Does Medicare Cover Genetic Testing for Melanoma (MyPath)?

June 10, 2019

• Medicare

Malignant melanoma is a type of skin cancer that starts in the skin’s pigment-producing cells. About two percent of people will develop melanoma in their lifetime, and 5-10 percent of those cases are hereditary.

Parents with specific gene mutations have about a 50 percent chance of passing those genes to their children. Genetic testing for melanoma can reveal the gene mutations associated with skin cancer and allow you to seek treatment right away.

Medicare Coverage for Genetic Skin Cancer Testing

Anyone who is eligible for Medicare has some financial assistance available for their healthcare. Medicare can help pay for expenses such as doctor appointments for diagnosing and treating melanoma. Medicare will cover genetic testing for melanoma if you have certain risk factors.

Melanoma is just one type of skin cancer. The most common types of skin cancer are called carcinomas and they are usually the result of exposure to UV rays. Melanoma can be attributed to certain gene mutations.

Medicare will only cover genetic testing for cancer if it’s medically necessary. Currently, Medicare offers coverage for the Myriad Genetics myPath and the Castle Biosciences DecisionDx tests.

Myriad Genetics myPath

The myPath Melanoma test from Myriad Genetics measures 23 genes and differentiates melanoma from normal cells. The genes in the test include:

• PRAME one gene involved in the process where a cell changes from one type to a different type
• S100A7, S100A8, S100A9, S100A12 and PI3, a group of genes involved in the cell communication process that regulates cell activities
• CCL5, CD38, CXCL10, CXCL9, IRF1, LCP2, PTPRC and SELL, involved in the immune system response to tumors
• Measurements of nine housekeeping genes (genes that maintain basic cell function) to use as a baseline in determining normal gene expression

Castle Biosciences DecisionDx

Castle Biosciences offers the DecisionDx-Melanoma test to help doctors determine if a patient has Stage I or Stage II melanoma. The test screens for the following genes:

BAP1, c MGP, SPP1, CXCL14, CLCA2, S100A8, BTG1, SAP130, ARG1, KRT6B, GJA1, ID2, EIF1B, S100A9, CRABP2, KRT14, ROBO1, RBM23, TACSTD2, DSC1, SPRR1B, TRIM29, AQP3, TYRP1, PPL, LTA4H, and CST6

Melanoma Risk Factors

Along with genetic risk factors, several other factors may mean you’re more likely to develop melanoma, including:

• Fair skin: People with fair skin have a much higher risk of developing melanoma than people with darker skin. Those with red or blonde hair, blue or green eyes, or skin that freckles easily and is susceptible to sunburn are at an increased risk of developing melanoma.
• Personal history of melanoma or other skin cancers: If you’ve already had melanoma or another type of skin cancer, you could be at risk for it again.
• Having a compromised immune system: Your immune system fights off cancer and other diseases. If your immune system is weak as a result of certain diseases or medical treatments, you’re more likely to develop melanoma.
• Age: Melanoma is more likely to occur in older adults than younger adults.
• Sex: Men older than 50 have a higher rate of melanoma than women.
• Xeroderma pigmentosum: People with xeroderma pigmentosum (XP) have a high risk of developing melanoma. XP is a rare condition that interferes with the skin’s ability to repair DNA damage.

Melanoma Statistics and Facts

Melanoma is becoming more common, and it can often be treated if it’s caught early.

• Melanoma rates have been steadily rising for the last 30 years.
• The American Cancer Society estimates that there will be approximately 96.5 new melanoma diagnoses and about 7,200 melanoma deaths in 2019.
• Melanoma’s five-year survival rate is about 97 percent when the cancer is detected early. If the disease spreads to the lymph nodes, the survival rate declines to 68 percent, and to 15 percent if the cancer reaches other organs.

Treatment for Melanoma

Treatment for melanoma is different depending on the stage of cancer (I-IV), where it is on your body, and your overall health.

• Stage 0: These melanomas have not penetrated the top layer of skin yet. A wide excision surgery will remove the melanoma and a small amount of normal skin around it.
• Stage I: Wide excision surgery will also remove these melanomas, and also portions of normal skin around them. The amount of normal skin removed depends on how thick the melanoma is, and where it is on the body.
• Stage II: Surgery to remove the melanoma and some of the normal skin around it is also the treatment for stage II melanoma. Many doctors will also recommend a lymph node biopsy, because cancer may have spread to the lymph nodes near the melanoma.
• Stage III: In stage III melanoma, the cancer has already reached the lymph nodes when it’s first diagnosed. The treatment usually involves removing the melanoma with surgery, and dissecting the lymph nodes around the tumor. After the surgery, doctors will recommend prescription drugs for immunotherapy or targeted therapy for cancers with BRAF gene changes.
• Stage IV: These melanomas are often difficult to cure because they have already spread to lymph nodes far from the melanoma. Skin tumors or enlarged lymph nodes can oftentimes be surgically removed or treated with radiation therapy. If the cancer has spread to internal organs, it can be removed depending on how many incidents of cancer there are, where the incidents are, and how likely the cancer is to cause symptoms. Other treatments include immunotherapy drugs and chemotherapy.

Contact Us Today

Medicare can cover specific genetic testing for melanoma and skin cancer treatment if you meet certain criteria. If you need coverage beyond what Original Medicare pays for, private health insurance plans called Medicare Advantage plans or Medicare Supplements may better suit your needs.

A representative with Medicare Plan Finder can help you find the right Medicare plan to fit your budget and lifestyle. Call us at 844-431-1832 or contact us here to learn more today.