51
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Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, Daniels GA, DiMaio D, Fields RC, Fleming MD, Freeman M, Galan A, Gastman B, Guild V, Johnson D, Joseph RW, Lange JR, Nath S, Olszanski AJ, Ott P, Gupta AP, Ross MI, Salama AK, Skitzki J, Sosman J, Swetter SM, Tanabe KK, Wuthrick E, McMillian NR, Engh AM. Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:367-402. [PMID: 30959471 DOI: 10.6004/jnccn.2019.0018] [Citation(s) in RCA: 257] [Impact Index Per Article: 51.4] [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: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cutaneous melanoma have been significantly revised over the past few years in response to emerging data on immune checkpoint inhibitor therapies and BRAF-targeted therapy. This article summarizes the data and rationale supporting extensive changes to the recommendations for systemic therapy as adjuvant treatment of resected disease and as treatment of unresectable or distant metastatic disease.
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Affiliation(s)
| | - John A Thompson
- 2Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - William E Carson
- 4The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Carlo Contreras
- 5University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | - Ryan C Fields
- 8Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Martin D Fleming
- 9St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Brian Gastman
- 12Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Julie R Lange
- 16The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Patrick Ott
- 19Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | - Jeffrey Sosman
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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52
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Schlessinger DI, Chhor G, Gevaert O, Swetter SM, Ko J, Novoa RA. Artificial intelligence and dermatology: opportunities, challenges, and future directions. Semin Cutan Med Surg 2019. [PMID: 31051021 DOI: 10.12788/j.sder.2019.] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The application of artificial intelligence (AI) to medicine has considerable potential within dermatology, where the majority of diagnoses are based on visual pattern recognition. Opportunities for AI in dermatology include the potential to automate repetitive tasks; optimize time-consuming tasks; extend limited medical resources; improve interobserver reliability issues; and expand the diagnostic toolbox of dermatologists. To achieve the full potential of AI, however, developers must aim to create algorithms representing diverse patient populations; ensure algorithm output is ultimately interpretable; validate algorithm performance prospectively; preserve human-patient interaction when necessary; and demonstrate validity in the eyes of regulatory bodies.
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Affiliation(s)
| | - Guillaume Chhor
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California.,Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Medicine, Stanford University, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Stanford, California.,Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Justin Ko
- Department of Dermatology, Stanford University, Stanford, California
| | - Roberto A Novoa
- Department of Dermatology, Stanford University, Stanford, California.
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53
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Schlessinger DI, Chhor G, Gevaert O, Swetter SM, Ko J, Novoa RA. Artificial intelligence and dermatology: opportunities, challenges, and future directions. Semin Cutan Med Surg 2019; 38:E31-37. [PMID: 31051021 DOI: 10.12788/j.sder.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The application of artificial intelligence (AI) to medicine has considerable potential within dermatology, where the majority of diagnoses are based on visual pattern recognition. Opportunities for AI in dermatology include the potential to automate repetitive tasks; optimize time-consuming tasks; extend limited medical resources; improve interobserver reliability issues; and expand the diagnostic toolbox of dermatologists. To achieve the full potential of AI, however, developers must aim to create algorithms representing diverse patient populations; ensure algorithm output is ultimately interpretable; validate algorithm performance prospectively; preserve human-patient interaction when necessary; and demonstrate validity in the eyes of regulatory bodies.
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Affiliation(s)
| | - Guillaume Chhor
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford University, Stanford, California
- Department of Medicine, Stanford University, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Stanford, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Justin Ko
- Department of Dermatology, Stanford University, Stanford, California
| | - Roberto A Novoa
- Department of Dermatology, Stanford University, Stanford, California.
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Schlessinger DI, Chhor G, Gevaert O, Swetter SM, Ko J, Novoa RA. Artificial intelligence and dermatology: opportunities, challenges, and future directions. ACTA ACUST UNITED AC 2019. [DOI: 10.12788/j.sder.2019.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shaub AR, Lewis ET, Nevedal AL, Swetter SM. Physician perceptions of primary-care-based skin cancer screening in a Veterans Affairs pilot study. Br J Dermatol 2019; 181:377-378. [PMID: 30695111 DOI: 10.1111/bjd.17699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A R Shaub
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, U.S.A.,Center for Innovation to Implementation, Health Services Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, U.S.A
| | - E T Lewis
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, U.S.A
| | - A L Nevedal
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, U.S.A
| | - S M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, U.S.A.,Center for Innovation to Implementation, Health Services Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, U.S.A
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56
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Affiliation(s)
- Susan M Hiniker
- Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California.
| | - Sunil A Reddy
- Department of Medicine, Division of Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.,Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
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Abstract
The combined use of immunotherapy and radiation therapy is emerging as a potentially effective treatment for patients with immunogenic tumors such as melanoma; however, evidence for long-term treatment outcomes is lacking. Herein, we summarize our previously described case study of a patient with metastatic melanoma treated with two cycles of ipilimumab, followed by stereotactic body radiotherapy to two of seven liver metastases, with two additional cycles of ipilimumab. In the longest follow-up to date, we report a successful treatment outcome at 6.5 years. Our patient remains in complete remission, with no evidence of disease or recurrence 6.5 years after treatment. He continues to manage chronic hypophysitis developed secondary to immunotherapy and has developed osteopenia from prolonged systemic glucocorticoid use. The use of radiotherapy in combination with targeted immune therapy appears to be an effective treatment strategy, with long-lasting efficacy.
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Affiliation(s)
- Paulina M Gutkin
- Radiation Oncology, Stanford University Medical Center, Stanford, USA
| | - Susan M Hiniker
- Radiation Oncology, Stanford University Medical Center, Stanford, USA
| | - Susan M Swetter
- Dermatology, Stanford University Medical Center, Stanford, USA
| | - Sunil A Reddy
- Oncology, Stanford University Medical Center, Stanford, USA
| | - Susan J Knox
- Radiation Oncology, Stanford University Medical Center, Stanford, USA
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Means AD, Lee KC, Korgavkar K, Swetter SM, Dellavalle RP, Chen S, Stricklin G, Weinstock MA. Development of a Pigmented Facial Lesion Scale Based on Darkness and Extent of Lesions in Older Veterans. J Invest Dermatol 2018; 139:1185-1187. [PMID: 30508548 DOI: 10.1016/j.jid.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander D Means
- Department of Dermatology, University of Wisconsin-Madison, Wisconsin, USA; Center for Dermatoepidemiology, Veterans Affairs Medical Center, Providence, Rhode Island, USA.
