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Fastner S, Shen N, Hartman RI, Chu EY, Kim CC, Kirkwood JM, Grossman D. Prognostic gene expression profile testing to inform use of adjuvant therapy: A survey of melanoma experts. Cancer Med 2023; 12:22103-22108. [PMID: 38098216 PMCID: PMC10757117 DOI: 10.1002/cam4.6819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/16/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023] Open
Abstract
OBJECTIVES To investigate current practices and attitudes regarding use of adjuvant immunotherapy and prognostic gene expression profile (GEP) testing among melanoma medical and surgical oncologists. METHODS An anonymous RedCap-based survey was emailed to ~300 melanoma experts. RESULTS Respondents generally favored adjuvant immunotherapy over observation (73% for all Stage IIIA, 50% for Stage IIB/IIC) and cited a minimum 10-year recurrence risk of 11%-20% (48%) or 21%-30% (33%) to justify treatment, but acknowledged that risks of serious adverse events may outweigh potential benefits for some Stage IIB/IIC patients. While GEP test results did not strongly influence decision-making regarding follow-up or intervention, most were receptive to randomized trials using GEP testing to identify subsets of Stage IIB/IIC (74%) and Stage IB/IIA (54%) patients who may not or may, respectively, benefit from adjuvant therapy. CONCLUSION Although most respondents do not routinely use GEP testing, many would participate in clinical trials to determine clinical utility.
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Affiliation(s)
- Suzanne Fastner
- Huntsman Cancer InstituteUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Nathan Shen
- Huntsman Cancer InstituteUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Rebecca I. Hartman
- Department of DermatologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
- Department of DermatologyBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of DermatologyVA Integrated Service Network (VISN‐1)Jamaica PlainMassachusettsUSA
| | - Emily Y. Chu
- Department of DermatologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Caroline C. Kim
- Department of DermatologyTufts Medical CenterBostonMassachusettsUSA
| | - John M. Kirkwood
- Departments of DermatologyUniversity of Pittsburgh, UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
- Departments of MedicineUniversity of Pittsburgh, UPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Douglas Grossman
- Huntsman Cancer InstituteUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
- Department of DermatologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
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2
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Kim CC, Lunken GR, Kelly WJ, Patchett ML, Jordens Z, Tannock GW, Sims IM, Bell TJ, Hedderley D, Henrissat B, Rosendale DI. Correction: Genomic insights from Monoglobus pectinilyticus: a pectin-degrading specialist bacterium in the human colon. ISME J 2023; 17:1520. [PMID: 37198406 PMCID: PMC10432477 DOI: 10.1038/s41396-023-01419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Caroline C Kim
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand.
- Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand.
| | - Genelle R Lunken
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand
- Massey Institute of Food Science and Technology, School of Food and Nutrition, Massey University, Palmerston North, New Zealand
| | | | - Mark L Patchett
- Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Zoe Jordens
- Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Gerald W Tannock
- Department of Microbiology and Immunology, Microbiome Otago, University of Otago, Dunedin, 9016, New Zealand
| | - Ian M Sims
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt, 5040, New Zealand
| | - Tracey J Bell
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt, 5040, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand
| | - Bernard Henrissat
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, Marseille, F-13288, France
- Institut National de la Recherche Agronomique, USC1408 Architecture et Fonction des Macromolécules Biologiques, Marseille, F-13288, France
- Department of Biological Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Douglas I Rosendale
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand.
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3
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Trepanowski N, Chang MS, Ziad A, Grossman D, Kim CC, Hartman RI. Update on patterns of use of a genetic expression profiling adhesive test to detect melanoma: a cross-sectional survey of academic pigmented lesion experts and private practice clinicians. Dermatol Online J 2023; 29. [PMID: 37921824 DOI: 10.5070/d329461913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, Massachusetts, USA Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Fried LJ, Tan A, Berry EG, Braun RP, Curiel-Lewandrowski C, Curtis J, Ferris LK, Hartman RI, Jaimes N, Kawaoka JC, Kim CC, Lallas A, Leachman SA, Levin A, Lucey P, Marchetti MA, Marghoob AA, Miller D, Nelson KC, Prodanovic E, Seiverling EV, Swetter SM, Savory SA, Usatine RP, Wei ML, Polsky D, Stein JA, Liebman TN. Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts. JAMA Dermatol 2021; 157:189-197. [PMID: 33404623 DOI: 10.1001/jamadermatol.2020.5213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know. Objectives To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency. Design, Setting, and Participants A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software. Main Outcomes and Measures Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians. Results Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists. Conclusions and Relevance Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.
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Affiliation(s)
- Lauren J Fried
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Ralph P Braun
- Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | - Clara Curiel-Lewandrowski
- The Skin Cancer Institute-University of Arizona Cancer Center, Tucson.,Division of Dermatology at the University of Arizona College of Medicine, Tucson
| | - Julia Curtis
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Melanoma Program, Dana-Farber Cancer Institute, Boston, Massachusetts.,VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
| | - Natalia Jaimes
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami, Florida
| | - John C Kawaoka
- Department of Dermatology, Brown Medical School, Providence, Rhode Island
| | - Caroline C Kim
- Melanoma and Pigmented Lesion Program, Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Alan Levin
- Division of Dermatology, University of Arizona College of Medicine, Tucson
| | - Patricia Lucey
- Inova Schar Cancer Institute Melanoma Center, Fairfax, Virginia
| | - Michael A Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debbie Miller
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward Prodanovic
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Elizabeth V Seiverling
- Tufts University School of Medicine, Department of Dermatology, Portland, Maine.,Maine Medical Center Division of Dermatology, Portland, Maine
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Medical Center and Cancer Institute, Stanford, California
| | - Stephanie A Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Richard P Usatine
- Department of Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio
| | - Maria L Wei
- Department of Dermatology, University of California-San Francisco, San Francisco.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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5
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Soenksen LR, Kassis T, Conover ST, Marti-Fuster B, Birkenfeld JS, Tucker-Schwartz J, Naseem A, Stavert RR, Kim CC, Senna MM, Avilés-Izquierdo J, Collins JJ, Barzilay R, Gray ML. Using deep learning for dermatologist-level detection of suspicious pigmented skin lesions from wide-field images. Sci Transl Med 2021; 13:13/581/eabb3652. [PMID: 33597262 DOI: 10.1126/scitranslmed.abb3652] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/17/2020] [Accepted: 01/08/2021] [Indexed: 11/03/2022]
Abstract
A reported 96,480 people were diagnosed with melanoma in the United States in 2019, leading to 7230 reported deaths. Early-stage identification of suspicious pigmented lesions (SPLs) in primary care settings can lead to improved melanoma prognosis and a possible 20-fold reduction in treatment cost. Despite this clinical and economic value, efficient tools for SPL detection are mostly absent. To bridge this gap, we developed an SPL analysis system for wide-field images using deep convolutional neural networks (DCNNs) and applied it to a 38,283 dermatological dataset collected from 133 patients and publicly available images. These images were obtained from a variety of consumer-grade cameras (15,244 nondermoscopy) and classified by three board-certified dermatologists. Our system achieved more than 90.3% sensitivity (95% confidence interval, 90 to 90.6) and 89.9% specificity (89.6 to 90.2%) in distinguishing SPLs from nonsuspicious lesions, skin, and complex backgrounds, avoiding the need for cumbersome individual lesion imaging. We also present a new method to extract intrapatient lesion saliency (ugly duckling criteria) on the basis of DCNN features from detected lesions. This saliency ranking was validated against three board-certified dermatologists using a set of 135 individual wide-field images from 68 dermatological patients not included in the DCNN training set, exhibiting 82.96% (67.88 to 88.26%) agreement with at least one of the top three lesions in the dermatological consensus ranking. This method could allow for rapid and accurate assessments of pigmented lesion suspiciousness within a primary care visit and could enable improved patient triaging, utilization of resources, and earlier treatment of melanoma.
