Melanoma gene test benefits select patients

"There's no question genetic testing is being performed in the research setting already," says Sancy A. Leachman, M.D., director of the familial melanoma program at Huntsman Cancer Institute and assistant professor of dermatology at the University of Utah Health Sciences Center.

Research groups including the Melanoma Genetics Consortium have begun performing such tests on patients, she says.

Right to know

Patients and proponents who favor such testing lean strongly on a right-to-know philosophy, whether anything can currently be done with such knowledge, she elaborates.

"The right to know gives patients the power to choose their lifestyle and their children's lifestyle," Dr. Leachman tells Dermatology Times.

"The fact is, there have been no reports of real risk for reporting test results," she says. "So if it's not going to hurt a patient, proponents say, why not do it?"

Testing proponents also believe that giving this information to patients emphasizes their responsibility in healthcare participation, Dr. Leachman points out. Under this scenario, she explains, "The physicians are basically providers of knowledge and information. And they assume the patients then are going to be capable and competent to apply that information in the ways they see fit."

Opponents' view

Conversely, opponents of clinical p16 testing emphasize the physician's responsibility in deciding when such information will benefit patients, Dr. Leachman says.

For example, she says those who oppose clinical testing believe it's irresponsible to share results if the data are incomplete or there is nothing doctors or patients can do about them.

A small handful of abstracts suggest such surveillance helps prevent melanoma in high-risk families (Leachman SA. Sixth World Congress on Melanoma; September 6-10, 2005; Vancouver, British Columbia), but overall, "The data on that is still short," Dr. Leachman contends.

"People who don't want to do clinical testing often ask what difference it will make, because if one has a family with a lot of melanoma running in it, whether or not there's a p16 mutation detected, one must communicate to that entire family that they all need to be doing all these things that we've asked them to," she says.

"One of the problems with that idea is that there probably aren't enough dermatologists in the United States to provide a total body skin exam on everybody who's at moderate to high risk," she says. "One must focus the resources in a more prudent way."

Cost perspective

Dr. Leachman says that as long as p16 tests are only performed on appropriate testing candidates, she disagrees with clinical testing opponents who say such tests probably aren't cost-effective.

Testing an initial family member costs about $750, she says, while testing for additional family members costs about $350 each.

"By comparison," she notes, "a single nevus biopsy runs around $300. So the cost of the genetic test is really not that great. If the test were to prevent one melanoma in one patient, one could avoid thousands of dollars in healthcare costs."