| | - Kachiu C Lee
- Center for Dermatoepidemiology, Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kaveri Korgavkar
- Center for Dermatoepidemiology, Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Medical Center, Palo Alto, California, USA; Department of Dermatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Robert P Dellavalle
- Dermatology Service, Veterans Affairs Medical Center, Denver, Colorado, USA; University of Colorado School of Medicine, Colorado School of Public Health, Denver, Colorado, USA
| | - Suephy Chen
- Dermatology Service, Veterans Affairs Medical Center, Atlanta, Georgia, USA; Department of Dermatology, Emory University, Atlanta, Georgia, USA
| | - George Stricklin
- Dermatology Service, Veterans Affairs Medical Center, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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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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60
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 307] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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61
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Jeter JM, Bowles TL, Curiel-Lewandrowski C, Swetter SM, Filipp FV, Abdel-Malek ZA, Geskin LJ, Brewer JD, Arbiser JL, Gershenwald JE, Chu EY, Kirkwood JM, Box NF, Funchain P, Fisher DE, Kendra KL, Marghoob AA, Chen SC, Ming ME, Albertini MR, Vetto JT, Margolin KA, Pagoto SL, Hay JL, Grossman D, Ellis DL, Kashani-Sabet M, Mangold AR, Markovic SN, Meyskens FL, Nelson KC, Powers JG, Robinson JK, Sahni D, Sekulic A, Sondak VK, Wei ML, Zager JS, Dellavalle RP, Thompson JA, Weinstock MA, Leachman SA, Cassidy PB. Chemoprevention agents for melanoma: A path forward into phase 3 clinical trials. Cancer 2018; 125:18-44. [PMID: 30281145 DOI: 10.1002/cncr.31719] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 03/12/2018] [Revised: 06/10/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022]
Abstract
Recent progress in the treatment of advanced melanoma has led to unprecedented improvements in overall survival and, as these new melanoma treatments have been developed and deployed in the clinic, much has been learned about the natural history of the disease. Now is the time to apply that knowledge toward the design and clinical evaluation of new chemoprevention agents. Melanoma chemoprevention has the potential to reduce dramatically both the morbidity and the high costs associated with treating patients who have metastatic disease. In this work, scientific and clinical melanoma experts from the national Melanoma Prevention Working Group, composed of National Cancer Trials Network investigators, discuss research aimed at discovering and developing (or repurposing) drugs and natural products for the prevention of melanoma and propose an updated pipeline for translating the most promising agents into the clinic. The mechanism of action, preclinical data, epidemiological evidence, and results from available clinical trials are discussed for each class of compounds. Selected keratinocyte carcinoma chemoprevention studies also are considered, and a rationale for their inclusion is presented. These data are summarized in a table that lists the type and level of evidence available for each class of agents. Also included in the discussion is an assessment of additional research necessary and the likelihood that a given compound may be a suitable candidate for a phase 3 clinical trial within the next 5 years.
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Affiliation(s)
- Joanne M Jeter
- Department of Medicine, Divisions of Genetics and Oncology, The Ohio State University, Columbus, Ohio
| | - Tawnya L Bowles
- Department of Surgery, Intermountain Health Care, Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center Cancer Institute, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Fabian V Filipp
- Systems Biology and Cancer Metabolism, Program for Quantitative Systems Biology, University of California Merced, Merced, California
| | | | - Larisa J Geskin
- Department of Dermatology, Cutaneous Oncology Center, Columbia University Medical Center, New York, New York
| | - Jerry D Brewer
- Department of Dermatologic Surgery, Mayo Clinic Minnesota, Rochester, Minnesota
| | - Jack L Arbiser
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Veterans Affairs Medical Center, Atlanta, Georgia
| | - Jeffrey E Gershenwald
- Departments of Surgical Oncology and Cancer Biology, Melanoma and Skin Cancer Center, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John M Kirkwood
- Melanoma and Skin Cancer Program, Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Neil F Box
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Dermatology Service, U.S. Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - David E Fisher
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kari L Kendra
- Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, Ohio
| | - Ashfaq A Marghoob
- Memorial Sloan Kettering Skin Cancer Center and Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Veterans Affairs Medical Center, Atlanta, Georgia
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark R Albertini
- Department of Medicine, University of Wisconsin, School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - John T Vetto
- Division of Surgical Oncology, Oregon Health & Science University, Portland, Oregon
| | - Kim A Margolin
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Sherry L Pagoto
- Department of Allied Health Sciences, UConn Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, Connecticut
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Douglas Grossman
- Departments of Dermatology and Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Darrel L Ellis
- Department of Dermatology, Vanderbilt University Medical Center and Division of Dermatology, Vanderbilt Ingram Cancer Center, Nashville, Tennessee.,Department of Medicine, Tennessee Valley Healthcare System, Nashville Veterans Affairs Medical Center, Nashville, Tennessee
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center, San Francisco, California
| | | | | | | | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Debjani Sahni
- Department of Dermatology, Boston Medical Center, Boston, Massachusetts
| | | | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Dermatology Service, U.S. Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John A Thompson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Veterans Affairs Medical Center, Providence, Rhode Island.,Department of Dermatology, Brown University, Providence, Rhode Island.,Department of Epidemiology, Brown University, Providence, Rhode Island.,Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island
| | - Sancy A Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Pamela B Cassidy
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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Filipp FV, Birlea S, Bosenberg MW, Brash D, Cassidy PB, Chen S, D'Orazio JA, Fujita M, Goh BK, Herlyn M, Indra AK, Larue L, Leachman SA, Le Poole C, Liu-Smith F, Manga P, Montoliu L, Norris DA, Shellman Y, Smalley KSM, Spritz RA, Sturm RA, Swetter SM, Terzian T, Wakamatsu K, Weber JS, Box NF. Frontiers in pigment cell and melanoma research. Pigment Cell Melanoma Res 2018; 31:728-735. [PMID: 30281213 DOI: 10.1111/pcmr.12728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
In this perspective, we identify emerging frontiers in clinical and basic research of melanocyte biology and its associated biomedical disciplines. We describe challenges and opportunities in clinical and basic research of normal and diseased melanocytes that impact current approaches to research in melanoma and the dermatological sciences. We focus on four themes: (1) clinical melanoma research, (2) basic melanoma research, (3) clinical dermatology, and (4) basic pigment cell research, with the goal of outlining current highlights, challenges, and frontiers associated with pigmentation and melanocyte biology. Significantly, this document encapsulates important advances in melanocyte and melanoma research including emerging frontiers in melanoma immunotherapy, medical and surgical oncology, dermatology, vitiligo, albinism, genomics and systems biology, epidemiology, pigment biophysics and chemistry, and evolution.
