Can we ask for this test currently?  Should we?  Is this more predictive than Breslow?

Can we ask for this test currently?  Should we?  Is this more predictive than Breslow?

Can we ask for this test currently?  Should we?  Is this more predictive than Breslow?

Jerry, the article you linked to is a press release. As with most press releases, it puts a "spin" on the information that is designed to attract publilcity and investors. 

When you read the original scientific articles by Dr. Gerami (see for example: http://www.archivesofpathology.org/doi/abs/10.1043/2011-0048-RAIR.1 ) what you learn is that this test (called a "FISH" test) is only designed to distinguish melanoma from nevi (ordinary moles) in the rare cases in which standard pathology results are ambiguous. That is a good thing, of course.

But this test CAN NOT TELL patients with known Stage I or Stage II melanoma whether or not they are likely to progress. That "spin" is public relations bs.

Jerry, the article you linked to is a press release. As with most press releases, it puts a "spin" on the information that is designed to attract publilcity and investors. 

When you read the original scientific articles by Dr. Gerami (see for example: http://www.archivesofpathology.org/doi/abs/10.1043/2011-0048-RAIR.1 ) what you learn is that this test (called a "FISH" test) is only designed to distinguish melanoma from nevi (ordinary moles) in the rare cases in which standard pathology results are ambiguous. That is a good thing, of course.

But this test CAN NOT TELL patients with known Stage I or Stage II melanoma whether or not they are likely to progress. That "spin" is public relations bs.

Jerry, the article you linked to is a press release. As with most press releases, it puts a "spin" on the information that is designed to attract publilcity and investors. 

When you read the original scientific articles by Dr. Gerami (see for example: http://www.archivesofpathology.org/doi/abs/10.1043/2011-0048-RAIR.1 ) what you learn is that this test (called a "FISH" test) is only designed to distinguish melanoma from nevi (ordinary moles) in the rare cases in which standard pathology results are ambiguous. That is a good thing, of course.

But this test CAN NOT TELL patients with known Stage I or Stage II melanoma whether or not they are likely to progress. That "spin" is public relations bs.

I wonder if the genes being “turned on” are also linked to other characteristics, such as high mitotic rate or ulceration.  So, either way, there is the implication of higher risk.  I also wonder how this is reconciled with the Queensland Australia study showing 96% 20-year survival rate for Stage I thin lesions; did they look at this data on those lesions?  I also wonder what type of more aggressive treatment they’d offer Stage I/II patients anyway, it doesn’t seem like they’d start offering any adjuvant therapy to a Stage I patient

I wonder if the genes being “turned on” are also linked to other characteristics, such as high mitotic rate or ulceration.  So, either way, there is the implication of higher risk.  I also wonder how this is reconciled with the Queensland Australia study showing 96% 20-year survival rate for Stage I thin lesions; did they look at this data on those lesions?  I also wonder what type of more aggressive treatment they’d offer Stage I/II patients anyway, it doesn’t seem like they’d start offering any adjuvant therapy to a Stage I patient

I wonder if the genes being “turned on” are also linked to other characteristics, such as high mitotic rate or ulceration.  So, either way, there is the implication of higher risk.  I also wonder how this is reconciled with the Queensland Australia study showing 96% 20-year survival rate for Stage I thin lesions; did they look at this data on those lesions?  I also wonder what type of more aggressive treatment they’d offer Stage I/II patients anyway, it doesn’t seem like they’d start offering any adjuvant therapy to a Stage I patient

I think this test is most often used to distinguish Spitz nevi from melanoma.  Spitz nevi are entirely benign and most often found on young individuals.  It looks almost identical to melanoma under the microscope.  So if a pathologist can't make the determination  of Spitz vs melanoma, the FISH test analyzes markers.  Lots of irregular gene findings means melanoma.  Normal gene findings means Spitz nevi.  I could be wrong, but I think this is most likely the major application of this test.

if it's just distinguishing spitz nevi from melanoma, then what's the "Kaplan-Meier analysis for 5-year metastasis free survival rates were 98% for Class 1 (low risk) and 37% for Class 2 (high risk)" referring to? 

If you read the actual paper and not the press release, it says they are determining a diagnosis between melanoma/spitz or atypical/melanoma and more.

