Currents: Smart Approaches to Skin Cancer

Study Finds DermTech’s Melanoma Test Can Cut Costs

DermTech’s Pigmented Lesion Assay can reduce costs for commercial health insurance plans when it’s incorporated into the current care pathway of assessing pigmented skin lesions or moles suspicious for melanoma, according to new research published in SKIN: The Journal of Cutaneous Medicine.

The PLA, a component of the DermTech Melanoma Test, objectively measures genomic markers associated with melanoma within skin tissue samples collected via non-invasive adhesive patches, or Smart Stickers. It is used to identify high-risk lesions and help providers determine the next best treatment: either a biopsy and histopathologic evaluation or clinical surveillance of the lesion in question. Comparatively, the traditional care pathway for evaluating suspicious moles is visual assessment, which is subjective, followed by a potentially avoidable surgical biopsy and histopathologic assessment.

The new findings suggest that use of the PLA to rule out melanoma can minimize avoidable surgical procedures on benign lesions and decrease downstream costs of late-stage melanoma diagnoses, which reduces overall cost of care.

To determine the per member per month (PMPM) net savings of incorporating the PLA into the current care pathway, a Return on Investment (ROI) model was developed from a US payer perspective. This model predicted annual net savings of $0.54 PMPM for commercial health plans over a three-year period with incorporation of the PLA.

“There is a clear need for objective, cost-effective technologies to help improve the assessment, classification and management of skin lesions and moles suspicious for melanoma,” says study author Daniel M. Siegel, MD, MS a clinical professor of dermatology at SUNY Downstate Medical Center. “The PLA offers just that, helping to make sure that the lesions and moles most likely to be malignant are the ones being biopsied.”

Study: Melanoma Referral Centers Worldwide Adopt Systemic Therapies, Reduce Lymph Node Removal Surgeries

Lymph node removal surgery for patients with high-risk melanoma has become less common over the past few years while the use of targeted and immune therapies has risen rapidly at melanoma referral centers worldwide, an international group of researchers found.

However, a large degree of variation remained in the treatments providers chose to give to patients that could not be explained by the severity of their cancer, according to the recent study by the International High-Risk Melanoma Consortium.

Over the past five years, clinical trials have shown that systemic medications, including pembrolizumab and ipilimumab, are effective in treating stage III melanoma. Other recent research has revealed that lymph node removal surgeries may be less effective for these patients than previously thought.

Surgeons at 21 melanoma referral centers collaborated to see whether these revelations had created changes in treatment plans for high-risk melanoma. It can often take significant time for providers to adopt or deescalate cancer treatments, even if the available evidence supports a shift in the landscape. (This lag can stem from a variety of factors, such as poor dissemination of study results and providers’ uncertainty about how trial results may apply to specific patients.)

In this case, though, the consortium saw signs that melanoma providers not only knew about the latest research but were also applying it in their practices.

“What this study shows is that, unlike the pace of adoption that we see for many scientific innovations, these research findings were adopted very quickly and quite broadly at major melanoma referral centers across the world,” says Kristy K. Broman, MD, MPH, an assistant professor of surgery at the University of Alabama at Birmingham and the first author of the study, in a news release. “We think this may be related to the potential lifelong complications of lymph node removal surgery, which surgeons and patients alike would readily choose to avoid when the surgery is unnecessary, as well as how effective the new systemic treatments are in a landscape where, only 10 years ago, we had no effective systemic therapies.”

“It’s great to see the fast pace of adoption of new data after major randomized clinical trials are published,” says Jonathan Zager, MD, chief academic officer, senior member, professor and the director of regional therapies at the Moffitt Cancer Center’s Donald A. Adam Comprehensive Melanoma Research Center and a co-senior author of the study.

“Yet, as we can see from the data, melanoma programs did implement these practice changes differently,” adds Lesly Dossett, MD, the division chief of surgical oncology at University of Michigan Health and a co-senior author of the study, “such that treatment a patient received depended a lot on where they were treated.”

This variation in melanoma treatment may be due in part to differences in regulations and health insurance systems in the United States compared to Europe and Australia. But it’s likely that the individual preferences of physicians play a role as well.

In the future, the researchers plan to delve further into the nuances of decision-making for high-risk melanoma treatments, including factors like the structure of health care teams and organizations and how information is communicated in different health systems.

The study appears in Annals of Surgery.

Blue Light: A Different Take

Targeted blue light can have beneficial effects on the skin, and Terrence Keaney, MD, says patients are getting more savvy. “I often get asked by my patients about blue light. There are a lot of at-home blue light devices, and patients are often intrigued by what blue light can do for them. The data and the efficacy of these low-energy at-home blue light treatments are still evolving, but there is some basic science evidence that blue light may be effective in certain subtypes of acne; it may affect the bacteria involved with acne production.”

He notes that longer wavelengths, like amber light, penetrate more deeply and have more anti-aging effects.

At home photobiomodulation is still evolving, he says. “It’s an area of clinical interest, but also patients are really intrigued by this. Patients want to take a more active role in their skin health by doing more things at home beyond skincare. It’s important for dermatologists to stay on top of this so when patients ask, we can send them in the right direction.”

Get more from Dr. Keaney. Watch the full video here

First Austrian Skin Cancer Patients Treated with Rhenium-SCT in New Study

The first Austrian patients have been treated in the global Phase 4 EPIC-Skin Study (Efficacy of Personalised Irradiation with Rhenium-SCT– for the treatment of non-melanoma skin cancer), according to OncoBeta GmbH.

Today’s patients are some of the first to be enrolled in the study with histologically confirmed stage I or II NMSC, and their progress will be followed up over a period up to 24 months. The international study will be conducted through study centers located in Austria, Australia, Germany, and the United Kingdom, with a planned total of 200 adult patients.

The EPIC-Skin study has an emphasis on Patient Reported Outcome Measures such as quality of life, treatment comfort and cosmetic outcomes, as well as further evaluating the efficacy of Rhenium-SCT for the treatment of NMSC. Patients in the study will utilize OncoBeta’s Clinical Study app, providing a simple and streamlined way to record their experiences.

Traditional treatments for NMSCs predominantly involve surgery, which may have a risk of scarring or loss of function. The Rhenium-SCT is a painless, single session† non-invasive therapy that utilizes the radioisotope Rhenium-188 in an epidermal application with optimal properties for the treatment of NMSCs (non-melanoma skin cancers).

The Rhenium-SCT is a precise, personalized therapy that is only applied to the area needed to treat without affecting the healthy tissue. The specially designed device ensures the Rhenium-SCT compound never comes in direct contact with the patient’s skin and the application is safe and simple for the applying physician. Most cases of NMSCs can be treated using the Rhenium-SCT in one single session withscar-free healing of the treated lesion area and the regeneration of healthy tissue.

Clinicians who are interested in enrolling patients in the study can contact OncoBeta directly at www.oncobeta.com/contact.