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Affiliation(s)
- Fabian V Filipp
- Systems Biology and Cancer Metabolism, Program for Quantitative Systems Biology, University of California Merced, Merced, California
| | - Stanca Birlea
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
| | - Marcus W Bosenberg
- Department of Dermatology and Dermatopathology, Yale School of Medicine, New Haven, Connecticut
| | - Douglas Brash
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Pamela B Cassidy
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Suzie Chen
- Susan Lehman Cullman Laboratory for Cancer Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - John A D'Orazio
- Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
| | - Boon-Kee Goh
- Mount Elizabeth Medical Centre, Skin Physicians Private Limited, Singapore, Singapore
| | - Meenhard Herlyn
- Department of Molecular and Cellular Oncogenesis, Wistar Institute, Philadelphia, Pennsylvania
| | - Arup K Indra
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon.,Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, Oregon
| | - Lionel Larue
- Equipe Labellisée Ligue Contre le Cancer, Normal and Pathological Development of Melanocytes, UMR 3347, CNRS, Institut Curie, Orsay, France
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Caroline Le Poole
- Lurie Comprehensive Cancer Center, Northwestern University at Chicago, Chicago, Illinois
| | - Feng Liu-Smith
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, California
| | - Prashiela Manga
- Ronald O Perlman Department of Dermatology, New York University Langone Medical Center, New York, New York
| | - Lluis Montoliu
- CNB-CSIC, CIBERER-ISCIII, Campus de Cantoblanco, Centro Nacional de Biotecnología, Madrid, Spain
| | - David A Norris
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
| | - Yiqun Shellman
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
| | | | - Richard A Spritz
- Human Medical Genetics and Genomics Program, University of Colorado Denver, Aurora, Colorado
| | - Richard A Sturm
- Dermatology Research Centre, University of Queensland Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Palo Alto, California
| | - Tamara Terzian
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
| | - Kazumasa Wakamatsu
- Department of Chemistry, Fujita Health University School of Health Sciences, Toyoake, Japan
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York
| | - Neil F Box
- Department of Dermatology, University of Colorado Denver, Aurora, Colorado
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63
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Lewellis SW, Roy K, Gojenola L, Swetter SM, Rieger KE. Cross-contamination of pathology specimens: a cautionary tale. Cutis 2018; 102:E12-E14. [PMID: 30489571] [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] [Indexed: 06/09/2023]
Abstract
There are many potential sources of error in clinical practice. An astute clinician must not only work hard to prevent errors but also minimize harmful sequelae that could arise from errors that do occur. A rare but real source of error is cross-contamination of pathology specimens. Such contaminants are colloquially referred to as floaters. If not recognized expediently, floaters can lead to misdiagnoses that may prompt unnecessary and inappropriate treatment. We report the case of a patient with a benign adnexal neoplasm on the face that, due to cross-contamination of pathology specimens, was initially diagnosed as an aggressive invasive melanoma that would have warranted wide local excision and sentinel lymph node biopsy.
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Affiliation(s)
- Stephen W Lewellis
- Department of Dermatology, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Katherine Roy
- Dermatology Group of the Carolinas, Concord, North Carolina, USA
| | - Linda Gojenola
- Department of Pathology, Stanford Hospital and Clinics, Redwood City, California, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford Hospital and Clinics, Redwood City, and Dermatology Service, VA Palo Alto Health Care System, California, USA
| | - Kerri E Rieger
- Departments of Dermatology and Pathology, Stanford Hospital and Clinics, Redwood City, California, USA
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64
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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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65
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Kwon GP, Gamba CS, Stefanick ML, Swetter SM, Li S, Shi RZ, Clarke CA, Feldman D, Millen AE, Messina C, Shikany JM, Manson JE, Chlebowski RT, Tang JY. Association of 25-hydroxyvitamin D levels and cutaneous melanoma: A nested case-control study of the Women's Health Initiative Observation Study. J Am Acad Dermatol 2018; 79:145-147. [PMID: 29908819 DOI: 10.1016/j.jaad.2017.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/11/2017] [Accepted: 05/21/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Gina P Kwon
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California; University of Washington Medical Center, Dermatology Division, Seattle, Washington.
| | - Christina S Gamba
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Run Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California; Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - David Feldman
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, University of Buffalo, Buffalo, New York
| | - Catherine Messina
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - James M Shikany
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rowan T Chlebowski
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
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66
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Abstract
Artificial intelligence and its machine learning (ML) capabilities are very promising technologies for dermatology and other visually oriented fields due to their power in pattern recognition. Understandably, many physicians distrust replacing clinical finesse with unsupervised computer programs. We describe convolutional neural networks and discuss how this method of ML will impact the field of dermatology. ML is a form of artificial intelligence well suited for pattern recognition in visual applications. Many dermatologists are wary of such unsupervised algorithms and their future implications.
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Affiliation(s)
- Sarah Mattessich
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Michael Tassavor
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology and VA Palo Alto Health Care System, Stanford University Medical Center and Cancer Institute, Farmington, Connecticut, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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67
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Nelson K, Swetter SM, Chen S, Curiel-Lewandrowski C. The estimated financial impact of diagnostic accuracy on melanoma diagnosis in 2018. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18903] [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)
- Kelly Nelson
- Department of Dermatology, MD Anderson Cancer Center, Houston, TX
| | | | - Suephy Chen
- Division of Dermatology, Atlanta VAMC, Decatur, GA
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68
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Dessinioti C, Geller AC, Stergiopoulou A, Swetter SM, Baltas E, Mayer JE, Johnson TM, Talaganis J, Trakatelli M, Tsoutsos D, Tsourouflis G, Stratigos AJ. Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis. JAMA Dermatol 2018; 154:544-553. [PMID: 29710122 PMCID: PMC6128502 DOI: 10.1001/jamadermatol.2018.0288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/03/2018] [Indexed: 01/30/2023]
Abstract
Importance Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer. Objective To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection. Design, Setting, and Participants This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included. Interventions A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis. Main Outcomes and Measures Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM. Results Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM. Conclusions and Relevance Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness.
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Affiliation(s)
- Clio Dessinioti
- First Department of Dermatology–Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Aravella Stergiopoulou
- First Department of Dermatology–Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Susan M. Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Palo Alto, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eszter Baltas
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Jonathan E. Mayer
- Department of Dermatology, University of Colorado School of Medicine, Aurora
| | | | - John Talaganis
- First Department of Dermatology–Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Dimitrios Tsoutsos
- Department of Plastic Surgery, General Hospital of Athens Georgios Gennimatas, Athens, Greece
| | | | - Alexander J. Stratigos
- First Department of Dermatology–Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
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69
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Swetter SM, Geller AC, Halpern AC. What the USPSTF "Insufficient" Skin Cancer Screening Recommendation Means for Primary Care Clinicians and Dermatologists. JAMA Dermatol 2018; 152:973-5. [PMID: 27459324 DOI: 10.1001/jamadermatol.2016.2606] [Citation(s) in RCA: 6] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California2Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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70
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Clarke CA, McKinley M, Hurley S, Haile RW, Glaser SL, Keegan TH, Swetter SM. Continued Increase in Melanoma Incidence across all Socioeconomic Status Groups in California, 1998–2012. J Invest Dermatol 2017; 137:2282-2290. [DOI: 10.1016/j.jid.2017.06.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022]
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71
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Affiliation(s)
- Amanda R Shaub
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Eleanor T Lewis
- Center for Innovation to Implementation, Health Services Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
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72
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Coit DG, Thompson JA, Algazi A, Andtbacka R, Bichakjian CK, Carson WE, Daniels GA, DiMaio D, Fields RC, Fleming MD, Gastman B, Gonzalez R, Guild V, Johnson D, Joseph RW, Lange JR, Martini MC, Materin MA, Olszanski AJ, Ott P, Gupta AP, Ross MI, Salama AK, Skitzki J, Swetter SM, Tanabe KK, Torres-Roca JF, Trisal V, Urist MM, McMillian N, Engh A. NCCN Guidelines Insights: Melanoma, Version 3.2016. J Natl Compr Canc Netw 2017; 14:945-58. [PMID: 27496110 DOI: 10.6004/jnccn.2016.0101] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Melanoma have been significantly revised over the past few years in response to emerging data on a number of novel agents and treatment regimens. These NCCN Guidelines Insights summarize the data and rationale supporting extensive changes to the recommendations for systemic therapy in patients with metastatic or unresectable melanoma.