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Affiliation(s)
- Luis R Soenksen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA. .,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Cir, Boston, MA 02115, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Timothy Kassis
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, 02139, MA, USA
| | - Susan T Conover
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Berta Marti-Fuster
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Judith S Birkenfeld
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Jason Tucker-Schwartz
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Asif Naseem
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Robert R Stavert
- Division of Dermatology, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA.,Department of Dermatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.,Department of Dermatology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Caroline C Kim
- Pigmented Lesion Program, Newton Wellesley Dermatology Associates, 65 Walnut Street Suite 520 Wellesley Hills, MA 02481, USA.,Department of Dermatology, Tufts Medical Center, 260 Tremont Street Biewend Building, Boston, MA 02116, USA
| | - Maryanne M Senna
- Department of Dermatology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Department of Dermatology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - José Avilés-Izquierdo
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo 46, 28007 Madrid, Spain
| | - James J Collins
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, 3 Blackfan Cir, Boston, MA 02115, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, 02139, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Regina Barzilay
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology Cambridge, MA 02148, USA
| | - Martha L Gray
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.,MIT linQ, Massachusetts Institute of Technology Cambridge, MA 02148, USA.,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology Cambridge, MA 02148, USA
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6
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Chang MS, Leachman SA, Berry EG, Curiel-Lewandrowski C, Geller AC, Grossman D, Kim CC, Stein JA, Swetter SM, Hartman RI. Changes in melanoma care practices during the COVID-19 pandemic: a multi-institutional cross-sectional survey. Dermatol Online J 2021; 27:13030/qt4sc3k9r0. [PMID: 33999590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023] Open
Affiliation(s)
- Michael S Chang
- Harvard Medical School, Boston, MA Department of Dermatology, Brigham and Women's Hospital, Boston, MA
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7
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Chang MS, Leachman SA, Berry EG, Curiel-Lewandrowski C, Geller AC, Grossman D, Kim CC, Stein JA, Swetter SM, Hartman RI. Changes in melanoma care practices during the COVID-19 pandemic: a multi-institutional cross-sectional survey. Dermatol Online J 2021. [DOI: 10.5070/d3274053169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Grossman D, Okwundu N, Bartlett EK, Marchetti MA, Othus M, Coit DG, Hartman RI, Leachman SA, Berry EG, Korde L, Lee SJ, Bar-Eli M, Berwick M, Bowles T, Buchbinder EI, Burton EM, Chu EY, Curiel-Lewandrowski C, Curtis JA, Daud A, Deacon DC, Ferris LK, Gershenwald JE, Grossmann KF, Hu-Lieskovan S, Hyngstrom J, Jeter JM, Judson-Torres RL, Kendra KL, Kim CC, Kirkwood JM, Lawson DH, Leming PD, Long GV, Marghoob AA, Mehnert JM, Ming ME, Nelson KC, Polsky D, Scolyer RA, Smith EA, Sondak VK, Stark MS, Stein JA, Thompson JA, Thompson JF, Venna SS, Wei ML, Swetter SM. Prognostic Gene Expression Profiling in Cutaneous Melanoma: Identifying the Knowledge Gaps and Assessing the Clinical Benefit. JAMA Dermatol 2020; 156:1004-1011. [PMID: 32725204 PMCID: PMC8275355 DOI: 10.1001/jamadermatol.2020.1729] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.
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Affiliation(s)
- Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
- Department of Oncological Sciences, University of Utah, Salt Lake City
| | | | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca I Hartman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Larissa Korde
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Sandra J Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Data Sciences, Harvard Medical School, Boston, Massachusetts
| | - Menashe Bar-Eli
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston
| | - Marianne Berwick
- Departments of Dermatology and Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque
| | - Tawnya Bowles
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Elizabeth I Buchbinder
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M Burton
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | | | - Julia A Curtis
- Department of Dermatology, University of Utah, Salt Lake City
| | - Adil Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Hematology/Oncology, University of California, San Francisco
| | - Dekker C Deacon
- Department of Dermatology, University of Utah, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology and University of Pittsburgh Clinical and Translational Science Institute, Pittsburgh, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth F Grossmann
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - John Hyngstrom
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Joanne M Jeter
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Robert L Judson-Torres
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
| | - Kari L Kendra
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Caroline C Kim
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
- Partners Healthcare, Newton Wellesley Dermatology Associates, Wellesley, Massachusetts
| | - John M Kirkwood
- Department of Internal Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Janice M Mehnert
- Department of Medical Oncology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - David Polsky
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Eric A Smith
- Department of Pathology, University of Utah, Salt Lake City
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa
| | - Mitchell S Stark
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Jennifer A Stein
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - John A Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Oncology, University of Washington, Seattle
- Seattle Cancer Care Alliance, Seattle, Washington
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Suraj S Venna
- Inova Schar Cancer Institute, Department of Medicine, Virginia Commonwealth University, Fairfax
| | - Maria L Wei
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Dermatology, University of California, San Francisco
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California
| | - Susan M Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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9
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Affiliation(s)
- Caroline C. Kim
- Food Nutrition and Health, The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
| | - Shanthi G. Parkar
- Food Nutrition and Health, The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
| | - Pramod K. Gopal
- Food Nutrition and Health, The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
- Riddet Institute, Massey University, Palmerston North, New Zealand
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10
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Grossman D, Kim CC, Hartman RI, Berry E, Nelson KC, Okwundu N, Curiel-Lewandrowski C, Leachman SA, Swetter SM. Prognostic gene expression profiling in melanoma: necessary steps to incorporate into clinical practice. Melanoma Manag 2019; 6:MMT32. [PMID: 31871621 PMCID: PMC6920745 DOI: 10.2217/mmt-2019-0016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Prognostic gene expression profiling (GEP) tests for cutaneous melanoma (CM) are not recommended in current guidelines outside of a clinical trial. However, their use is becoming more prevalent and some practitioners are using GEP tests to guide patient management. Thus, there is an urgent need to bridge this gap between test usage and clinical guideline recommendations by obtaining high-quality evidence to guide us toward best practice use of GEP testing in CM patients. We focus here on the opportunities and uncertainties associated with prognostic GEP testing in CM, review how GEP testing was incorporated into clinical care guidelines for uveal melanoma and breast cancer and discuss the role of clinical trials to determine best use in patients with CM.
