Advances in science and technology are transforming the way doctors understand, diagnose and treat skin cancers. From total body scanning to genomic testing, emerging technologies are helping dermatologists make more informed decisions to improve health outcomes and the patient experience.
At the heart of it all is data. Increasingly, physicians have access to big data — personalized, precise information to fine-tune skin cancer detection and patient management. The ultimate goal is to help patients live longer, healthier lives.
This is especially good news for patients at greater risk for more serious types of skin cancer, as well as those diagnosed with skin cancers at high risk for returning (recurring) or spreading (metastasizing).
Read on for more information about emerging technologies that are helping doctors advance the level of care for patients.
Personalized Genomic Information
Scientists have developed genomic tests that provide dermatologists and oncologists with information about the molecular biology of tumors in patients with more aggressive skin cancers, including invasive melanomas and high-risk squamous cell carcinomas (SCCs).
The tests analyze genetic information from a patient’s primary tumor. The data helps physicians better predict whether or not the cancer will return after treatment and whether or not it will spread to other parts of the body. Further, the tests provide greater patient-specific insight not available through traditional cancer staging. Current staging systems use clinical information and lab reports, and compare them with population-based data to arrive at a patient’s chance of recovery, also known as a prognosis.
What You Should Know
Gene expression profiling tests are not for everyone diagnosed with skin cancer. The tests are designed for invasive melanoma tumors and squamous cell carcinoma tumors with proven risk factors.
What Is a High-Risk SCC?
- Tumors larger than 2 cm in diameter
- Tumors that invade beyond the subcutaneous fat
- Tumors that are growing around a nerve
- Tumors that are poorly differentiated, meaning that the cancer cells look very abnormal or disorganized under a microscope
What Does This Mean?
Early stage, superficial melanomas do not qualify for testing. Similarly, early SCCs are not testable. Currently, there are no tests available for aggressive basal cell carcinomas or Merkel cell carcinomas.
How It Works
When appropriate, the physician orders the test. The test measures the activity of dozens of genes by using a tissue sample previously removed from the patient’s tumor during a biopsy or excisional surgery. This genetic information about the tumor is integrated with a sophisticated algorithm driven by artificial intelligence to arrive at an assessment of how aggressively a tumor might behave. Once completed, the test results (including a score) are sent directly to the physician.
“These tests are emerging to provide independent risk stratification for metastasis, and also for an individual’s risk for recurrence of that tumor,” says Allan C. Harrington, MD, Mohs surgeon at Anne Arundel Dermatology in Annapolis, Maryland. “We can look at these test scores to better predict five-year melanoma-free survival and metastasis-free survival for each patient.”
Why It’s Important
The tests enable physicians to combine a gene expression profile score with traditional approaches — like reviewing patient history, staging and lab results — to personalize patient care:
- Helping the doctor better predict the patient’s prognosis.
- Guiding the doctor to determine the best-informed patient management plans, including how often a patient sees a doctor, strategy for monitoring the tumor, treatment options and the need for further testing, including imaging and, in the case of melanoma patients, sentinel lymph node biopsies.
“We can look at these test scores to better predict five-year melanoma-free survival and metastasis-free survival for each patient.”
According to Dr. Harrington, the test can also reduce the likelihood that a tumor is misidentified as low risk using traditional staging, when in fact, the tumor has a significant chance for metastasizing.
“I had a patient who presented with a melanoma that would typically be in a good prognostic category,” he explains. “However, the patient’s tumor had a higher test score. We know that if we can diagnose patients with metastatic disease when it’s not symptomatic, these patients have a much better chance of survival. So, this patient is someone that we’re imaging and following much more closely.”
From a patient perspective, the tests can provide peace of mind in the form of clarity about the seriousness of their skin cancer, and next steps for management and treatment.
“We have patients who are greatly relieved as far as predicting their prognosis,” says Dr. Harrington. “Providing them with their biological risk is significant and can be a great release of stress.”
If you have been diagnosed with invasive melanoma or high-risk squamous cell carcinoma and are concerned about your prognosis, you can ask your dermatologist if you would benefit from this type of testing.
Precision Imaging Technology
Skin cancer detection is a visual process. And while dermatologists are experts at identifying skin cancers, high-tech imaging devices such as total body scanners can provide additional precision data to help doctors monitor and manage certain patients.
What You Should Know
Total body scanners are a sophisticated technology for melanoma screening and ongoing surveillance. They are neither widely available, nor commonly used. But for physicians with patients at very high risk for melanoma, they can provide state-of-the-art data.
How It Works
Dozens of digital cameras take high resolution photos of the patient’s entire body, while advanced image-processing software creates a digital 3-D model of the body, showing every mole or spot on a computer screen. Doctors can zoom in for even closer details that can help them identify very early skin cancers and track evolving moles.
Why It’s Important
Because dermatology is a visual specialty, advances in imaging can bring enormous value for patients at high risk for melanoma. When combined with routine skin checks, regular professional skin exams and patient history, these devices can help dermatologists monitor high risk patients over time and spot melanoma or other skin cancers early, when they are easier to treat and cure.