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Affiliation(s)
- Daniel G Coit
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - John A Thompson
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Alain Algazi
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Robert Andtbacka
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Christopher K Bichakjian
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - William E Carson
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Gregory A Daniels
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Dominick DiMaio
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Ryan C Fields
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Martin D Fleming
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Brian Gastman
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Rene Gonzalez
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Valerie Guild
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Douglas Johnson
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Richard W Joseph
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Julie R Lange
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Mary C Martini
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Miguel A Materin
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Anthony J Olszanski
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Patrick Ott
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Aparna Priyanath Gupta
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Merrick I Ross
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - April K Salama
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Joseph Skitzki
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Susan M Swetter
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Kenneth K Tanabe
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Javier F Torres-Roca
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Vijay Trisal
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Marshall M Urist
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Nicole McMillian
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
| | - Anita Engh
- From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network
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Ally MS, Swetter SM, Hirotsu KE, Gordon J, Kim D, Wysong A, Donnelly L, Li S, Nord KM. Promoting sunscreen use and sun-protective practices in NCAA athletes: Impact of SUNSPORT educational intervention for student-athletes, athletic trainers, and coaches. J Am Acad Dermatol 2017; 78:289-292.e2. [PMID: 28993006 DOI: 10.1016/j.jaad.2017.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/23/2017] [Revised: 07/07/2017] [Accepted: 08/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Student-athletes (SAs) have an increased skin cancer risk on account of significant ultraviolet exposure; however, their sun-protective practices are suboptimal. A novel program, Stanford University Network for Sun Protection, Outreach, Research, and Teamwork (SUNSPORT), was designed to target SAs, coaches, and athletic trainers (ATs). OBJECTIVE To measure the impact of educational intervention on sun protection beliefs and practices of SAs. METHODS A survey of sun protection beliefs and practices was administered to National Collegiate Athletic Association athletes before and after intervention. SUNSPORT dermatologists educated SAs, coaches, and ATs regarding skin cancer risk and prevention methods. The main outcome was frequency of sunscreen use by SAs before versus after intervention. RESULTS A total of 846 National Collegiate Athletic Association athletes were surveyed between September 23, 2012, and September 20, 2015. After intervention, significant increases were observed in sunscreen use 4 or more days per week by SAs (from 26% to 39% [P = .02]), SAs spoken to by their coach about sun safety (from 26% to 57% [P = .0001]), and SA recognition of higher skin cancer risk (from 54% to 67% [P = .04]). LIMITATIONS Intervention in only 1 West Coast university and no paired data. CONCLUSIONS Following the SUNSPORT intervention, SAs were significantly more likely to use sunscreen, especially if encouraged by their coach. This study emphasizes that education directed to SAs, ATs, and coaches can improve sun-protective practices in SAs.
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Affiliation(s)
- Mina S Ally
- Dermatology Service, Veterans Administration Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Susan M Swetter
- Dermatology Service, Veterans Administration Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Kelsey E Hirotsu
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Justin Gordon
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - David Kim
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Ashley Wysong
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Lindsy Donnelly
- Department of Sports Medicine, Stanford University, Stanford, California
| | - Shufeng Li
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Kristin M Nord
- Dermatology Service, Veterans Administration Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Stanford University Medical Center, Stanford, California.
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Swetter SM, Chang J, Shaub AR, Weinstock MA, Lewis ET, Asch SM. Primary Care-Based Skin Cancer Screening in a Veterans Affairs Health Care System. JAMA Dermatol 2017; 153:797-801. [PMID: 28593242 DOI: 10.1001/jamadermatol.2017.1324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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 Skin cancer screening may improve melanoma outcomes and keratinocyte carcinoma morbidity, but little is known about the feasibility of skin cancer training and clinical skin examination (CSE) by primary care practitioners (PCPs) in large health care systems. Objective To assess the association of skin cancer training and screening by PCPs with dermatology referral patterns and rates of skin biopsies. Design, Setting, and Participants In this pilot interventional study performed at the Veterans Affairs Palo Alto Health Care System, patients 35 years or older scheduled for an annual health habits screen in the PCP general medicine clinics were studied. Interventions Six PCPs underwent Internet Curriculum for Melanoma Early Detection (INFORMED) training in May 2015, and 5 screened patients during the following 14 months. Main Outcomes and Measures Proportion of dermatology referrals, subsequent skin biopsies, and PCP diagnostic accuracy for skin cancer or precancer compared with dermatologist diagnosis were assessed in screened patients 14 months before the intervention (February 18, 2014, through April 30, 2015) and after the intervention (June 18, 2015, through August 30, 2016). Results Among 258 patients offered screening (median age, 70 years; age range, 35-94 years; 255 [98.8%] male), 189 (73.3%) received CSE and 69 (26.7%) declined. A total of 62 of 189 patients (32.8%) were referred to a dermatologist after intervention: 33 (53.2%) for presumptive skin cancers and 15 (24.2%) for precancers. Nine of 50 patients (18.0%) evaluated in dermatology clinic underwent biopsy to exclude skin cancer. Correct diagnoses were made by PCPs in 13 of 38 patients (34.2%; 4 of 27 patients [14.8%] diagnosed with skin cancers and 5 of 11 patients [45.5%] diagnosed with actinic keratoses). Comparison of all outpatient visits for the 5 main participating PCPs before vs after intervention revealed no significant differences in dermatology referrals overall and those for presumptive skin cancer or actinic keratoses, skin biopsies, or PCP diagnostic accuracy with the exception of significantly fewer postintervention dermatology referrals that lacked specific diagnoses (25 [1.0%] vs 10 [0.4%], P = .01). Conclusions and Relevance This pilot study suggests that PCP-based skin cancer training and screening are feasible and have the potential to improve PCP diagnostic accuracy without increasing specialty referrals or skin biopsies. Additional studies comparing screening rates, specialty referrals, and patient outcomes in trained vs untrained PCPs are needed before screening is widely implemented in large health care systems in the United States.
