Darrell S. Rigel, MD, MS, delves into the power and potential of precision medicine in diagnosis, prognosis and therapy selection.
“With traditional ways of diagnosis and prognosis, we looked at clinical, histologic, demographic and historical factors and these are the factors we consider when looking a model to make predictions about whether something is going tobe ‘good’ or ‘bad,” Darrell S. Rigel, MD, MS, FAAD, clinical professor of dermatology and director, melanoma surveillance clinic at Mount Sinai Icahn School of Medicine in New York and co-director of the 2022 Fall Clinical Dermatology Conference for PAs & NPs told Dermatology Times ® in a follow-up interview highlighting key points from his presentation at the 2022 Fall Clinical Dermatology Conference for PAs & NPs.1 “The fact is that everyone’s genetics are a little different. If we can use precision techniques to hone in on diagnosis, prognosis and what’s going to be effective in treatment, we can make our use of healthcare resources more efficient. We now have other factors that were previously undetectable or undefined. If we can incorporate those factors into our models, we can make better diagnoses, prognoses and therapy selections—that is the idea behind precision medicine.”
In diagnostics, tests such as DermTech’s 2-GEP (LINC and PRAME) and 3-GEP (LINC, PRAME and TERT) tests for melanoma can use increased sensitivity and specificity to better predict whether a lesion is benign or malignant. “There were a couple of studies that really been exciting about this one that was in skin that showed basically, the further down the malignancy path, the lesion was, the higher the expression of these genes were, the greater the expression and therefore better diagnostically, which really validates the test in a bunch of ways,” said Rigel. “More importantly, if you have a negative test, the chance that the lesion is really negative is now 99.6%. That's really important, because what that tells you is you have the ability to say, ‘okay, maybe I can pass on this,’ and not do a biopsy.
When it comes to prognosis, the additional information delivered by tests such as the 40-GEP test for squamous cell carcinoma and the 31-GEP test for melanoma can help give a better assessment for prognosis, as well as predicting whether sentinel lymph nodes will be positive.
Finally, said Rigel, a patient’s genetic makeup may provide keys to determine which biologic will work best for patients with psoriasis. “We’re just scratching the surface with this.”
“I think the important takeaway is the precision medicine is not just coming to dermatology,” said Rigel. “It is already here but it is going to make a much bigger difference in the next few years and really influence the way we practice in a clinical setting.”
Disclosures: Rigel is an advisory board member of, speaker for, and/or has received grants/research funding from Castle Biosciences and DermTech.
1. Rigel D. What You Need to Know About Precision Dermatology. Presented at: 2022 Fall Clinical Dermatology Conference for PAs & NPs; June 3-5, 2022; Scottsdale, AZ.