In all cases, preliminary diagnoses were rendered before sending a tissue for FISH analysis. In most cases, the histologic differential diagnosis was between Spitz nevus and spitzoid melanoma or between atypical nevus (such as variants of deep penetrating/clonal/inverted type-A nevus, pigmented spindle cell nevus, atypical genital nevus, atypical conjunctival nevus showing cytologic atypia, mitotic activity, limited maturation, or proliferative nodules, among others) and nevoid melanoma (Table 1). In some cases, diagnostic considerations included dysplastic nevus and superficial spreading melanoma. In 2 cases, FISH was performed to confirm a suspected but histologically challenging diagnosis of nonsarcomatoid desmoplastic melanoma. At the time of preliminary diagnosis, based on histologic features, each lesion was designated as likely representing an atypical nevus (favoring a benign type), a truly borderline lesion, or a melanoma. These designations reflect the most likely interpretation if FISH was not performed.

I picked this little sentence out later, which basically sums most of it up for me:

Obviously, a FISH test is not needed for histologically unequivocal cases. The only current justification for use of this expensive test in a diagnostic setting is to employ it as a diagnostic adjunct to help classify histologically ambiguous lesions.

I don't have time at the moment to go back and read the hype, but I think the actual study does a good job of describing the purpose and usage for this test.

http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0673-OA

If you look at the original scientific papers, you will see that the authors did a "retrospective" study. They collected OLD biopsy specimens in parafin (for microscopic analysis) and did their test. When they did the FISH test on "ambiguous" specimens (i.e., the original pathology could not say for sure), if the FISH test was strongly positive and then they looked at the patients' historical records, those patients turned out to have no evidence of melanoma in later years. When the FISH test on the ambiguous specimens was negative, those patients turned out not to have melanoma in later years. Therefore, the authors decided to designate FISH negative as "low risk" and FISH positive as "high risk". Confusing, I know.

Oops! I mis-typed. Positive FISH = later melanoma; negative FISH=no later melanoma on AMBIGUOUS specimens only.

But Janner said it better (above) so ignore everything I said, anyway.

I do not think it is yet clinically available.  Even if it is, these results would not apply to certain subsets–for instance, a microinvasive very thin stage I tumor–that is, one could not generalize a "Bad" prognosis from their dataset of typical stage I or II tumors onto this subset, and, importantly, there is no data on whether treatments (esp after a couple years) would alter the outcome.

I do not think it is yet clinically available.  Even if it is, these results would not apply to certain subsets–for instance, a microinvasive very thin stage I tumor–that is, one could not generalize a "Bad" prognosis from their dataset of typical stage I or II tumors onto this subset, and, importantly, there is no data on whether treatments (esp after a couple years) would alter the outcome.

I do not think it is yet clinically available.  Even if it is, these results would not apply to certain subsets–for instance, a microinvasive very thin stage I tumor–that is, one could not generalize a "Bad" prognosis from their dataset of typical stage I or II tumors onto this subset, and, importantly, there is no data on whether treatments (esp after a couple years) would alter the outcome.

I think this test is most often used to distinguish Spitz nevi from melanoma.  Spitz nevi are entirely benign and most often found on young individuals.  It looks almost identical to melanoma under the microscope.  So if a pathologist can't make the determination  of Spitz vs melanoma, the FISH test analyzes markers.  Lots of irregular gene findings means melanoma.  Normal gene findings means Spitz nevi.  I could be wrong, but I think this is most likely the major application of this test.

I think this test is most often used to distinguish Spitz nevi from melanoma.  Spitz nevi are entirely benign and most often found on young individuals.  It looks almost identical to melanoma under the microscope.  So if a pathologist can't make the determination  of Spitz vs melanoma, the FISH test analyzes markers.  Lots of irregular gene findings means melanoma.  Normal gene findings means Spitz nevi.  I could be wrong, but I think this is most likely the major application of this test.

if it's just distinguishing spitz nevi from melanoma, then what's the "Kaplan-Meier analysis for 5-year metastasis free survival rates were 98% for Class 1 (low risk) and 37% for Class 2 (high risk)" referring to? 

if it's just distinguishing spitz nevi from melanoma, then what's the "Kaplan-Meier analysis for 5-year metastasis free survival rates were 98% for Class 1 (low risk) and 37% for Class 2 (high risk)" referring to? 

If you read the actual paper and not the press release, it says they are determining a diagnosis between melanoma/spitz or atypical/melanoma and more.

