PLA in Practice: Biopsy Fatigue and Peace of Mind
by Jennifer Trubshenck, PA-C | May 22, 2019
Jennifer Trubshenck, PA-C, is a board-certified Physician Assistant, and an active member of the Society of Dermatology Physician Assistants, California Association of Physician Assistants and the American Academy of Physician Assistants.
Recently, I had a woman in her mid 40’s come in for a skin check with a suspicious lesion on her cheek. Clinically the lesion appeared to have some visual characteristics of melanoma and I wanted to biopsy the lesion. This patient has a history of non-melanoma skin-cancer and has had many biopsies and subsequent scars. Because of this she refused a biopsy and was extremely reluctant to have any additional cutting on her face. I discussed my concerns regarding the lesion with her, but she was simply fatigued at the thought of another biopsy and was going to walk out of my office without one.
I presented the DermTech PLA option to my patient as a way to get further information on the melanoma risk of this lesion, without being cut and she agreed! The PLA was double gene positive for both LINC and PRAME, and therefore at high risk for melanoma. Having this result gave the patient enough information to confidently proceed with the biopsy. The decision was no longer based on an opinion that it “looked like a melanoma”, but on the objective information of the gene expression test. I referred this patient to a dermatology plastics specialist to perform an excisional biopsy and the pathology confirmed the lesion was melanoma-in-situ.
I chose to add DermTech to my practice for two main reasons: to catch more early stage melanoma and to have a highly accurate way to test suspicious pigmented lesions without cutting. I have had numerous patients that are needle and biopsy phobic, and some flat out refuse a biopsy out of fear. The PLA allows me the peace of mind of being able to test these patients. If the PLA is negative, the patients enjoy not having to be stuck with a needle, having a wound to take care of, and most of all having an unnecessary permanent scar.
“I chose to add DermTech to my practice for two main reasons: to catch more early stage melanoma and to have a highly accurate way to test suspicious pigmented lesions without cutting.”
I am confident in the gene expression results of the PLA and if a lesion is positive for one or more genes I biopsy the lesion. If a dermatopathologist calls the lesion benign I can ask them to re-look at the slide or test additional sections. The PLA can benefit both the dermatologist and dermatopathologist in this way.