Management Decisions Made by Physician Assistants and Nurse Practitioners in Cutaneous Malignant Melanoma Patients: Impact of a 31-Gene Expression Profile Test

Mirsky R, Prado G, Svoboda R, Glazer A, Rigel D.

Abstract

IMPORTANCE:

The 31 gene-expression profiling test (31-GEP) has been shown to provide useful prognostic information in patients with cutaneous melanoma. The test dichotomizes patients into lower risk (Class 1) or higher risk (Class 2) for melanoma metastasis. Previous studies have demonstrated the clinical utility of the test in impacting dermatologists’ management decisions. Physician assistants and nurse practitioners (PA/NPs) account for a significant portion of dermatologic providers. The impact of a 31-GEP assay on clinical management has not been evaluated in this group.

OBJECTIVE:

To determine the impact of 31-GEP test results on management decisions made by dermatology PA/NPs for cutaneous melanoma patients.

DESIGN, SETTING, AND PARTICIPANTS:

164 PA/NPs attending a national dermatology conference completed an online survey designed to determine the impact of 31-GEP test results on management decisions in a variety of clinical situations. Participants answered a series of questions related to six melanoma patient vignettes, each featuring different patient and lesion characteristics. Main Outcomes and Measures: Proportion of PA/NPs who would recommend sentinel lymph node biopsy (SLNBx) or further imaging for each patient vignette (without 31-GEP results, with a lower risk result, or with a higher risk result). The effect of the test results on the follow-up intervals recommended by PA/NPs was also examined.

RESULTS:

In the majority of cases, a lower risk 31-GEP test result led to a statistically significant decrease in the proportion of PA/NPs who would recommend SLNBx, imaging, or quarterly follow-up. Conversely, a higher risk 31-GEP result significantly altered management toward increased intensity (more recommendations for SLNBx, imaging, or quarterly follow-up) in all cases.

CONCLUSIONS AND RELEVANCE:

The results of a 31-GEP test appear to significantly impact management decisions made by dermatology PA/NPs regarding SLNBx, acquisition of imaging, and follow-up for patients with cutaneous melanoma.