Mark Gimbel, MD, reviews some highlights from his lecture " Melanoma: Updates, Genomics, and Molecular Profiling" on Thursday, November 7, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, Arizona.

In this video

Dr. Gimbel walks through the tools available beyond the biopsy itself, starting with knowing "what to biopsy." When there's uncertainty, he points to the DermTech patch test, which samples skin cells to look for genomic markers with good sensitivity, and to MyPath for lesions that don't declare themselves as melanoma under standard H&E or immunohistochemistry. He's blunt about the downsides — cost to the system and indeterminate results that can mean "double the work" — and stresses that a test is only worth ordering if the result will actually change management.

On follow-up, he frames low-risk melanoma as a team approach: he follows patients for recurrence and spread while dermatology handles surveillance for new cancers, and he's comfortable dropping off a patient's care when he's "not adding any value." He warns that thin, early-stage melanomas are the "biggest misconception" — many patients who die of melanoma first presented with early-stage disease — which is where stage-agnostic gene expression profiling helps sort high- from low-risk biology. Looking ahead, after immunotherapy's "game changer" impact, he expects a biopsy to eventually predict node positivity, recurrence risk, and which treatments a patient will respond to.

  • Genomic tests like DermTech and MyPath help most when a lesion is uncertain or doesn't read as melanoma on standard H&E and immunohistochemistry — but only order a test whose result will change what you do.
  • Weigh the downsides: added cost to the system and indeterminate results that can leave you doing the work you should have done anyway.
  • Low-risk melanoma care is a collaboration — the surgeon follows for recurrence and spread while dermatology handles new-cancer surveillance and skin checks.
  • Thin melanomas aren't automatically low risk; a large share of melanoma deaths began as early-stage disease, so use gene expression profiling to risk-stratify in a stage-agnostic way.
  • The future he anticipates: a single biopsy predicting lymph node status, recurrence risk, and likely response to immunotherapy or BRAF-targeted therapy.