Burshtein J, Cockerell C, Cotter D, et al. 31-Gene expression profiling for cutaneous melanoma: an expert consensus panel. Dermatol Online J. 2025;31(5). https://doj.dermsquared.com/index.php/doj/article/view/50/53 An expert panel reviewing the published literature on the clinical efficacy, utility, and accuracy of the 31-gene expression profile (31-GEP) test concluded that the robust existing literature strongly supports its use as a best practice for the appropriate melanoma patient. The panel was comprised of 10 board-certi-fied dermatologists with expertise in the management of melanoma. Following review and discussion of 26 published articles deemed relevant to the research questions, the panel developed nine con-sensus statements, all of which received a unanimous vote for adoption. The nine consensus statements are listed below. The first eight statements received an “A” rating for strength of the recommendation (consistent, good-qual-ity, patient-oriented evidence); the last statement was given a “C” rating (con-sensus, opinion, etc.). • Multiple studies (including prospective studies) have demonstrated clinical efficacy for the 31-GEP test in provid-ing consistent and accurate prognostic information for invasive melanoma. • Studies have shown clinical utility for the 31-GEP test for providing prognos-tic information for invasive melanoma. • Studies have shown clinical efficacy for the 31-GEP test in providing prognos-tic information for invasive melanoma when the thickness or other tradition-al factors are unknown. • Integration of 31-GEP testing with tra-ditional staging methods can accurate-ly inform the decision to recommend sentinel lymph node biopsy. • There is a statistically significant improvement in assessing prognosis when adding 31-GEP results to AJCC 8 staging. • 31-GEP testing is more accurate and precise than online nomograms in predicting the need for sentinel lymph node biopsy. • Patients who have received 31-GEP testing have improved melanoma-specific survival and overall survival in comparison to patients who have not received 31-GEP testing. • The existing data strongly support the utilization of 31-GEP testing as a best practice for the appropriate melanoma patient. • Limited data suggest that patients are more likely than not to be receptive to receiving the data from the 31-GEP test in the discussion about their inva-sive melanoma and management. “This expert panel report consolidates what we know about the 31-GEP test to date and underscores its value as a part of a comprehensive approach to invasive melanoma. While AJCC 8 staging is essential to categorize patients, it does not account for tumor biology and misses melanoma patients that go on to metastasize and die from their disease. When the 31-GEP test results are added to AJCC 8 staging, there is a statistically significant improvement in assessing prognosis, which is an import-ant clinical consideration when devising a skin-surveillance plan and considering additional work-up and a multidisci-plinary approach, the panel concluded. This is helpful to tease out patients at high risk for recurrence. In our practice, early-stage patients who do not meet criteria for SLNB, or SLNB-negative patients that are designated as high risk (i.e., 2B) by the 31-GEP test, are followed with routine imaging to detect recur-rence and/or metastases. “One of the most pressing clinical questions is whether to pursue SLNB in patients with invasive melanomas. Many providers follow staging and Na-tional Comprehensive Cancer Network (NCCN) Guidelines and/or clinical factors like age, histopathological factors like mitoses, and clinical experience to recommend SLNB. Others might utilize online nomograms to assist in deci-sion-making. However, this paper noted that the i31-GEP can accurately inform the decision to recommend SLNB. In ad-dition, the paper stated the i31-GEP test is more accurate and precise than online nomograms in predicting the need for SLNB. This finding makes the i31-GEP test an important tool to assess SLNB positivity risk and identify patients who would benefit most from the procedure. The ability of the i31-GEP to assist with SLNB is one of its most useful applica-tions in practice. It allows me to give the patient their individual risk of having a positive node and inform the decision to move forward or potentially forego the procedure. “This paper also brings up the point of patient receptiveness to having the 31-GEP test as a part of their melano-ma care. From my clinical experience, patients are very open to having the test and appreciate the additional infor-“In light of the limitations present in current staging guidelines for melanoma, the expert panel’s recommendations, which are backed by statistically significant findings, provide essential direction for clinical decision-making, especially in the context of SLNB.” —Andrew Baker, MPAS, MBA, PA-C S4
The Dermatology Digest November/December 2025 Castle Supplement: S-4