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Affiliation(s)
- Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Julia Chang
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Amanda R Shaub
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Providence Veterans Affairs Medical Center, Providence, Rhode Island.,Department of Dermatology, Brown University, Providence, Rhode Island
| | - Eleanor T Lewis
- Center for Innovation to Implementation, Health Services Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Steven M Asch
- Center for Innovation to Implementation, Health Services Research and Development, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Department of Medicine, Stanford University Medical Center, Stanford, California
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Porter JB, Rosenthal EL, Winget M, Smith AS, Seshadri SB, Vetteth Y, Kiamanesh EF, Badwe A, Advani RH, Buyyounouski MK, Coutre S, Dirbas F, Divi V, Dorigo O, Ganjoo KN, Johnston LJ, Recht LD, Shrager JB, Skinner EC, Swetter SM, Visser BC, Blayney DW. Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center. J Oncol Pract 2017; 13:e673-e682. [PMID: 28727487 DOI: 10.1200/jop.2017.021139] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
PURPOSE Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the manual data collection required is resource intensive, and reporting is delayed. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCPs) to identify, measure, and improve quality metrics that were meaningful to the care teams and their patients. METHODS Each CCP physician leader collaborated with the cancer quality team to identify metrics, abiding by established guiding principles. Financial incentive was provided to the CCPs if performance at the end of the study period met predetermined targets. Reports were developed and provided to the CCP physician leaders on a monthly or quarterly basis, for dissemination to their CCP teams. RESULTS A total of 15 distinct quality measures were collected in depth for the first time at this cancer center. Metrics spanned the patient care continuum, from diagnosis through end of life or survivorship care. All metrics improved over the study period, met their targets, and earned a financial incentive for their CCP. CONCLUSION Our quality program had three essential elements that led to its success: (1) engaging physicians in choosing the quality measures and prespecifying goals, (2) using automated extraction methods for rapid and timely feedback on improvement and progress toward achieving goals, and (3) offering a financial team-based incentive if prespecified goals were met.
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Affiliation(s)
| | | | - Marcy Winget
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | | | - Yohan Vetteth
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Amogh Badwe
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Ranjana H Advani
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Steven Coutre
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Frederick Dirbas
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Vasu Divi
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Oliver Dorigo
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Kristen N Ganjoo
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Laura J Johnston
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Joseph B Shrager
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Eila C Skinner
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Susan M Swetter
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Brendan C Visser
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
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76
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Esteva A, Kuprel B, Novoa RA, Ko J, Swetter SM, Blau HM, Thrun S. Corrigendum: Dermatologist-level classification of skin cancer with deep neural networks. Nature 2017; 546:686. [PMID: 28658222 DOI: 10.1038/nature22985] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This corrects the article DOI: 10.1038/nature21056.
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77
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Abstract
Importance Controversy persists regarding the appropriate management of incompletely excised, biopsy-proven, mild and moderate dysplastic nevi (DN). Objective To determine long-term risk of associated melanoma in biopsied mild or moderate DN with positive histologic margins that were clinically observed vs reexcised with negative margins. Design, Setting, and Participants Retrospective cohort study of mixed referral and community patients from an academic pigmented lesion clinic and dermatology clinics of the affiliated Veteran Affairs medical center with biopsy-confirmed DN with positive histologic margins diagnosed from May 15, 1991, to July 8, 2015, and followed up through May 30, 2016. A consecutive sample of 1473 histologically confirmed DN was identified using surgical pathology databases at the study sites; 590 cases in 498 patients met eligibility criteria. Main Outcomes and Measures The primary outcome was the proportion of biopsied DN that progressed to histologically confirmed invasive or in situ melanoma. Secondary outcomes included local nevus recurrence and development of primary melanoma at other anatomic sites. Results The 498 patients had a mean (range) age of 57.6 (14-93) years and 90% were male. Among 590 positive-margin DN, 191 were reexcised and 399 clinically observed without further surgery; 170 reexcised and 304 observed DN had available follow-up data, with mean (SD) follow-up of 5.5 (4.6) years. Cases in the observation group were more likely to demonstrate nevus recurrence than those that were reexcised (3.3% vs 0%; P = .02). Six of 304 (2.0%) observed DN subsequently developed melanoma at the same site, compared with 1 of 170 (0.06%) that were reexcised (P = .43). Five of 6 observed patients who developed melanoma initially underwent partial biopsy with grossly positive margins; 1 melanoma in situ evolved from an excisionally biopsied moderately dysplastic nevus 5 years later. Only 1 case of thin invasive melanoma (≤1 mm) was observed, and no deaths from melanoma arising from biopsy-proven DN occurred through the latest dermatology follow-up. New primary melanoma developed at other sites in 9.9% of excised and 9.4% of resected DN. Conclusions and Relevance In cases of mild and moderate DN with microscopically positive margins and no concerning clinical residual lesion, observation, rather than reexcision, was a reasonable management option. Partial biopsies of pigmented lesions suspicious for melanoma may lead to delayed melanoma diagnosis and should be discouraged.