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Affiliation(s)
- Douglas Grossman
- Dermatology, Huntsman Cancer Institute & University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA
| | - Caroline C Kim
- Dermatology, Tufts Medical Center, Boston & Newton Wellesley Hospital, Wellesley, MA 02111, USA
| | - Rebecca I Hartman
- Dermatology, Brigham & Women's Hospital, Harvard Medical School, & Veterans Affairs Boston Healthcare System, Boston, MA 02446, USA
| | - Elizabeth Berry
- Dermatology, Oregon Health & Sciences University & Knight Cancer Institute, Portland, OR 97239, USA
| | - Kelly C Nelson
- Dermatology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nwanneka Okwundu
- Dermatology, Huntsman Cancer Institute & University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA
| | | | - Sancy A Leachman
- Dermatology, Oregon Health & Sciences University & Knight Cancer Institute, Portland, OR 97239, USA
| | - Susan M Swetter
- Dermatology, Stanford University Medical Center & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94305, USA
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11
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Varedi A, Gardner LJ, Kim CC, Chu EY, Ming ME, Leachman SA, Curiel-Lewandrowski C, Swetter SM, Grossman D. Use of new molecular tests for melanoma by pigmented-lesion experts. J Am Acad Dermatol 2019; 82:245-247. [PMID: 31415835 DOI: 10.1016/j.jaad.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Amir Varedi
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City
| | | | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Michael E Ming
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health Sciences University, Portland
| | | | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City; Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City; Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City.
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12
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Varedi A, Bishop MD, Boucher KM, Kim CC, Grossman D. Powering a prospective melanoma chemoprevention trial in high-risk cohorts. Int J Dermatol 2019; 58:e232-e234. [PMID: 31206619 DOI: 10.1111/ijd.14538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/18/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Varedi
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael D Bishop
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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13
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Danesh M, Faulkner-Jones B, Desai A, Kim CC. Extensive Pigment Incontinence Mimicking Persistent Melanoma After Talimogene Laherparepvec Therapy. JAMA Dermatol 2019; 155:496-497. [DOI: 10.1001/jamadermatol.2018.5347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Melissa Danesh
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Anupam Desai
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Caroline C. Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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14
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Kim CC, Healey GR, Kelly WJ, Patchett ML, Jordens Z, Tannock GW, Sims IM, Bell TJ, Hedderley D, Henrissat B, Rosendale DI. Genomic insights from Monoglobus pectinilyticus: a pectin-degrading specialist bacterium in the human colon. ISME J 2019; 13:1437-1456. [PMID: 30728469 PMCID: PMC6776006 DOI: 10.1038/s41396-019-0363-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 12/16/2022]
Abstract
Pectin is abundant in modern day diets, as it comprises the middle lamellae and one-third of the dry carbohydrate weight of fruit and vegetable cell walls. Currently there is no specialized model organism for studying pectin fermentation in the human colon, as our collective understanding is informed by versatile glycan-degrading bacteria rather than by specialist pectin degraders. Here we show that the genome of Monoglobus pectinilyticus possesses a highly specialized glycobiome for pectin degradation, unique amongst Firmicutes known to be in the human gut. Its genome encodes a simple set of metabolic pathways relevant to pectin sugar utilization, and its predicted glycobiome comprises an unusual distribution of carbohydrate-active enzymes (CAZymes) with numerous extracellular methyl/acetyl esterases and pectate lyases. We predict the M. pectinilyticus degradative process is facilitated by cell-surface S-layer homology (SLH) domain-containing proteins, which proteomics analysis shows are differentially expressed in response to pectin. Some of these abundant cell surface proteins of M. pectinilyticus share unique modular organizations rarely observed in human gut bacteria, featuring pectin-specific CAZyme domains and the cell wall-anchoring SLH motifs. We observed M. pectinilyticus degrades various pectins, RG-I, and galactan to produce polysaccharide degradation products (PDPs) which are presumably shared with other inhabitants of the human gut microbiome (HGM). This strain occupies a new ecological niche for a primary degrader specialized in foraging a habitually consumed plant glycan, thereby enriching our understanding of the diverse community profile of the HGM.
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Affiliation(s)
- Caroline C Kim
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand. .,Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand.
| | - Genelle R Healey
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand.,Massey Institute of Food Science and Technology, School of Food and Nutrition, Massey University, Palmerston North, New Zealand
| | | | - Mark L Patchett
- Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Zoe Jordens
- Institute of Fundamental Sciences, Massey University, Palmerston North, 4442, New Zealand
| | - Gerald W Tannock
- Department of Microbiology and Immunology, Microbiome Otago, University of Otago, Dunedin, 9016, New Zealand
| | - Ian M Sims
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt, 5040, New Zealand
| | - Tracey J Bell
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt, 5040, New Zealand
| | - Duncan Hedderley
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand
| | - Bernard Henrissat
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, Marseille, F-13288, France.,Institut National de la Recherche Agronomique, USC1408 Architecture et Fonction des Macromolécules Biologiques, Marseille, F-13288, France.,Department of Biological Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Douglas I Rosendale
- The New Zealand Institute for Plant and Food Research, Palmerston North, 4474, New Zealand.
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15
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Okhovat JP, Tahan SR, Kim CC. A pink enlarging plaque on the plantar foot: amelanotic acral lentiginous melanoma. Dermatol Online J 2019; 25:13030/qt3p91j5db. [PMID: 30710904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 06/09/2023] Open
Abstract
Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.
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Affiliation(s)
| | | | - Caroline C Kim
- Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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16
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Strazzulla LC, Li X, Zhu K, Okhovat JP, Lee SJ, Kim CC. Clinicopathologic, misdiagnosis, and survival differences between clinically amelanotic melanomas and pigmented melanomas. J Am Acad Dermatol 2019; 80:1292-1298. [PMID: 30654075 DOI: 10.1016/j.jaad.2019.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/26/2018] [Accepted: 01/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. OBJECTIVE To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). METHODS A cross-sectional retrospective medical record review at a tertiary academic medical center. RESULTS A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). LIMITATIONS Retrospective study design, single-institutional study. CONCLUSION Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.
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Affiliation(s)
- Lauren C Strazzulla
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Xiaoxue Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen Zhu
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jean-Phillip Okhovat
- Department of Dermatology, Stanford University Medical Center, Stanford University School of Medicine, Palo Alto, California
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Caroline C Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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17
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18
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Kim CC, Berry EG, Marchetti MA, Swetter SM, Lim G, Grossman D, Curiel-Lewandrowski C, Chu EY, Ming ME, Zhu K, Brahmbhatt M, Balakrishnan V, Davis MJ, Wolner Z, Fleming N, Ferris LK, Nguyen J, Trofymenko O, Liu Y, Chen SC. Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol 2018; 154:1401-1408. [PMID: 30304348 PMCID: PMC6583364 DOI: 10.1001/jamadermatol.2018.3359] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/10/2018] [Indexed: 11/14/2022]
Abstract
Importance Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P < .001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P = .01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.
