Dr. Orit Markowitz Sheds Light on Melanoma Staging, Therapy, and Genetic Testing Insights

Orit Markowitz, MD, a leading dermatologist, skin cancer specialist and CEO and founder of Markowitz Medical, reviewed melanoma staging and therapy for an informative at the SDPA 21st Annual Fall Dermatology Conference in Nashville.  In her practice, Dr. Markowitz focuses on noninvasive early diagnosis and refers to oncology for management of advanced melanomas.  She highlighted the National Comprehensive Cancer Network Clinical Guidelines for the Staging, Diagnosis, and Management of Cutaneous Malignant Melanoma with emphasis on depth/thickness, mitosis and evidence of lymphovascular invasion. When counseling a patient with a stage 1A melanoma, Dr. Markowitz describes the depth of these lesions as “less than a tip of a pencil” with a favorable prognosis that doesn’t require lymph node biopsy. She discussed the use of DecisionDx (Castle Biosciences) genetic testing in her practice and feels that utilizing these tests can lead to fewer deaths.  Gene expression profiling testing can be used with suspicious pigmented lesions, malignant melanomas and squamous cell cancers with high risk factors.

Dr. Markowitz discussed her experience in referring for genetic testing in oncology. She reports that identifying pathologic variants can help change melanoma screening guidelines, while somatic testing of tumors can help identify the best treatment for patients with melanoma. She discussed the phenotype of redheaded patients with the MC1R gene and dermoscopic characteristics of pigmented lesions in these patient populations. A pearl that Dr. Markowitz imparted on the audience is to be wary of patients who have had lesions lasered repeatedly without resolution. In her experience, a good number of these patients and these lesions are often melanoma, which is why they can’t be “erased.”

Further, Dr. Markowitz discussed staged melanoma and advanced melanoma therapy. She discussed systemic melanoma therapy for patients with stage 3 melanoma and comparing targeted vs immunotherapy for these patients. Immunotherapy tends to provide a durable, lasting response but can take longer to work and is associated with more severe side effects. Targeted therapy for somatic mutations results in more limited side effects but with a response that may not be as long lasting with improvements possibly resolving when treatment stops.   Dr. Markowitz briefly touched on future treatments with MRNA vaccine therapy as well as current research regarding the melanoma microbiome.  Specifically, encouraged attendees to be cautious with oral antibiotics in patients with melanoma.  Finally, to help patients find care, Dr. Markowitz recommends referring to regional oncologists, National Cancer Institute-designated centers and clinicaltrials.gov.

Byline: Sarah B.W. Patton, PA-C

Pictured: Orit Markowitz, MD