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

The following case studies are real-world examples of how gene expression profiling (GEP) can provide objective data to inform risk-appropriate treatment planning and follow-up care, and help improve management of cutaneous squamous cell carcinoma (cSCC) patients with one or more risk factors. 

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SCC Patient Case #1
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Could this patient benefit from lower intensity treatment?
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Patient presentation
A 74-year-old Caucasian male presents with two NCCN high risk factors. The patient's lesion was a 2.2cm x 2.2cm primary cutaneous squamous cell carcinoma (cSCC) on the left posterior scalp. The patient required three stages of Mohs surgery and no additional high-risk pathological features were observed. The final post-surgical defect size was 4.2 cm x 4.2 cm with a defect depth to adipose tissue. 

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Management plan
  • CT scan
  • Radiation
  • Monthly follow-up
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Why DecisionDx-SCC?

Due to the patient’s age, the clinician hoped to avoid radiation treatment. As well, the clinician was concerned with multiple cellular abnormalities, along with a depth within the adipose tissue, albeit not a depth beyond subcutaneous tissue. The clinician’s concerns were further compounded 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.

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Test result

DecisionDx-SCC test result of Class 1 indicates a low biological risk for metastasis (7.4%). This assisted the clinician in deciding to forgo radiation and proceed with a lower intensity-level of treatment. One year post-treatment the wound healed and there was no sign of the disease present.

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Impact to Patient Care

In light of the Class 1 DecisionDx-SCC test result, and the indication of a low risk of metastasis, the clinician determined that a lower intensity level of post-surgical management and surveillance would be more appropriate for the patient. 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 6 months. One-year post-treatment, the wound had healed with no evidence of recurrence or metastasis.

 This case study was published by Singh et al. Clinical, Cosmetic and Investigational Dermatology 2023 
1. Wysong et al. Late breaking presentation at AAD 2023; Data on file, Castle Biosciences

 

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Could this patient benefit from lower intensity treatment?
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Patient presentation
An elderly Caucasian male, over 90 years old, presents with two NCCN high risk factors. The patient's lesion was a 3.1cm x 2.9cm primary cutaneous squamous cell carcinoma (cSCC) on the left lateral neck. The patient required multiple stages of Mohs surgery and no additional high-risk pathological features were observed. The final post-surgical defect size was 4.4 x 4.1 cm.

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Management plan
  • SLNB
  • Radiation
  • Follow-up every 6 months
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Why DecisionDx-SCC?

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.

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Test result

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.

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Impact to Patient Care

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.

 This case study was published by Singh et al. Clinical, Cosmetic and Investigational Dermatology 2023
1. Wysong et al. Late breaking presentation at AAD 2023; Data on file, Castle Biosciences

 

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Is there rationale for this frequency of imaging and follow-up?
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Patient presentation
A 63-year-old Caucasian male presents with two NCCN high risk factors and one very high risk factor. The patient's lesion, located on his right posterior scalp, was greater than 2 cm in size. The patient required multiple stages of Mohs surgery, and the lesion was found to have invaded beyond subcutaneous fat.

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Management plan
  • Imaging surveillance of lymph nodes every 6 months
  • Follow-up every 3 months
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Why DecisionDx-SCC?

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.

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Test result

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.

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Impact to Patient Care

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.

 This case study was published by Singh et al. Clinical, Cosmetic and Investigational Dermatology 2023 
1. Wysong et al. Late breaking presentation at AAD 2023; Data on file, Castle Biosciences

 

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