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Affiliation(s)
- Caroline C. Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth G. Berry
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Michael A. Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan M. Swetter
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Geoffrey Lim
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Douglas Grossman
- Department of Dermatology, Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Clara Curiel-Lewandrowski
- Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
| | - Emily Y. Chu
- Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Michael E. Ming
- Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Kathleen Zhu
- University of Massachusetts Medical School, Worcester
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Morehouse School of Medicine, Atlanta, Georgia
| | - Vijay Balakrishnan
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Michael J. Davis
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Zachary Wolner
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nathaniel Fleming
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Laura K. Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Oleksandr Trofymenko
- Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
| | - Yuan Liu
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C. Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
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19
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Nelson KC, Grossman D, Kim CC, Chen SC, Curiel-Lewandrowski CN, Grichnik JM, Kirkwood JM, Leachman SA, Marghoob AA, Swetter SM, Venna SS, Ming ME. Management strategies of academic pigmented lesion clinic directors in the United States. J Am Acad Dermatol 2018; 79:367-369. [DOI: 10.1016/j.jaad.2017.12.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 12/19/2017] [Accepted: 12/25/2017] [Indexed: 11/28/2022]
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20
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Tan SY, Strazzulla LC, Li X, Park JJ, Lee SJ, Kim CC. Association of clinicopathological features of melanoma with total naevus count and a history of dysplastic naevi: a cross-sectional retrospective study within an academic centre. Clin Exp Dermatol 2018; 43:566-572. [PMID: 29450912 DOI: 10.1111/ced.13393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND High naevus count (HNC) (≥ 50 naevi) and presence of dysplastic naevi (DN) are risk factors for malignant melanoma (MM); however, MMs also occur in patients with low naevus count (LNC) (< 50 naevi) and in patients without DN. Little is known about differences between MMs in these groups. AIM To characterize the clinicopathological differences between MMs in patients with HNC and those in patients with LNC, with or without biopsy-proven DN. METHODS This was a cross-sectional retrospective chart review of 281 patients with MM seen between April 2013 and March 2014 at an academic pigmented lesion clinic (Boston, MA, USA). RESULTS Patients with LNC MMs were diagnosed at an older age (51 vs. 41 years, P < 0.001, OR = 0.95, 95% CI 0.93-0.97), with more aggressive MM features, including greater Breslow thickness (1.1 vs. 0.8 mm, P = 0.01), more mitoses (2 vs. 1 mitoses/mm2 , P < 0.001), lower rate of superficial spreading subtype (58 vs. 78%, P < 0.01, OR = 2.57, 95% CI 1.31-5.03) and higher MM stage (P < 0.001), compared to patients with HNC. Patients with DN had similar trends as those in patients with HNC described above, and in addition, were more likely to have a truncal MM (55 vs. 39%, P < 0.01, OR = 1.97, 95% CI 1.22-3.18) with less ulceration (13 vs. 29%, P < 0.01, OR = 0.36, 95% CI 0.19-0.71). Patients without DN were more likely to have a history of a non-MM skin cancer (32 vs. 19%, P = 0.01, OR = 0.49, 95% CI 0.28-0.85) and an amelanotic MM (33 vs 21%, P = 0.03, OR = 0.55, 95% CI 0.31-0.96). CONCLUSIONS Patients with LNC may develop MMs with more aggressive features at an older age than patients with HNC. A history of biopsy-proven DN reveals distinct MM differences compared to patients without DN.
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Affiliation(s)
- S Y Tan
- Harvard Medical School, Boston, MA, USA
| | - L C Strazzulla
- New York University School of Medicine, New York, NY, USA
| | - X Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - J J Park
- Department of Dermatology, Stony Brook School of Medicine, New York, NY, USA
| | - S J Lee
- Harvard Medical School, Boston, MA, USA.,Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C C Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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21
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Wong V, Cheng CE, Tahan SR, Kim CC. Carcinoma erysipeloides of papillary serous ovarian cancer mimicking cellulitis of the abdominal wall. Cutis 2018; 101:E9-E10. [PMID: 29554168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Vivian Wong
- Department of Dermatology, Brown University, Providence, Rhode Island, USA
| | - Carol E Cheng
- Department of Medicine, Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Steven R Tahan
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Caroline C Kim
- Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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22
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Kim CC, Kelly WJ, Patchett ML, Tannock GW, Jordens Z, Stoklosinski HM, Taylor JW, Sims IM, Bell TJ, Rosendale DI. Monoglobus pectinilyticus gen. nov., sp. nov., a pectinolytic bacterium isolated from human faeces. Int J Syst Evol Microbiol 2017; 67:4992-4998. [PMID: 29039307 DOI: 10.1099/ijsem.0.002395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A novel anaerobic pectinolytic bacterium (strain 14T) was isolated from human faeces. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain 14T belonged to the family Ruminococcaceae, but was located separately from known clostridial clusters within the taxon. The closest cultured relative of strain 14T was Acetivibrio cellulolyticus (89.7 % sequence similarity). Strain 14T shared ~99 % sequence similarity with cloned 16S rRNA gene sequences from uncultured bacteria derived from the human gut. Cells were Gram-stain-positive, non-motile cocci approximately 0.6 µm in diameter. Strain 14T fermented pectins from citrus peel, apple, and kiwifruit as well as carbohydrates that are constituents of pectins and hemicellulose, such as galacturonic acid, xylose, and arabinose. TEM images of strain 14T, cultured in association with plant tissues, suggested extracellular fibrolytic activity associated with the bacterial cells, forming zones of degradation in the pectin-rich regions of middle lamella. Phylogenetic and phenotypic analysis supported the differentiation of strain 14T as a novel genus in the family Ruminococcaceae. The name Monoglobus pectinilyticus gen. nov., sp. nov. is proposed; the type strain is 14T (JCM 31914T=DSM 104782T).
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Affiliation(s)
- Caroline C Kim
- Institute of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand.,The New Zealand Institute for Plant and Food Research, Palmerston North 4474, New Zealand
| | | | - Mark L Patchett
- Institute of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Gerald W Tannock
- Department of Microbiology and Immunology, Microbiome Otago, University of Otago, Dunedin 9016, New Zealand
| | - Z Jordens
- Institute of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Halina M Stoklosinski
- The New Zealand Institute for Plant and Food Research, Palmerston North 4474, New Zealand
| | - Jordan W Taylor
- Institute of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Ian M Sims
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt 5040, New Zealand
| | - Tracey J Bell
- Ferrier Research Institute, Victoria University of Wellington, Gracefield Research Centre, Lower Hutt 5040, New Zealand
| | - Douglas I Rosendale
- The New Zealand Institute for Plant and Food Research, Palmerston North 4474, New Zealand
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23
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Strazzulla LC, Wu H, Heller M, Kim CC. An incomplete picture: challenges of partial biopsies in large diameter atypical melanocytic lesions. Dermatol Online J 2017; 23:13030/qt665835jq. [PMID: 28541884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023] Open
Abstract
Large diameter atypical pigmented lesions (LDAPL) can be challenging to diagnose accurately using partial biopsies because of pathologic heterogeneity, while at the same time large excisions of these lesions confer significant morbidity to patients. Consequently, clinicians are often challenged by the management of these lesions. In this case, we describe an elderly patient with a history of multiple basal cell carcinomas, prior melanomas, and a family history of melanoma who presented with an irregularly pigmented brown and dark brown patch on his upper back. This lesion was evaluated with multiple partial incisional biopsies from the most atypical appearing areas of the lesion identified on dermoscopy, each showing mild and moderate atypical melanocytes. However, the patch continued to change clinically and eventually the patient underwent a 5mm wide local excision, which revealed severely atypical melanocytic proliferation with areas consistent with melanoma in situ. This case highlights the need for clinicians to lower their threshold for excisional biopsy of LDAPL in high-risk patients.
