Pearls of Wisdom: Noninvasive Method of Identifying Melanoma
Allison is a 36-year-old fair-skinned white woman who has spent too much time in the sun and has a family history of skin cancer. She presents with a lesion that is moderately suspicious for melanoma on her lip margin.
You are concerned about the cosmetic difficulties of doing a biopsy right at the lip margin, but you want to promptly determine whether this lesion is skin cancer or not. She is ambivalent about allowing a biopsy and wonders whether there is any other way to discern the likelihood of this being a melanoma.
What noninvasive method could be used to identify Allison’s lesion?
A. Saliva testing for β2 microglobulin
B. Adhesive patch testing for mRNA
C. UV reflectometry
D. Cutaneous dual-energy x-ray absorptiometry (DEXA) scanning
What is the correct answer?
(Answer and discussion on next page)
Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. His “Pearls of Wisdom” as we like to call them, have been shared with primary care physicians annually in an educational presentation entitled 5TIWIKLY (“5 Things I Wish I Knew Last Year”…. or the grammatically correct, “5 Things I Wish I’d Known Last Year”).
Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.
Answer: B. Adhesive patch testing for mRNA
The incidence of melanoma is increasing, particularly in members of the fair-skinned white population, such as our patient Allison. Since survival is directly linked to depth of invasion, it is critical to diagnose melanoma early. In contrast with other cancers, there has been no apparent reduction in melanoma-related mortality over the past several decades. Yet we do not want to perform unnecessary biopsies, especially in areas where cosmetic results are a concern. We want to reinforce Allison for bringing the lesion to our attention, since the literature shows that screening skin examinations can reduce skin-cancer–related mortality.1
_____________________________________________________________________________________________________________________________________________________________________
RELATED CONTENT
Melanoma—or Mimic?
Melanoma is 7 Times as Likely in Today's Seniors
_____________________________________________________________________________________________________________________________________________________________________
The Research
Recently, a study was published that detailed the results of a new noninvasive test for melanoma, the DermTech Adhesive Patch Skin Biopsy Kit.1 The test is an adhesive patch that, after vigorous rubbing over a suspicious lesion, can identify mRNA from abnormal genes that are common to malignant melanomas.
A Noninvasive Adhesive Patch Test for Pigmented Lesions1
The Results
Trial data that compared the results of lesions that were first tested by DermTech with follow-up biopsy were encouraging. For instance, of the 42 lesions with a biopsy diagnosis of melanoma, 41 were correctly identified by DermTech (sensitivity, 97.6%); of the 22 lesions identified by pathologic assessment as benign nevi, DermTech identified 16 correctly (specificity, 72.7%). At first glance, a specificity of only 72.7% might seem insufficient, but clarification about the nevi is contained within the article1:
“Six of 22 cases with a histologic diagnosis of nevus had a molecular score consistent with a diagnosis of melanoma. Interestingly, among those 6 cases, 3 had a histologic reading of dysplastic nevus with severe atypia. Unfortunately, it is impossible to determine whether these 3 cases were truly false positives or actually early melanomas.”
A Noninvasive Adhesive Patch Test for Pigmented Lesions: Results1
Some of our patients would probably opt for a high-sensitivity tool like DermTech, especially in areas where biopsy is more difficult or might lead to greater cosmetic deficit.
What’s the “Take Home”?
DermTech appears to be a promising new noninvasive tool for identification of melanoma.
Reference:
1. Gerami P, Alsobrook JP II, Palmer TJ, Robin HS. Development of a novel noninvasive adhesive patch test for the evaluation of pigmented lesions of the skin. J Am Acad Dermatol. 2014;71:237-44.