Can a Gene Expression Test Guide Atopic Dermatitis Therapy Selection?

Molecular testing is moving from prognosis into treatment selection, and nonsurgical options for common skin cancers keep growing, according to Aaron S. Farberg, MD, chief medical officer at Bare Dermatology in Dallas, Texas. Farberg is a double board-certified dermatologist and fellowship-trained Mohs surgeon.

In a new interview, Farberg discussed both trends with HCPLive at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada, where he presented on biomarker-driven testing in dermatology and on multidisciplinary care in high-risk cutaneous squamous cell carcinoma.

How Can Gene Expression Profiling Guide Atopic Dermatitis Therapy?

For moderate-to-severe atopic dermatitis, Farberg highlighted the 487-gene AdvanceAD-Tx test, which assigns patients to a JAK inhibitor responder profile or a T helper 2 (Th2) molecular profile. Among patients with the JAK inhibitor responder profile, 45.5% of those treated with a JAK inhibitor reached Eczema Area and Severity Index 90 by 3 months, compared with 8.3% of those given Th2-targeted therapy (P = .021).³ Farberg described the test as a way to match systemic therapy to each patient’s disease biology rather than relying on clinical features alone. He has submitted a paper on how the test is used in practice, including for topical treatment decisions.

In melanoma, new prospective data for the 31-gene DecisionDx-Melanoma test were presented at the 2026 European Academy of Dermatology and Venereology Congress. The study included 2,799 patients across 29 US centers. Patients with a predicted sentinel lymph node positivity risk below 5% had an observed positivity rate of 4.4%, compared with 22.8% for those above 10%.² Among 565 low-risk patients who were eligible for sentinel lymph node biopsy but didn’t have one, 5-year recurrence-free survival was 99.6%.²

What Does the Ameluz Approval Mean for Basal Cell Carcinoma Care?

In September 2026, the US Food and Drug Administration (FDA) approved aminolevulinic acid hydrochloride 10% gel (Ameluz) with BF-RhodoLED photodynamic therapy for superficial basal cell carcinoma in adults. In the pivotal trial, 66% (95/145) of treated patients achieved a composite clinical and histological complete response at 12 weeks, compared with 5% (2/42) receiving placebo.¹ Farberg noted that many patients would rather avoid excision, and the approval gives them a nonsurgical alternative for the most common cancer worldwide.

Looking ahead, Farberg expects psoriasis, atopic dermatitis and hidradenitis suppurativa to stay at the center of dermatology, with a deep psoriasis pipeline still advancing. For early-career clinicians, he stressed honesty and doing each task well enough that there’s no lingering doubt about patient care.

Editor’s Note: This summary has been edited for grammar and clarity using artificial intelligence tools. Farberg has previously disclosed serving as an advisor for Galderma, Johnson & Johnson Consumer, Castle Biosciences, Novartis, Orthodermatologics, and Sun Pharmaceuticals.

References

1. Smith T. Ameluz treatment becomes first FDA-approved PDT for skin cancer. HCPLive. Published September 14, 2026. Accessed November 2, 2026. https://www.hcplive.com/view/ameluz-treatment-becomes-first-fda-approved-pdt-skin-cancer.

2. Castle Biosciences. Late-breaking EADV 2026 data support use of DecisionDx-Melanoma in SLNB decision-making and risk-aligned post surgical management. Published September 30, 2026. Accessed November 2, 2026.

3. Silverberg JI, Eichenfield LF, Armstrong AW, et al. The 487-gene expression profile test guides systemic therapy selection [full title to confirm]. J Am Acad Dermatol. Published online February 16, 2026. doi:10.1016/j.jaad.2026.02.034.