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Affiliation(s)
| | | | | | - Caroline C Kim
- Pigmented Lesion Clinic; Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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24
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Johnson MM, Leachman SA, Aspinwall LG, Cranmer LD, Curiel-Lewandrowski C, Sondak VK, Stemwedel CE, Swetter SM, Vetto J, Bowles T, Dellavalle RP, Geskin LJ, Grossman D, Grossmann KF, Hawkes JE, Jeter JM, Kim CC, Kirkwood JM, Mangold AR, Meyskens F, Ming ME, Nelson KC, Piepkorn M, Pollack BP, Robinson JK, Sober AJ, Trotter S, Venna SS, Agarwala S, Alani R, Averbook B, Bar A, Becevic M, Box N, E Carson W, Cassidy PB, Chen SC, Chu EY, Ellis DL, Ferris LK, Fisher DE, Kendra K, Lawson DH, Leming PD, Margolin KA, Markovic S, Martini MC, Miller D, Sahni D, Sharfman WH, Stein J, Stratigos AJ, Tarhini A, Taylor MH, Wisco OJ, Wong MK. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag 2017; 4:13-37. [PMID: 28758010 PMCID: PMC5480135 DOI: 10.2217/mmt-2016-0022] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023] Open
Abstract
Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.
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Affiliation(s)
- Mariah M Johnson
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.,Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.,Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Lisa G Aspinwall
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Lee D Cranmer
- University of Washington, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Clara Curiel-Lewandrowski
- University of Arizona Cancer Center, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Vernon K Sondak
- Moffitt Cancer Center, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Clara E Stemwedel
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Susan M Swetter
- Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - John Vetto
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Tawnya Bowles
- Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA.,Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA
| | - Robert P Dellavalle
- University of Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - Larisa J Geskin
- Columbia University, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Douglas Grossman
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Kenneth F Grossmann
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Jason E Hawkes
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Joanne M Jeter
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Caroline C Kim
- Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - John M Kirkwood
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Aaron R Mangold
- Mayo Clinic Arizona, Scottsdale, AZ, USA.,Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Frank Meyskens
- University of California, Irvine, Orange, CA, USA.,University of California, Irvine, Orange, CA, USA
| | - Michael E Ming
- University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly C Nelson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Piepkorn
- University of Washington, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Brian P Pollack
- Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.,Emory University & Atlanta VA Medical Center, Atlanta, GA, USA
| | - June K Robinson
- Northwestern University Feinberg School of Medicine, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Arthur J Sober
- Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Shannon Trotter
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Suraj S Venna
- Inova Medical Group, Fairfax, VA, USA.,Inova Medical Group, Fairfax, VA, USA
| | - Sanjiv Agarwala
- St Luke's University Hospital & Temple University, Bethlehem, PA, USA.,St Luke's University Hospital & Temple University, Bethlehem, PA, USA
| | - Rhoda Alani
- Boston University, Boston, MA, USA.,Boston University, Boston, MA, USA
| | - Bruce Averbook
- Case Western Reserve University, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Anna Bar
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Mirna Becevic
- University of Missouri, Columbia, MO, USA.,University of Missouri, Columbia, MO, USA
| | - Neil Box
- University of Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - William E Carson
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Pamela B Cassidy
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Suephy C Chen
- Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.,Emory University & Atlanta VA Medical Center, Atlanta, GA, USA
| | - Emily Y Chu
- University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Darrel L Ellis
- Vanderbilt University, Nashville, TN, USA.,Vanderbilt University, Nashville, TN, USA
| | - Laura K Ferris
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - David E Fisher
- Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA
| | - Kari Kendra
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - David H Lawson
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Philip D Leming
- The Christ Hospital, Cincinnati, OH, USA.,The Christ Hospital, Cincinnati, OH, USA
| | - Kim A Margolin
- City of Hope National Cancer Center, Duarte, CA, USA.,City of Hope National Cancer Center, Duarte, CA, USA
| | | | - Mary C Martini
- Northwestern University Feinberg School of Medicine, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Debbie Miller
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Debjani Sahni
- Boston University, Boston, MA, USA.,Boston University, Boston, MA, USA
| | - William H Sharfman
- Johns Hopkins University, Baltimore, MD.,Johns Hopkins University, Baltimore, MD
| | - Jennifer Stein
- NYU Langone Medical Center, New York, NY, USA.,NYU Langone Medical Center, New York, NY, USA
| | - Alexander J Stratigos
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.,Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Ahmad Tarhini
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew H Taylor
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Oliver J Wisco
- Bend Memorial Clinic, Bend, OR, USA.,Bend Memorial Clinic, Bend, OR, USA
| | - Michael K Wong
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Strazzulla LC, Wu H, Heller M, Kim CC. An incomplete picture: challenges of partial biopsies in large diameter atypical melanocytic lesions. Dermatol Online J 2017. [DOI: 10.5070/d3234034649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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26
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27
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Truong A, Strazzulla L, March J, Boucher KM, Nelson KC, Kim CC, Grossman D. Reduction in nevus biopsies in patients monitored by total body photography. J Am Acad Dermatol 2016; 75:135-143.e5. [PMID: 26947450 DOI: 10.1016/j.jaad.2016.02.1152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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28
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Tong LX, Wu PA, Kim CC. Degree of clinical concern and dysplasia affect biopsy technique and management of dysplastic nevi with positive biopsy margins: Results from a survey of New England dermatologists. J Am Acad Dermatol 2016; 74:389-91.e1-2. [DOI: 10.1016/j.jaad.2015.09.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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29
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Kim CC, Najita JS, Tan SYM, Varada S, Tong LX, Dunbar H, Lee MY, Seery VJ, Buchbinder EI, Tawa NE, Fuller J, Frankenthaler RA, McDermott DF, Lee SJ, Atkins MB. Factors associated with worse outcome for patients with AJCC stage IIC relative to stage IIIA melanoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Caroline C. Kim
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | | | - Lana X. Tong
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Haili Dunbar
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | | | | | | | - Sandra J. Lee
- Dana Farber Cancer Institute/Harvard Medical School, Boston, MA
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30
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Tong LX, Weinstock MJ, Drews R, Sheikine Y, Kim CC. Widely metastatic squamous cell carcinoma originating from malignant transformation of hypertrophic lichen planus in a 24-year-old woman: case report and review of the literature. Pediatr Dermatol 2015; 32:e98-101. [PMID: 25739384 DOI: 10.1111/pde.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hypertrophic lichen planus (HLP) is a T-cell-mediated process typically presenting with hypertrophic or verrucous plaques on the lower limbs. We report the case of a 24-year-old woman with a history of HLP since age 3 years presenting with rapid malignant transformation of one lesion into a large squamous cell carcinoma (SCC). Subsequent examination revealed progressive, widespread metastatic involvement, and the patient ultimately died from her disease. SCC associated with HLP is rare, with a review of the literature revealing fewer than 50 cases. This case highlights the need to be aware of suspicious changes in HLP and to educate patients as to when to be reevaluated.
