When you hear the words “cancer” or “Melanoma” you have every right to be concerned.

Skin cancer, especially melanoma, is no different. It’s important to do what you can to prevent skin cancer, and it’s also important to catch it early in order to have the best outcome. 

Melanoma is the most commonly diagnosed cancer between the ages of 25-29. If you are able to catch it early the 5 year survival rate is extremely high (99%). The survival rate goes down significantly if the melanoma has spread to surrounding tissues like the lymph nodes (68%) and even more if the melanoma has spread to distant parts of the body, like other organs (30%). These numbers are based on people from 5-10 years ago. With new treatments, these percentages have improved, but the treatments are not without significant side effects and expenses. This makes it crucial to catch melanomas early, and there are a couple ways to do it.

If you’ve gone to a dermatologist before, you’re probably familiar with a biopsy. A biopsy will test if a spot on your skin is a melanoma or another form of skin cancer by ideally taking all or most of all of the visibly pigmented area and sending it to a lab for testing, where a highly trained specialist will be able to look at the cells underneath a microscope and see if there are aspects of the cells that indicate it is a melanoma.

If you are a patient seeking a rapid assessment and treatment plan from a board-certified dermatologist today? Modern Ritual Virtual Dermatology may be a great option! Questions? Reach out to +1 866 438 6712 

Dermtech Review: What is Dermtech?

As you can imagine, some people are not keen on being cut on, so some other options are available. One of the newer options is DermTech. In this article we provide a Dermtech Review, as we look at the benefits and limitations of DermTech, what it can mean for your skin, and how it compares to other at-home testing solutions for skin cancer.

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In order to provide an accurate Dermtech review, you need to know what it is. DermTech is a method to test for melanoma in the skin. It uses a specialized sticker to non-invasively remove the top layer of your skin. Because it only removes the very top layer of skin cells, you’re not able to process it in the same way you do a biopsy, so how does it work?

As a primary care provider, nurse practitioner or PA, are you interested in learning more about how you can have skin concerns in your practice co-managed with an 'on-demand' dermatologist? Learn more here.

Instead of looking at the characteristics of cells, DermTech looks at the characteristics within cells that we can’t see- their genes. High levels of some genes have been associated with melanoma, meaning that if these skin cells have these genes within them they’re more likely to be melanoma. The top layer of your skin contains this genetic material. Using a process called RT-PCR (reverse transcription-polymerase chain reaction), the specific genes associated with melanoma can be copied and measured to assess the probability that the measured spot is cancerous.

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Dermtech Review: How does Dermtech work?

Dermtech uses a unique scientific process. A gene is basically a recipe for the cells of your body to make something. Depending on what the gene codes for and how much of it is in your cells, it can have a big impact on your health.

There are three genes/mutations that DermTech specifically assesses: LINC, PRAME, and TERT.

LINC is short-hand for LINC00518 or Long Intergenic Non-Protein Coding RNA 518 (a mouthful- let’s stick with LINC). This is a non-coding RNA gene, meaning it produces an RNA molecule. These RNA molecules are necessary for proper functioning, but high levels of some non-coding RNA genes are associated with cancer and other human diseases. High levels of LINC00518 is specifically associated with melanoma.

PRAME (or preferentially expressed Antigen in Melanoma), as the name suggests, is an antigen associated with melanoma. At its core, an antigen is a molecule that the immune system recognizes as foreign. Some cancers, like melanoma, are able to produce antigens that let your immune system recognize that it is not a regular cell. PRAME is one of these molecules. Therefore, high levels of PRAME can let researchers know that a spot is most likely a melanoma and not something else.

Lastly, DermTech can look at TERT (or telomerase reverse transcriptase) promoter mutations. To keep it simple, a promoter is like a “start here” signal for a gene. It tells your body where it needs to start reading the recipe to produce whatever its intended product is. There are two mutations in this promoter that are commonly found in cancer cells, specifically melanoma. Therefore, like with LINC and PRAME, high levels of this mutated gene promotor can indicate a high probability of cancer. The below image shows a heat map from the DermTech website. These grids help provide a summary of how high or low certain gene levels are.

Dermtech Review: How accurate is the DermTech melanoma patch test?

Whenever it comes to testing for something, in this case melanoma, there are four things to keep in mind: sensitivity, specificity, NPV (negative predictive value), and PPV (positive predictive value). Sensitivity refers to how likely a test is to “pick up” what it is testing for, or how likely a test is to have a positive result when what is being tested is positive. Specificity refers to how likely a test is to exclude results that do not have the subject of interest, or how likely a test is to have negative results when what is being tested is truly negative.

Dermtech tests are highly sensitive, with studies that have shown sensitivities around 92% and NPVs of 99%. This means that if the DermTech test is negative, with low levels of LINC, PRAME, or TERT promoter mutations, it’s very unlikely that the spot is melanoma. DermTech, however, is less specific at around 70% with a PPV of around 19%.