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Affiliation(s)
- Nathaniel H Fleming
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California2Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Barbara M Egbert
- Pathology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jinah Kim
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California4Dermatopathology Section, Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California2Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California
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78
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Walker JL, Siegel JA, Sachar M, Pomerantz H, Chen SC, Swetter SM, Dellavalle RP, Stricklin GP, Qureshi AA, DiGiovanna JJ, Weinstock MA. 5-Fluorouracil for Actinic Keratosis Treatment and Chemoprevention: A Randomized Controlled Trial. J Invest Dermatol 2017; 137:1367-1370. [DOI: 10.1016/j.jid.2016.12.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022]
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79
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Porter J, Segura Smith A, Winget M, Rosenthal EL, Seshadri SB, Vetteth Y, Kiamanesh EF, Badwe A, Advani RH, Buyyounouski MK, Coutre S, Dorigo O, Ganjoo KN, Johnston LJ, Recht LD, Shrager JB, Skinner EC, Swetter SM, Visser BC, Blayney DW. Improving care with portfolio of physician-led cancer quality measures at an academic center. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.49] [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: 11/20/2022] Open
Abstract
49 Background: Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the required manual data collection is slow and resource-intensive. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCP). Methods: CCP physician leaders (MD) identified two measures that were meaningful to their team and patients. The quality team worked with hospital and university analytics teams to develop metrics and reports. Hospital leadership provided financial incentives (FI) for each CCP if jointly set targets were met. Results: 16 metrics were identified and measured for 13 CCPs (Table). Measures spanned from new diagnosis (ND) through end of life or survivorship care, and were a mix of process and outcome measures. To build and manage metrics required 2 full-time equivalent data analysts and quality specialists over 12 months. CCP MDs received monthly reports for dissemination to their team. Almost all measures improved or maintained initial high levels (*). FI awards will be used for quality improvement, education, and team-building, as determined by CCP MDs. Conclusions: A successful quality reporting system with measured improvements takes considerable engagement and resources, including FI, data systems, and staff to build, manage, and improve measures. This may not be feasible or sustainable for centers in the current fiscal environment. [Table: see text]
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80
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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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81
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Esteva A, Kuprel B, Novoa RA, Ko J, Swetter SM, Blau HM, Thrun S. Dermatologist-level classification of skin cancer with deep neural networks. Nature 2017; 542:115-118. [PMID: 28117445 DOI: 10.1038/nature21056] [Citation(s) in RCA: 4670] [Impact Index Per Article: 667.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/14/2016] [Indexed: 11/09/2022]
Abstract
Skin cancer, the most common human malignancy, is primarily diagnosed visually, beginning with an initial clinical screening and followed potentially by dermoscopic analysis, a biopsy and histopathological examination. Automated classification of skin lesions using images is a challenging task owing to the fine-grained variability in the appearance of skin lesions. Deep convolutional neural networks (CNNs) show potential for general and highly variable tasks across many fine-grained object categories. Here we demonstrate classification of skin lesions using a single CNN, trained end-to-end from images directly, using only pixels and disease labels as inputs. We train a CNN using a dataset of 129,450 clinical images-two orders of magnitude larger than previous datasets-consisting of 2,032 different diseases. We test its performance against 21 board-certified dermatologists on biopsy-proven clinical images with two critical binary classification use cases: keratinocyte carcinomas versus benign seborrheic keratoses; and malignant melanomas versus benign nevi. The first case represents the identification of the most common cancers, the second represents the identification of the deadliest skin cancer. The CNN achieves performance on par with all tested experts across both tasks, demonstrating an artificial intelligence capable of classifying skin cancer with a level of competence comparable to dermatologists. Outfitted with deep neural networks, mobile devices can potentially extend the reach of dermatologists outside of the clinic. It is projected that 6.3 billion smartphone subscriptions will exist by the year 2021 (ref. 13) and can therefore potentially provide low-cost universal access to vital diagnostic care.
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Affiliation(s)
- Andre Esteva
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Brett Kuprel
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University, Stanford, California, USA.,Department of Pathology, Stanford University, Stanford, California, USA
| | - Justin Ko
- Department of Dermatology, Stanford University, Stanford, California, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Stanford, California, USA.,Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Helen M Blau
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology and Immunology, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
| | - Sebastian Thrun
- Department of Computer Science, Stanford University, Stanford, California, USA
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82
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Abstract
We describe the case of a 26-year-old woman with a history of congenital ichthyosiform erythroderma (CIE) who initially presented with a stage IIA amelanotic melanoma on her forearm that was surgically excised. We also review the literature on CIE-associated skin cancers and discuss the possible contribution of ichthyosis to the risk of cutaneous malignancies. Our findings emphasize the importance of close lifelong skin cancer screening in individuals with CIE and highlight the unique malignancy risk of these individuals.
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Affiliation(s)
- Prajakta Jaju
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Roberto A Novoa
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Stanford, California.,Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, California
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83
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Abstract
Molecular profiling of malignant tumors is gaining increasing interest in oncology. In recent years, several molecular techniques have been studied in melanoma, with the goal to improve upon the diagnostic and prognostic abilities of currently available clinical and histopathologic parameters. Reliable tests performed early in the diagnosis and management of melanoma could lead to decreased morbidity and mortality by selecting appropriate patients for more-aggressive therapy and sparing those for whom it is not indicated. This article reviews the molecular diagnostic and prognostic techniques currently available for melanoma and evaluates their potential role in clinical practice.
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Affiliation(s)
- Andrew L Ji
- VA Palo Alto Health Care System, Dermatology Service, Palo Alto, Stanford, California,Stanford University Medical Center and Cancer Institute, Department of Dermatology Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford, California
| | | | - Susan M Swetter
- VA Palo Alto Health Care System, Dermatology Service, Palo Alto, Stanford, California,Stanford University Medical Center and Cancer Institute, Department of Dermatology Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford, California
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84
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Sun BK, Wang H, Kim J, Chen JK, Sun L, Zhang Y, Swetter SM. Mutational profile of primary dermal melanoma: A case series. J Am Acad Dermatol 2016; 75:1263-1265.e5. [DOI: 10.1016/j.jaad.2016.08.028] [Citation(s) in RCA: 6] [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: 03/20/2016] [Revised: 06/27/2016] [Accepted: 08/12/2016] [Indexed: 02/03/2023]
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85
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Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now. CA Cancer J Clin 2016; 66:460-480. [PMID: 27232110 PMCID: PMC5124531 DOI: 10.3322/caac.21352] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.
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Affiliation(s)
- Mary K Tripp
- Instructor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meg Watson
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sophie J Balk
- Attending Pediatrician, Children's Hospital at Montefiore, and Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Swetter
- Professor, Department of Dermatology, and Director, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
- Professor and Assistant Chief, Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jeffrey E Gershenwald
- Dr. John M. Skibber Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Professor, Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
- Co-Leader, Melanoma Moon Shot, The University of Texas MD Anderson Cancer Center, Houston, TX
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86
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Affiliation(s)
- Emily de Golian
- Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA
| | - Bernice Y Kwong
- Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA
| | - Susan M Swetter
- Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Silvina B Pugliese
- Department of Dermatology, Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 780 Welch Road, CJ220F, Palo Alto, CA, 94304-5779, USA.
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87
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Geller AC, Mayer JE, Sober AJ, Miller DR, Argenziano G, Johnson TM, Swetter SM. Total Nevi, Atypical Nevi, and Melanoma Thickness: An Analysis of 566 Patients at 2 US Centers. JAMA Dermatol 2016; 152:413-8. [PMID: 26934430 DOI: 10.1001/jamadermatol.2016.0027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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 Nevi are among the strongest risk factors for melanoma. However, little is known about the association of many total nevi (TN) or atypical nevi (AN) with tumor thickness. OBJECTIVES To examine the association between age and the number of TN and AN and to explore whether there was a relationship between TN or AN and tumor thickness, controlling for multiple variables. DESIGN, SETTING, AND PARTICIPANTS Survey of patients with melanoma at 2 academic sites and an affiliated Veteran Affairs medical center. Participants included 566 patients surveyed within 3 months of diagnosis. Patients were surveyed in the melanoma clinics from May 17, 2006, through March 31, 2009, within 3 months of diagnostic biopsy. The dates of the analysis were April 1, 2015, to August 1, 2015. MAIN OUTCOMES AND MEASURES Counts of TN and AN were performed at the first visit after diagnosis and were categorized as 0 to 20, 20 to 50, or more than 50 for TN and as 0, 1 to 5, or more than 5 for AN. Tumor thickness was categorized as 2.00 mm or less or as 2.01 mm or greater. All analyses were stratified by patient age (<60 or ≥60 years). Logistic regression was used to test associations, controlling for age, sex, anatomic location of melanoma, institution, histologic subtype, marital status, performance of skin self-examination, number of health care visits in the past year, mode of melanoma discovery, and receipt of skin examination by a physician. RESULTS The study population included 566 patients. Their mean (SD) age was 56.7 (15.9) years, and 39.0% (n = 221) were female. Of 566 patients, the number of TN was classified as 0 to 20 (66.4% [n = 376]), 20 to 50 (20.5% [n = 116]), or more than 50 (13.1% [n = 74]). Atypical nevus counts were 0 (73.3% [n = 415]), 1 to 5 (14.5% [n = 82]), or more than 5 (12.2% [n = 69]). For those younger than 60 years, the presence of more than 50 TN was associated with a sharply reduced risk of thick melanoma (odds ratio, 0.32; 95% CI, 0.12-0.81), and the presence of more than 5 AN compared with no AN was associated with thicker melanoma (odds ratio, 2.43; 95% CI, 1.02-5.75). CONCLUSIONS AND RELEVANCE Most patients with melanoma had few nevi and no AN. In younger patients (<60 years), thick melanomas were commonly found in those with fewer TN but more AN, suggesting that physicians and patients should not rely on the total nevus count as a sole reason to perform skin examinations or to determine a patient's at-risk status. Younger patients should be educated on the increased risk of thicker melanomas that is associated with having more AN.
