additional information when considered in combination with current AJCC staging criteria and guideline recommendations.5-8Although the 31-GEP has demonstrated reproducibility and clinical validity in assessing recurrence risk, another important aspect of molecular testing is clinical utility – the impact of the test results on clinical decision making. We sought to
