Document Type

Article

Abstract

Background:

The treatment and prognosis of melanoma have historically been based on histologic stage and Breslow depth; however, due to the increase in surveillance, melanomas are being identified at an earlier stage and lower Breslow depth. Advances in genetic testing, such as Decision Dx®, mean that melanoma diagnostic decisions and prognosis can now be directed by genetics. The purpose of this project was to assess the influence of a Decision Dx® high-grade (Class 2A/B) classification on the treatment of melanoma patients at a regional medical center, particularly those not deemed high risk by conventional classification methods, including Breslow depth and Clark level.

Materials and Methods:

Melanomas that were diagnosed as Decision Dx® class 2A/B (high risk) at a single institution between 2019 and 2020 were retrospectively evaluated. Patients were stratified by recurrence and sentinel lymph node (SLN) positivity.

Results:

A total of 97 Decision Dx® high-risk patients were evaluated, in whom the average Breslow depth was 2.38 (0.45–7.5 mm), and three most common histologic stages were pT2a (19%), pT2b (18%), and pT4b (22%). Overall, 65% had oncology follow-up, 37% received immunotherapy, and 91% were alive. Recurrence was noted in 22% of the patients (n = 22); there was no significant difference in Breslow depth between those with and without recurrence. Significantly more of those with recurrence had Stage T3a (P = 0.0390; no recurrence 0%), oncology follow-up (95%; P = 0.0030), and immunotherapy (86%, P = 0.0001) but no difference in survival (P = 0.3161). Analysis of the patients with SLN biopsy (SLNBx) positivity showed that they were younger (mean: 63.3 years; P = 0.0040); however, no significant differences were found in histologic variables. Oncology follow-up was higher in the patients who were SLNBx positive (90%; P = 0.0126) as was immunotherapy (P = 0.0001); however, due to the Decision Dx® high-risk classification, 60% of the SLNBx-negative patients received oncology follow-up. Overall, recurrence and survival rates were not significantly different between cohorts.

Conclusion:

Although there were no significant differences in survival/recurrence, some patients would not have received additional follow-up based on the initial pathology who eventually developed recurrence. These data emphasize that genetic analysis can change management decisions and allow for more intensive surveillance, and that Decision Dx® can play an integral role in defining melanoma behavior along with histologic characterization. Larger studies to substantiate these results are warranted.

Digital Object Identifier (DOI)

https://doi.org/10.4103/ejcrp.ejcrp-d-25-00014

Rights

© 2026 Journal of Cancer Research and Practice | Published by Wolters Kluwer - Medknow This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

APA Citation

Reyes, R., Skenteris, G., Self, S., Schammel, C. M.-G., & Trocha, S. D. (2026). Does Genetic Testing Influence Outcomes: Early Experience in Melanoma Case Series. Journal of Cancer Research and Practice, 13(1), 18–24. https://doi.org/10.4103/ejcrp.ejcrp-d-25-00014

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