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Affiliation(s)
- Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jonathan E Mayer
- Department of Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Donald R Miller
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | | | | | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California8Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
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88
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Siegel JA, Chren MM, Weinstock MA, Weinstock MA, Marcolivio K, Weinstock MA, Chen SC, Dellavalle RP, Warshaw EM, DiGiovanna JJ, Ferguson R, Lew RA, Ringer RJ, Yoon J, Phibbs CS, Kraemer K, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob S, Romero L, Warshaw EM, Stricklin GP, Dellavalle RP, Konnikov N, Werth V, Sidhu-Malik N, Keri JE, Swan JW, Nord K, Pollack B, Kempiak S, High W, Fett N, Hall RP, Alonso-Llamazares J, Rodriguez G, Sisler L, O'Sullivan M, Wilson S, Agrawal M, Bartenfeld D, Nicalo K, Johnson D, Parks P, Bidek B, Boyd N, Watson B, Wolfe D, Zacheis M, Okawa J, Iannacchione MA, Quintero J, Cuddapah S, Muller K, Lichon V, Anhalt T, Khosravi V, Rahman Z, Lawley L, McCoy R, Foman N, Bershow A, Zic J, Miller J, Arbuckle HA, Hemphill L, Fujita M, Norris D, Ramaswamy P, Nevas J, Rao CH, Gifford AJ, Asher KA, Cardones ARG, Richardson AF, Patrick CA, Fiore L, Ferguson R, Thwin SS, Lew RA, Kebabian CE, Pavao J, Sather M, Fye C, Ringer RJ, Hunt D, Robinson-Bostom L, Telang G, Wilkel C, Haynes HA, Brookhart MA, Mostow EN, Rector T. Correlates of skin-related quality of life (QoL) in those with multiple keratinocyte carcinomas (KCs): A cross-sectional study. J Am Acad Dermatol 2016; 75:639-642. [DOI: 10.1016/j.jaad.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
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Swetter SM. Commentary: Improved patient outcomes remain elusive after intensive imaging surveillance for high-risk melanoma. J Am Acad Dermatol 2016; 75:525-527. [PMID: 27317056 DOI: 10.1016/j.jaad.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Susan M Swetter
- Dermatology Service, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California.
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90
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Kuo KY, Jiang W, Swetter SM, Kwong BY. Enhanced radiation dermatitis associated with concurrent palliative radiation and vemurafenib therapy. Cutis 2016; 98:E4-E6. [PMID: 27622267] [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: 06/06/2023]
Affiliation(s)
- Karen Y Kuo
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, California, USA
| | - Wen Jiang
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, California, USA
| | - Susan M Swetter
- Dermatology Service, VA Palo Alto Health Care System and Department of Dermatology, Stanford University Medical Center and Cancer Institute, California, USA
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91
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Hiniker SM, Reddy SA, Maecker HT, Subrahmanyam PB, Rosenberg-Hasson Y, Swetter SM, Saha S, Shura L, Knox SJ. A Prospective Clinical Trial Combining Radiation Therapy With Systemic Immunotherapy in Metastatic Melanoma. Int J Radiat Oncol Biol Phys 2016; 96:578-88. [PMID: 27681753 DOI: 10.1016/j.ijrobp.2016.07.005] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/21/2016] [Accepted: 07/07/2016] [Indexed: 10/25/2022]
Abstract
PURPOSE Local radiation therapy (RT) combined with systemic anti-cytotoxic T-lymphocyte-associated protein-4 immunotherapy may enhance induction of systemic antimelanoma immune responses. The primary objective of the present trial was to assess the safety and efficacy of combining ipilimumab with RT in patients with stage IV melanoma. The secondary objectives included laboratory assessment of induction of antimelanoma immune responses. METHODS AND MATERIALS In our prospective clinical trial, 22 patients with stage IV melanoma were treated with palliative RT and ipilimumab for 4 cycles. RT to 1 to 2 disease sites was initiated within 5 days after starting ipilimumab. Patients had ≥1 nonirradiated metastasis measuring ≥1.5 cm available for response assessment. Tumor imaging studies were obtained at baseline, 2 to 4 weeks after cycle 4 of ipilimumab, and every 3 months until progression. Laboratory immune response parameters were measured before and during treatment. RESULTS Combination therapy was well-tolerated without unexpected toxicities. Eleven patients (50.0%) experienced clinical benefit from therapy, including complete and partial responses and stable disease at median follow-up of 55 weeks. Three patients (27.3%) achieved an ongoing systemic complete response at a median follow-up of 55 weeks (range 32-65), and 3 (27.3%) had an initial partial response for a median of 40 weeks. Analysis of immune response data suggested a relationship between elevated CD8-activated T-cells and response. CONCLUSION This is the second prospective clinical trial of treatment of metastatic melanoma using the combination of RT and systemic immunotherapy and the first using this sequence of therapy. The results from the present trial demonstrate that a subset of patients may benefit from combination therapy, arguing for continued clinical investigation of the use of RT combined with immunotherapy, including programmed cell death 1 inhibitors, which might have the potential to be even more effective in combination with RT.