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Affiliation(s)
- Lana X Tong
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Health Policy and Management, School of Public Health, Harvard University, Boston, Massachusetts
| | - Matthew J Weinstock
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Reed Drews
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yuri Sheikine
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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31
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Kim CC, Swetter SM, Curiel-Lewandrowski C, Grichnik JM, Grossman D, Halpern AC, Kirkwood JM, Leachman SA, Marghoob AA, Ming ME, Nelson KC, Veledar E, Venna SS, Chen SC. Addressing the knowledge gap in clinical recommendations for management and complete excision of clinically atypical nevi/dysplastic nevi: Pigmented Lesion Subcommittee consensus statement. JAMA Dermatol 2015; 151:212-8. [PMID: 25409291 DOI: 10.1001/jamadermatol.2014.2694] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence. OBJECTIVES To outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how positive margins arise, (2) whether incompletely excised DN evolve into melanoma, (3) current data on the outcomes of DN with positive histologic margins, (4) consensus recommendations, and (5) a proposal for future studies, including a large-scale study to help guide the management of DN with positive margins. EVIDENCE REVIEW The literature, including recent studies examining management and outcomes of DN with positive margins between 2009 to 2014, was reviewed. FINDINGS A consensus statement by the PLS of the MPWG following review of the literature, group discussions, and a structured Delphi method consensus. CONCLUSIONS AND RELEVANCE This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.
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Affiliation(s)
- Caroline C Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan M Swetter
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California3Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Clara Curiel-Lewandrowski
- Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
| | - James M Grichnik
- Melanoma Program, Department of Dermatology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Douglas Grossman
- Pigmented Lesion Clinic, Departments of Dermatology and Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Allan C Halpern
- Pigmented Lesion Clinic, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John M Kirkwood
- Melanoma Program, University of Pittsburgh Cancer Institute, Department of Medicine, Dermatology and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sancy A Leachman
- Melanoma and Cutaneous Oncology Program, Department of Dermatology, Oregon Health and Science University, Portland
| | - Ashfaq A Marghoob
- Pigmented Lesion Clinic, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael E Ming
- Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Kelly C Nelson
- Pigmented Lesion Clinic, Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Emir Veledar
- Center for Research and Grants, Baptist Health South Florida, Miami
| | - Suraj S Venna
- Skin Oncology and Melanoma Center, Department of Medicine, MedStar Washington Cancer Institute and Georgetown University Medical Center, Washington, DC
| | - Suephy C Chen
- Melanoma and Pigmented Lesion Clinic, Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia15Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
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32
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Xing Y, Hu CY, Lee MY, Seery VJ, Kim CC, Tawa NE, Frankenthaler RA, McDermott DF, Buchbinder EI. Association between mitotic rate and lymph node metastasis in thin melanoma in the general population.. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yan Xing
- Mount Auburn Hospital, Boston, MA
| | - Chung-Yuan Hu
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Park JJ, Hawryluk EB, Tahan SR, Flaherty K, Kim CC. Cutaneous Granulomatous Eruption and Successful Response to Potent Topical Steroids in Patients Undergoing Targeted BRAF Inhibitor Treatment for Metastatic Melanoma. JAMA Dermatol 2014; 150:307-11. [DOI: 10.1001/jamadermatol.2013.7919] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- June J. Park
- University of Illinois College of Medicine, Chicago
| | - Elena B. Hawryluk
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Steven R. Tahan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Keith Flaherty
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Caroline C. Kim
- Pigmented Lesion Clinic, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts6Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Bo
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Kim CC, Kim EJ, Curiel-Lewandrowski C, Marks V, Maloney M, Frieden IJ. A model in dermatology for long-distance mentoring. J Am Acad Dermatol 2013; 68:860-2. [DOI: 10.1016/j.jaad.2012.10.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
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Lacouture ME, Duvic M, Hauschild A, Prieto VG, Robert C, Schadendorf D, Kim CC, McCormack CJ, Myskowski PL, Spleiss O, Trunzer K, Su F, Nelson B, Nolop KB, Grippo JF, Lee RJ, Klimek MJ, Troy JL, Joe AK. Analysis of dermatologic events in vemurafenib-treated patients with melanoma. Oncologist 2013; 18:314-22. [PMID: 23457002 DOI: 10.1634/theoncologist.2012-0333] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vemurafenib has been approved for the treatment of patients with advanced BRAF(V600E)-mutant melanoma. This report by the Vemurafenib Dermatology Working Group presents the characteristics of dermatologic adverse events (AEs) that occur in vemurafenib-treated patients, including cutaneous squamous cell carcinoma (cuSCC). METHODS Dermatologic AEs were assessed from three ongoing trials of BRAF(V600E) mutation-positive advanced melanoma. Histologic central review and genetic characterization were completed for a subset of cuSCC lesions. RESULTS A total of 520 patients received vemurafenib. The most commonly reported AEs were dermatologic AEs, occurring in 92%-95% of patients. Rash was the most common AE (64%-75% of patients), and the most common types were rash not otherwise specified, erythema, maculopapular rash, and folliculitis. Rash development did not appear to correlate with tumor response. Photosensitivity occurred in 35%-63% of patients, and palmar-plantar erythrodysesthesia (PPE) occurred in 8%-10% of patients. The severity of rash, photosensitivity, and PPE were mainly grade 1 or 2. In all, 19%-26% of patients developed cuSCC, mostly keratoacanthomas (KAs). The majority of patients with cuSCC continued therapy without dose reduction after resection. Genetic analysis of 29 cuSCC/KA samples demonstrated HRAS mutations in 41%. CONCLUSIONS Dermatologic AEs associated with vemurafenib treatment in patients with melanoma were generally manageable with supportive care measures. Dose interruptions and/or reductions were required in <10% of patients.
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Affiliation(s)
- Mario E Lacouture
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
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Seol J, Lee SG, Park BH, Lee HH, Terzolo L, Shaing KC, You KI, Yun GS, Kim CC, Lee KD, Ko WH, Kwak JG, Kim WC, Oh YK, Kim JY, Kim SS, Ida K. Effects of electron-cyclotron-resonance-heating-induced internal kink mode on the toroidal rotation in the KSTAR Tokamak. Phys Rev Lett 2012; 109:195003. [PMID: 23215391 DOI: 10.1103/physrevlett.109.195003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Indexed: 06/01/2023]
Abstract
It is observed that the magnitude of the toroidal rotation speed is reduced by the central electron cyclotron resonance heating (ECRH) regardless of the direction of the toroidal rotation. The magnetohydrodynamics activities generally appear with the rotation change due to ECRH. It is shown that the internal kink mode is induced by the central ECRH and breaks the toroidal symmetry. When the magnetohydrodynamics activities are present, the toroidal plasma viscosity is not negligible. The observed effects of ECRH on the toroidal plasma rotation are explained by the neoclassical toroidal viscosity in this Letter. It is found that the neoclassical toroidal viscosity torque caused by the internal kink mode damps the toroidal rotation.
