DecisionDx-SCC can provide objective data to inform risk-appropriate patient management 

• SLNB
• Radiation
• Follow-up every 6 months

Due to the patient’s age, and the extensive Mohs surgery, the clinician preferred to avoid radiation and sentinel lymph node biopsy (SLNB). However, the clinician was concerned with the patient having two NCCN high risk factors, and the DecisionDx-SCC GEP test was ordered to help inform the level of post-surgical care required.

DecisionDx-SCC test result of Class 2A indicates a higher biological risk for metastasis (18.8%). This assisted the clinician in deciding to forgo reflexive SLNB and radiation and to proceed with a lower intensity-level of treatment follow-up every three months. Three months post-treatment the wound healed and there was no sign of the disease present.

In light of the Class 2A DecisionDx-SCC test result, the indication of a higher risk of metastasis, and the patient’s age, the clinician determined that a lower intensity level of post-surgical management with more frequent surveillance would be more appropriate for the patient. A reflexive SLNB and radiation treatment was deemed unnecessary and removed from the patient’s care plan. Follow-up was scheduled for monthly wound check, and nodal exams were scheduled for every 3 months, rather than 6 months. Three months post-treatment, the wound had healed with no evidence of recurrence or metastasis.

• Imaging surveillance of lymph nodes every 6 months
• Follow-up every 3 months

Due to the patient’s age, the clinician preferred to avoid radiation and sentinel lymph node biopsy (SLNB), and to do surveillance of the patient’s lymph nodes with imaging instead. However, the clinician was concerned with the patient having two NCCN high risk factors, along with a very high risk factor, and the DecisionDx-SCC GEP test was ordered to determine whether the clinician's desired management plan was appropriate.

The DecisionDx-SCC test result of Class 2A indicates a higher biological risk for metastasis (38.6%). This assisted the clinician in deciding to proceed with the treatment pathway – imaging surveillance twice a year for two years with clinical follow-up every three months. 16 months post-treatment, the wound has healed with no sign of the disease present.

Based on the Class 2A DecisionDx-SCC test result, the indication of a higher risk of metastasis, and the patient’s age, the clinician determined that the pre-test rationale for post-surgical management with frequent surveillance was appropriate for the patient. Follow-up was scheduled for every three months, with imaging surveillance of lymph nodes twice a year for two years. 16 months post-treatment, the wound has healed with no evidence of recurrence or metastasis.

• Post-operative adjuvant radiation therapy. 

Post-operative radiation therapy considered due to the high-risk features of large size and tumor depth> 4 mm. The patient wished to avoid further treatment if possible. 

The DecisionDx-SCC test result of Class 2A indicates a higher biological risk for metastasis (38.6%). This assisted the clinician in deciding to proceed with the treatment pathway – ART treatment 5 months post-initial surgery to decrease chance of recurrence or metastasis. 

9 months post-surgery there was no evidence of recurrence or metastasis.