SCC Expert Consensus Panel Report

New consensus guideline publication in The Journal of Clinical and Aesthetic Dermatology (JCAD) titled “Integrating 40-GEP Testing to Improve Clinical Recommendations for Adjuvant Radiation for Cutaneous Squamous Cell Carcinoma.” The publication highlights multidisciplinary (two radiation oncologists and three Mohs surgeons) consensus guidelines that recommend combining traditional staging with the 40-GEP test to allow for more accurate prognostic staging of SCC tumors, and to improve precision in multidisciplinary treatment recommendations, including the use of ART.

Three clinical practice gaps emerged during the consensus discussion for which the panel members agreed that the addition of 40-GEP testing has significant clinical utility:
- In escalation of care for lower-stage patients with high-risk tumors
- In de-escalation of care for patients for whom the risks of ART may outweigh the benefits
- In decision-making regarding elective radiation to the nodal basin
The expert panelists also agreed with a report from a recent survey of members of the multidisciplinary Skin Cancer Outcomes (SCOUT) consortium that recommended ART be considered when risk of metastasis is 20% or higher
There was agreement that a Class 2A or 2B result serves as a high or very high-risk feature for consideration in recommending ART, as the metastatic risk conferred by these two results is similar to those of poor differentiation and PNI
For multi-disciplinary care, panelists agree that dermatologists should image these Class 2A and 2B patients and refer them to radiation oncology, with a recommendation for multidisciplinary tumor board discussion for patients with Class 2B results
Radiation oncologists should discuss individual risks and benefits of radiation with all of their patients and integrate Class 2A and 2B results into the context of other high-risk features when considering radiation, with a stronger recommendation of ART for Class 2B patients
Panelists also recommend imaging by the physician’s choice of preferred modality in SCC patients with 40-GEP high-risk Class 2A or 2B results
Consensus was also reached that imaging is preferred over sentinel lymph node biopsy (SLNB), given the absence of clear benefit and the possible morbidity of that procedure

The panel's unanimous adoption of consensus statements and recommendations of Castle Biosciences' DecisionDx-SCC prognostic test is the focal point of the article. A distinguished panel of 8 dermatologists, including the esteemed current president of the AAD, with specialized expertise in the diagnosis and management of squamous cell carcinoma, convened to meticulously analyze 21 pertinent articles on the utilization of gene expression profiling (GEP) testing for assessing prognosis in cSCC. After a comprehensive evaluation, the panel unanimously agreed to embrace 7 consensus statements and recommendations pertaining to cSCC and the application of GEP testing for prognosis assessment. Notably, 6 of these recommendations were given a robust strength rating of "A," while 1 received a rating of "C."

This comprehensive literature review, along with the unanimous vote on the statements above, is of great clinical value and provides actionable insights. It further highlights the significant limitations of current clinicopathologic staging systems in accurately predicting metastasis in patients. It is imperative to identify a more precise method for assessing this risk in order to minimize the negative impact on patients' health and well-being caused by both cSCC and unnecessary treatments. The 40-GEP test has undergone extensive validation as an independent predictor of cSCC metastasis risk, surpassing the capabilities of traditional staging systems. When combined with these systems, it offers a more accurate and reliable prognostic assessment.

There is data to support that specific genes influence cSCC clinical behavior
The data supports the 40-GEP test’s ability to identify a subset of cSCCs that are at a high risk for metastasis
The 40-GEP test provides clinically useful data for cSCC prognosis that is independent of the AJCC8 and BWH staging systems
Adding 40-GEP data to the AJCC8 and BWH staging systems enhances the prognostic assessment of cSCC
Test results can increase the precision and confidence in cSCC management decisions
The 40-GEP test should be considered for use on cSCC tumors with at least 1 high-risk feature per AJCC8 and/or BWH and/or NCCN guidelines
The 40-GEP test should not be used on cSCC in situ or invasive cSCC without a high-risk feature, or for patients that are not candidates for additional procedures or therapies

New publication: In the Journal of Clinical and Aesthetic Dermatology (JCAD) highlights multidisciplinary consensus guidelines that recommend combining traditional staging with DecisionDx-SCC (40-GEP) to improve treatment recommendations, including the use of ART.

Read the article here.

New publication: “Incorporating a Prognostic Gene Expression Profile Test into the Management of Cutaneous Squamous Cell Carcinoma: An Expert Consensus Panel Report” was recently published in the Journal of Drugs in Dermatology (JDD).

Read the article here.