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Affiliation(s)
- J Seol
- National Fusion Research Institute, Gwahangno 113, Yuseong-gu, Daejeon 305-333, Korea
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37
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Curiel-Lewandrowski C, Kim CC, Swetter SM, Chen SC, Halpern AC, Kirkwood JM, Leachman SA, Marghoob AA, Ming ME, Grichnik JM. Survival is not the only valuable end point in melanoma screening. J Invest Dermatol 2012; 132:1332-7. [PMID: 22336950 PMCID: PMC4575123 DOI: 10.1038/jid.2012.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Livedo reticularis is a lacy mottling of the skin that can have many etiologies. We report a case of an 8-year-old boy with a diagnosis of melanoma who developed persistent livedo reticularis during treatment with interferon alpha-2B. To our knowledge, this is the first case report of livedo reticularis occurring as a side effect of interferon treatment for pediatric melanoma. Given the increasing incidence of pediatric melanoma, it is important that dermatologists be aware of potential side effects of interferon therapy to optimize care and education for these patients.
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Affiliation(s)
- Michelle Fox
- Harvard Medical School, Boston, Massachusetts 02215, USA
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39
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O'Donnell AT, Kim CC. Update and Clinical Use of Imaging Technologies for Pigmented Lesions of the Skin. ACTA ACUST UNITED AC 2012; 31:38-44. [DOI: 10.1016/j.sder.2011.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 11/28/2022]
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Affiliation(s)
- Michael Bigby
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Hu SW, Tahan SR, Kim CC. Follicular malignant melanoma: A case report of a metastatic variant and review of the literature. J Am Acad Dermatol 2011; 64:1007-10. [DOI: 10.1016/j.jaad.2009.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 12/06/2009] [Accepted: 12/16/2009] [Indexed: 10/18/2022]
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Hu S, Kim CC, Jessup C, Phung TL, Curiel-Lewandrowski C. Primary cutaneous melanomas seen as inflamed pigmented lesions in patients undergoing adjuvant interferon treatment: a possible diagnostic clue for physicians. ACTA ACUST UNITED AC 2009; 145:565-8. [PMID: 19451501 DOI: 10.1001/archdermatol.2009.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In addition to a complete skin examination every few months, adjuvant interferon treatment is often recommended for patients with high-risk melanomas. Therefore, dermatologists play an important role in detecting multiple primary melanomas and may be required to attempt to identify the primary melanoma in patients with metastatic disease. OBSERVATIONS We describe 3 patients with a diagnosis of melanoma who were diagnosed as having a new primary cutaneous melanoma within weeks of initiating interferon treatment. All 3 melanomas were inflamed clinically, prompting excisional biopsy. Histopathologic analysis of the melanomas revealed thin (<1.0 mm Breslow thickness) invasive tumors, as well as the presence of tumor-infiltrating lymphocytes and/or regression. CONCLUSIONS Inflamed melanocytic lesions in patients undergoing interferon treatment should be further evaluated to investigate the possibility of primary cutaneous melanomas. This observation may enable earlier detection and treatment of melanomas in patients with multiple tumors or metastatic melanoma with an unknown primary site.
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Affiliation(s)
- Stephanie Hu
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Abstract
We show that the kinetic effects of energetic particles can play a crucial role in the stability of the m/n=2/1 tearing mode in tokamaks (e.g., JET, JT-60U, and DIII-D), where the fraction of energetic particle beta(frac) is high. Using model equilibria based on DIII-D experimental reconstructions, the nonideal MHD linear stability of cases unstable to the 2/1 mode is investigated including a deltaf particle-in-cell model for the energetic particles coupled to the nonlinear 3D resistive MHD code NIMROD [C. C. Kim et al., Phys. Plasmas 15, 072507 (2008)10.1063/1.2949704]. It is observed that energetic particles have significant damping and stabilizing effects at experimentally relevant beta, beta(frac), and S, and excite a real frequency of the 2/1 mode. Extrapolation of the results is discussed for implications to JET and ITER, where the effects are projected to be significant.
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Affiliation(s)
- R Takahashi
- Department of Physics and Engineering Physics, University of Tulsa, 800 South Tucker Drive, Tulsa, Oklahoma 74104, USA
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Kim M, Lee S, Jung CK, Lim J, Cho SG, Kim DW, Kim Y, Han K, Min WS, Kim CC. Transient trisomy 8 abnormality in Philadelphia-negative cells during imatinib mesylate treatment of chronic myelogenous leukemia. Int J Lab Hematol 2008; 30:508-12. [PMID: 18983302 DOI: 10.1111/j.1751-553x.2007.00991.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated chronic myelogenous leukemia (CML) patients who developed trisomy 8 abnormalities in Philadelphia-negative (Ph-) cells during imatinib mesylate treatment to evaluate the clinical outcome and laboratory features. Of the 470 CML patients, 1.5% (n = 7) developed trisomy 8 chromosomal abnormalities in Ph- cells. The median interval of the first trisomy 8 observation was 12 months. Our follow-up cytogenetic evaluations revealed that six of the patients demonstrated a complete or partial cytogenetic response and that all of the six patients revealed no dysplastic changes following a bone marrow examination. Moreover, the percentage of trisomy 8 in metaphase karyotyping has decreased in five of the seven subjects. In conclusion, these results suggest that the emergence of trisomy 8 in Ph- cells is transient and not related to therapy-related myelodysplasia or acute leukemia.
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Affiliation(s)
- M Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
This article discusses several solid organ and hematologic neoplasms that can metastasize to the skin. Special emphasis is placed on the most frequent solid and hematological malignancies that have cutaneous metastases, including breast cancer, melanoma, lung cancer, colon cancer, and leukemia. In addition, mammary and extramammary Paget's disease are further discussed as examples of direct extension of primary tumors to the skin.