This means that a positive DermTech test doesn’t necessarily mean that the mole removed is a melanoma.

Dermtech Review: Dermtech vs. an in-office, clinical evaluation for skin cancer?

How does DermTech differ from other methods to test for skin cancer?

A trained professional can look at a mole with the naked eye and also assess the likelihood that it is cancer. For melanoma, clinical evaluations are highly specific with specificities and NPVs around 99%, but not as sensitive with sensitivities of around 40-80% and PPVs of around 4-7% depending on the type of melanoma**. This means that using the naked eye to evaluate a spot of concern as being a melanoma is very effective for ruling out a diagnosis of melanoma, but few of the possible melanomas upon evaluation actually are a melanoma histologically.** The sensitivity of evaluation goes up substantially, however, when dermoscopy (or looking at the lesions under an intense magnifying glass) and specialist evaluation is involved. In one study evaluating melanomas where dermoscopy was used in a dermatologic setting, the sensitivity and PPV were reported as 71% and 51% respectively. Another study estimating the sensitivity and PPV of dermatologic expertise with dermoscopy is even higher, at 71% and 75% respectively. This means that a clinical evaluation with dermoscopy is more likely to accurately assess a mole as a melanoma when it is a melanoma compared to DermTech, and just as likely to not miss it.

DermTech recently released a new app, DermTech Connect, which allows for patients to upload photos of a mole to be evaluated by a dermatologist. Unfortunately, this method does not use dermoscopy, which reduces the ability of the test to give you a meaningful result.

It’s important to also note the limitations of DermTech. As of now, DermTech only is able to test for genetic markers of melanoma. This means that it is not able to assess any other skin malignancy, such as basal cell carcinomas or squamous cell carcinomas that can be assessed clinically or dermoscopically.

DermTech Virtual Dermatology Alternatives: Modern Ritual

One of the downsides of a clinical evaluation, however, is that it can be a challenge to get an appointment with a dermatologist.

This is especially an issue for patients and primary care providers operating in rural parts of the US. While DermTech is less invasive than a traditional biopsy and can be done at home, it still requires supervision from a healthcare professional, which may make it less accessible.

A Dermtech alternative, or rather, a complimentary option for primary care providers to consider, is Modern Ritual. 

 The Modern Ritual Virtual Dermatology Program can help to alleviate many struggles of getting to see a healthcare professional in a reasonable amount of time. With the Modern Ritual Spot Check, patients or a primary care provider may take an image of the skin and ensure patients hear back within 2 days or less on next steps for your suspicious mole, rash or wound.

If working with a primary care provider, the provider will receive your results back which will inform you how concerning the spot is on a scale from 1-4, where 1 is considered normal and 4 is considered highly abnormal and you should schedule an appointment with a dermatologist as soon as possible.

This is a great option too compared to DermTech because it can be used to evaluate suspicious spots that aren’t melanoma, like basal cell carcinomas or squamous cell carcinomas. Ensuring treatment of all skin cancers in a timely fashion is vital for having your best skin.

Especially in areas where the nearest dermatologist can be hours away, or the wait time to see a dermatologist is several months, it’s important to know you have options.

Cost of Dermtech:

Most commercial insurances and Medicare cover a DermTech test at least in part, with most patients paying less than $75 for a test, however, the overall cost of the test is around $760. DermTech does not report how much it costs for uninsured patients, but does offer some financial assistance. This is, however, only the cost of the test and assessment. If your DermTech test comes back positive, costs for full removal of the mole may be much higher.

Most commercial insurances also cover skin biopsies. For most insured people, a biopsy costs on average $188, but this will depend greatly on a patient’s specific insurance plan.

Final Thoughts

If you’re worried you have melanoma, you have options. DermTech is extremely sensitive, meaning if your test comes back negative it is extremely unlikely you have melanoma. On the other hand, if your test comes back positive, there is about an 80% chance that you don’t actually have melanoma. If you’re in an area where it's difficult to see a dermatologist, the peace of mind of a negative test result can be worth it.

If you’re worried about other kinds of skin cancer, DermTech is not currently designed to detect those.

If you’re concerned about skin cancer, consider asking your primary care provider if they offer access to dermatology with Modern Ritual or begin a virtual dermatology visit with Modern Ritual today. This method is able to assess all types of skin malignancies, such as rashes, basal cell carcinoma, squamous cell carcionma and melanoma, with both high sensitivity and specificity.

As a primary care provider, nurse practitioner or PA, are you interested in learning more about how you can have skin concerns in your practice co-managed with an 'on-demand' dermatologist? Learn more here.

If you are a patient seeking a first or second opinion from a dermatologist on a spot mole or rash of concern, being an online appointment here or find our list of partner locations here.