In all cases, preliminary diagnoses were rendered before sending a tissue for FISH analysis. In most cases, the histologic differential diagnosis was between Spitz nevus and spitzoid melanoma or between atypical nevus (such as variants of deep penetrating/clonal/inverted type-A nevus, pigmented spindle cell nevus, atypical genital nevus, atypical conjunctival nevus showing cytologic atypia, mitotic activity, limited maturation, or proliferative nodules, among others) and nevoid melanoma (Table 1). In some cases, diagnostic considerations included dysplastic nevus and superficial spreading melanoma. In 2 cases, FISH was performed to confirm a suspected but histologically challenging diagnosis of nonsarcomatoid desmoplastic melanoma. At the time of preliminary diagnosis, based on histologic features, each lesion was designated as likely representing an atypical nevus (favoring a benign type), a truly borderline lesion, or a melanoma. These designations reflect the most likely interpretation if FISH was not performed.

I picked this little sentence out later, which basically sums most of it up for me:

Obviously, a FISH test is not needed for histologically unequivocal cases. The only current justification for use of this expensive test in a diagnostic setting is to employ it as a diagnostic adjunct to help classify histologically ambiguous lesions.

I don't have time at the moment to go back and read the hype, but I think the actual study does a good job of describing the purpose and usage for this test.

http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0673-OA

If you read the actual paper and not the press release, it says they are determining a diagnosis between melanoma/spitz or atypical/melanoma and more.

In all cases, preliminary diagnoses were rendered before sending a tissue for FISH analysis. In most cases, the histologic differential diagnosis was between Spitz nevus and spitzoid melanoma or between atypical nevus (such as variants of deep penetrating/clonal/inverted type-A nevus, pigmented spindle cell nevus, atypical genital nevus, atypical conjunctival nevus showing cytologic atypia, mitotic activity, limited maturation, or proliferative nodules, among others) and nevoid melanoma (Table 1). In some cases, diagnostic considerations included dysplastic nevus and superficial spreading melanoma. In 2 cases, FISH was performed to confirm a suspected but histologically challenging diagnosis of nonsarcomatoid desmoplastic melanoma. At the time of preliminary diagnosis, based on histologic features, each lesion was designated as likely representing an atypical nevus (favoring a benign type), a truly borderline lesion, or a melanoma. These designations reflect the most likely interpretation if FISH was not performed.

I picked this little sentence out later, which basically sums most of it up for me:

Obviously, a FISH test is not needed for histologically unequivocal cases. The only current justification for use of this expensive test in a diagnostic setting is to employ it as a diagnostic adjunct to help classify histologically ambiguous lesions.

I don't have time at the moment to go back and read the hype, but I think the actual study does a good job of describing the purpose and usage for this test.

http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0673-OA

If you look at the original scientific papers, you will see that the authors did a "retrospective" study. They collected OLD biopsy specimens in parafin (for microscopic analysis) and did their test. When they did the FISH test on "ambiguous" specimens (i.e., the original pathology could not say for sure), if the FISH test was strongly positive and then they looked at the patients' historical records, those patients turned out to have no evidence of melanoma in later years. When the FISH test on the ambiguous specimens was negative, those patients turned out not to have melanoma in later years. Therefore, the authors decided to designate FISH negative as "low risk" and FISH positive as "high risk". Confusing, I know.

If you look at the original scientific papers, you will see that the authors did a "retrospective" study. They collected OLD biopsy specimens in parafin (for microscopic analysis) and did their test. When they did the FISH test on "ambiguous" specimens (i.e., the original pathology could not say for sure), if the FISH test was strongly positive and then they looked at the patients' historical records, those patients turned out to have no evidence of melanoma in later years. When the FISH test on the ambiguous specimens was negative, those patients turned out not to have melanoma in later years. Therefore, the authors decided to designate FISH negative as "low risk" and FISH positive as "high risk". Confusing, I know.

Oops! I mis-typed. Positive FISH = later melanoma; negative FISH=no later melanoma on AMBIGUOUS specimens only.

But Janner said it better (above) so ignore everything I said, anyway.

Oops! I mis-typed. Positive FISH = later melanoma; negative FISH=no later melanoma on AMBIGUOUS specimens only.

But Janner said it better (above) so ignore everything I said, anyway.