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Affiliation(s)
- Gabriela Rolz-Cruz
- Clinical Unit for Research Trials in Skin, Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA
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Min CK, Kim SY, Lee MJ, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Kim CC, Cho CS. Vascular endothelial growth factor (VEGF) is associated with reduced severity of acute graft-versus-host disease and nonrelapse mortality after allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 38:149-56. [PMID: 16751784 DOI: 10.1038/sj.bmt.1705410] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated whether or not there is a correlation between the changes in the serum levels of vascular endothelial growth factor (VEGF) and the outcome of allogeneic stem cell transplantation (allo-SCT). Eighty-five patients undergoing allo-SCT were prospectively studied. The serum VEGF levels were measured on days 0, +7 and +14 after transplantation. The VEGF levels decreased significantly on day +7 and recovered on day +14. The highest levels from day +7 through day +14 were categorized by cluster analysis, which were then correlated with the nonrelapse mortality (NRM). There was a significant correlation between a low VEGF level and the occurrence of severe acute graft-versus-host disease (GVHD) including grade III-IV (P=0.029). The 1-year probability of NRM in patients with a low VEGF level was 22.5% compared with 3.5% for those with a high VEGF level (P=0.024). Multivariate analysis revealed clinically defined infections (P=0.011), advanced disease (P=0.014) and a low VEGF cluster (P=0.05) to be significantly associated with the occurrence of NRM in the cohort. In conclusion, low VEGF levels after allo-SCT are associated with NRM with an exacerbated severity of acute GVHD. VEGF monitoring after a transplant might identify those patients at risk of severe transplant-related mortality.
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Affiliation(s)
- C-K Min
- Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea.
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Min CK, Kim SY, Eom KS, Kim YJ, Kim HJ, Lee S, Kim DW, Lee JW, Min WS, Kim CC. Patterns of C-reactive protein release following allogeneic stem cell transplantation are correlated with leukemic relapse. Bone Marrow Transplant 2006; 37:493-8. [PMID: 16435015 DOI: 10.1038/sj.bmt.1705276] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The C-reactive protein (CRP) is an acute-phase protein produced by hepatocytes, and is a reliable marker of systemic inflammation, which is relevant to the release of the proinflammatory cytokines. The value of monitoring the CRP levels after stem cell transplantation (SCT) can identify patients at risk of treatment-related complications and mortality. Inflammatory cytokines facilitate donor T-cell activation via antigen presenting cells immediately after SCT. This study examined the relationship between the post-SCT CRP levels and a leukemic relapse. Fifty-four consecutively transplanted patients who relapsed after the allogeneic SCT were compared with nonrelapsing patients. The serum CRP levels were measured on day 0 and every 7 days thereafter until 4 weeks after the SCT. The mean CRP levels throughout the early post-SCT episode were significantly lower in the relapsing patients than in those who did not experience relapse (mean+/-s.e.: 26.8 +/- 6.3 vs 65.3 +/- 9.4 for first week, P = 0.001; 23.9 +/- 3.8 vs 44.6 +/- 6.6 for second week, P = 0.008). Univariate analysis showed that the CRP level on the first and second week, and graft-versus-host disease were significantly associated with a relapse. Multivariate analysis showed that the CRP level on the first week was the strongest independent variable predicting the risk of a relapse after SCT (P = 0.04). These results indicate that the serum CRP levels early after allogeneic SCT might display the graft-versus-leukemia (GvL) effect. CRP is a surrogate of the proinflammatory cytokine release that was not measured in this study. The GvL effect appears to be efficiently strengthened by the high CRP levels that may be reflecting T-cell activation.
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Affiliation(s)
- C-K Min
- Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea.
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Kim JG, Sohn SK, Kim DH, Baek JH, Lee KB, Min WS, Kim CC, Lee MH, Lee JJ, Chung IJ, Kim HJ, Lee JW. Impact of ABO incompatibility on outcome after allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 2005; 35:489-95. [PMID: 15654350 DOI: 10.1038/sj.bmt.1704816] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Few studies have addressed the incidence of graft-versus-host disease (GVHD) or survival after ABO-incompatible allogeneic peripheral blood stem cell transplantation (PBSCT). We analyzed the clinical outcome of ABO incompatibility after allogeneic PBSCT. A total of 89 consecutive adult patients with hematological diseases including 49 ABO-identical, 20 major, 15 minor, and five bidirectional ABO-incompatible transplants were enrolled from four medical centers in Korea. No significant difference in engraftment times, graft failure, or transfusion requirements between groups was noted. A clinical diagnosis of severe immune hemolysis or pure red cell aplasia was not made for any patient after transplantation. The incidence of acute or chronic GVHD did not statistically differ between groups. With a median follow-up duration of 13 months (range, 0.5-61 months), the 3-year overall survival estimates for the ABO-identical, major/bidirectional, and minor group were 44.6.0+/-9.0, 43.1+/-11.6, and 43.8+/-13.5%, respectively (P=0.8652), while the 3-year disease-free survival estimates were 33.8+/-7.6, 39.9+/-11.4, and 45.7+/-13.1%, respectively (P=0.8546). We observed that time to neutrophil, platelet, and red blood cell engraftment, transfusion requirements, incidence of acute or chronic GVHD, relapse, and survival were not influenced by ABO incompatibility after allogeneic PBSCT from HLA-matched sibling donors.
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Affiliation(s)
- J G Kim
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea
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Hwu Y, Tsai WL, Chang HM, Yeh HI, Hsu PC, Yang YC, Su YT, Tsai HL, Chow GM, Ho PC, Li SC, Moser HO, Yang P, Seol SK, Kim CC, Je JH, Stefanekova E, Groso A, Margaritondo G. Imaging cells and tissues with refractive index radiology. Biophys J 2004; 87:4180-7. [PMID: 15465870 PMCID: PMC1304927 DOI: 10.1529/biophysj.103.034991] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Can individual cells, including live cells, be imaged using hard x rays? Common wisdom until now required sophisticated staining techniques for this task. We show instead that individual cells and cell details can be detected in culture solution and tissues with no staining and no other contrast-enhancing preparation. The sample examined can be much thicker than for many other microscopy techniques without sacrificing the capability to resolve cells. The key factor in our approach is the use of a coherent synchrotron source and of contrast mechanisms based on the refractive index. The first successful tests were conducted on a variety of cell systems including skin and internal leaf cells, mouse neurons, rabbit fibroblast cells, and human tumor cells.
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Affiliation(s)
- Y Hwu
- Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan
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Abstract
DNA microarrays have been successfully used with different microorganisms, including Mycobacterium tuberculosis, to detect genomic deletions relative to a reference strain. However, the cost and complexity of the microarray system are obstacles to its widespread use in large-scale studies. In order to evaluate the extent and role of large sequence polymorphisms (LSPs) or insertion-deletion events in bacterial populations, we developed a technique, termed deligotyping, which hybridizes multiplex-PCR products to membrane-bound, highly specific oligonucleotide probes. The approach has the benefits of being low cost and capable of simultaneously interrogating more than 40 bacterial strains for the presence of 43 genomic regions. The deletions represented on the membrane were selected from previous comparative genomic studies and ongoing microarray experiments. Highly specific probes for these deletions were designed and attached to a membrane for hybridization with strain-derived targets. The targets were generated by multiplex PCR, allowing simultaneous amplifications of 43 different genomic loci in a single reaction. To validate our approach, 100 strains that had been analyzed with a high-density microarray were analyzed. The membrane accurately detected the deletions identified by the microarray approach, with a sensitivity of 99.9% and a specificity of 98.0%. The deligotyping technique allows the rapid and reliable screening of large numbers of M. tuberculosis isolates for LSPs. This technique can be used to provide insights into the epidemiology, genomic evolution, and population structure of M. tuberculosis and can be adapted for the study of other organisms.
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