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Affiliation(s)
- Susan M Hiniker
- Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California.
| | - Sunil A Reddy
- Division of Oncology, Department of Medicine, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Holden T Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University Medical Center, Stanford, California
| | - Priyanka B Subrahmanyam
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University Medical Center, Stanford, California
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University Medical Center, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | | | - Lei Shura
- Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
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92
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Curiel-Lewandrowski C, Swetter SM. Lack of harms from community-based melanoma screening by primary care providers. Cancer 2016; 122:3102-3105. [PMID: 27392136 DOI: 10.1002/cncr.30194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Stanford, California.,Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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93
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Najita JS, Swetter SM, Geller AC, Gershenwald JE, Zelen M, Lee SJ. Sex Differences in Age at Primary Melanoma Diagnosis in a Population-Based Analysis (US Surveillance, Epidemiology, and End Results, 2005-2011). J Invest Dermatol 2016; 136:1894-1897. [PMID: 27251792 DOI: 10.1016/j.jid.2016.03.044] [Citation(s) in RCA: 6] [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] [Received: 12/08/2015] [Revised: 03/03/2016] [Accepted: 03/24/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Julie S Najita
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California, USA; Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin Zelen
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
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94
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Merlino G, Herlyn M, Fisher DE, Bastian BC, Flaherty KT, Davies MA, Wargo JA, Curiel-Lewandrowski C, Weber MJ, Leachman SA, Soengas MS, McMahon M, Harbour JW, Swetter SM, Aplin AE, Atkins MB, Bosenberg MW, Dummer R, Gershenwald JE, Halpern AC, Herlyn D, Karakousis GC, Kirkwood JM, Krauthammer M, Lo RS, Long GV, McArthur G, Ribas A, Schuchter L, Sosman JA, Smalley KS, Steeg P, Thomas NE, Tsao H, Tueting T, Weeraratna A, Xu G, Lomax R, Martin A, Silverstein S, Turnham T, Ronai ZA. The state of melanoma: challenges and opportunities. Pigment Cell Melanoma Res 2016; 29:404-16. [PMID: 27087480 DOI: 10.1111/pcmr.12475] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The Melanoma Research Foundation (MRF) has charted a comprehensive assessment of the current state of melanoma research and care. Intensive discussions among members of the MRF Scientific Advisory Council and Breakthrough Consortium, a group that included clinicians and scientists, focused on four thematic areas - diagnosis/early detection, prevention, tumor cell dormancy (including metastasis), and therapy (response and resistance). These discussions extended over the course of 2015 and culminated at the Society of Melanoma Research 2015 International Congress in November. Each of the four groups has outlined their thoughts as per the current status, challenges, and opportunities in the four respective areas. The current state and immediate and long-term needs of the melanoma field, from basic research to clinical management, are presented in the following report.
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Affiliation(s)
- Glenn Merlino
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Meenhard Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - David E Fisher
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Boris C Bastian
- Departments of Dermatology and Pathology, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Keith T Flaherty
- Developmental Therapeutics, Cancer Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Michael A Davies
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer A Wargo
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Michael J Weber
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sancy A Leachman
- Department of Dermatology, Knight Cancer Institute Melanoma and Skin Cancer Program, Oregon Health Science University, Portland, OR, USA
| | - Maria S Soengas
- Molecular Oncology Program, Melanoma Laboratory, CNIO, Madrid, Spain
| | - Martin McMahon
- Department of Dermatology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - J William Harbour
- Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute/VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael B Atkins
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Marcus W Bosenberg
- Department of Dermatology and Dermatopathology, Cancer Center, Yale University, New Haven, CT, USA
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zürich, Switzerland
| | - Jeffrey E Gershenwald
- Department of Genomic Medicine and Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allan C Halpern
- Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dorothee Herlyn
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | | | - John M Kirkwood
- Melanoma and Skin Cancer Program, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Roger S Lo
- Department of Medical Oncology and Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgina V Long
- Melanoma Institute, University of Sydney, Sydney, NSW, Australia
| | - Grant McArthur
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - Antoni Ribas
- Department of Medical Oncology and Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lynn Schuchter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey A Sosman
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical School, Nashville, TN, USA
| | - Keiran S Smalley
- Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Patricia Steeg
- Women Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nancy E Thomas
- Melanoma Program, Department of Dermatology, Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Hensin Tsao
- Melanoma and Pigmented Lesion Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Thomas Tueting
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Ashani Weeraratna
- Melanoma Research Center, The Wistar Institute, Philadelphia, PA, USA
| | - George Xu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Randy Lomax
- Melanoma Research Foundation, Washington, DC, USA
| | | | | | - Tim Turnham
- Melanoma Research Foundation, Washington, DC, USA
| | - Ze'ev A Ronai
- Tumor Initiation and Maintenance Program, Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
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95
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Coit DG, Thompson JA, Algazi A, Andtbacka R, Bichakjian CK, Carson WE, Daniels GA, DiMaio D, Ernstoff M, Fields RC, Fleming MD, Gonzalez R, Guild V, Halpern AC, Hodi FS, Joseph RW, Lange JR, Martini MC, Materin MA, Olszanski AJ, Ross MI, Salama AK, Skitzki J, Sosman J, Swetter SM, Tanabe KK, Torres-Roca JF, Trisal V, Urist MM, McMillian N, Engh A. Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2016; 14:450-73. [DOI: 10.6004/jnccn.2016.0051] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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96
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Siegal JA, Walker JL, Sachar M, Lew RA, Chen SC, Swetter SM, Dellavalle RP, Stricklin GP, Weinstock MA. Actinic keratoses progress more quickly to squamous cell carcinoma than basal cell carcinoma. Dermatol Online J 2016. [DOI: 10.5070/d3229032516] [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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97
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Fu T, Swetter SM, Tao L, Geller AC, Clarke CA, Keegan THM. Characterizing subsequent primary melanomas (SPM) in adolescents and young adults: A population-based study from 1973 to 2011. J Am Acad Dermatol 2016; 74:181-182.e3. [PMID: 26702802 PMCID: PMC4692187 DOI: 10.1016/j.jaad.2015.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Teresa Fu
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, California
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, California; Dermatology Service, Department of Veterans Affairs Palo Alto Health Care System, California
| | - Li Tao
- Cancer Prevention Institute of California, Fremont, California
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California; Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California; Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California.
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98
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Leachman SA, Cassidy PB, Chen SC, Curiel C, Geller A, Gareau D, Pellacani G, Grichnik JM, Malvehy J, North J, Jacques SL, Petrie T, Puig S, Swetter SM, Tofte S, Weinstock MA. Methods of Melanoma Detection. Cancer Treat Res 2016; 167:51-105. [PMID: 26601859 DOI: 10.1007/978-3-319-22539-5_3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 12/11/2022]
Abstract
Detection and removal of melanoma, before it has metastasized, dramatically improves prognosis and survival. The purpose of this chapter is to (1) summarize current methods of melanoma detection and (2) review state-of-the-art detection methods and technologies that have the potential to reduce melanoma mortality. Current strategies for the detection of melanoma range from population-based educational campaigns and screening to the use of algorithm-driven imaging technologies and performance of assays that identify markers of transformation. This chapter will begin by describing state-of-the-art methods for educating and increasing awareness of at-risk individuals and for performing comprehensive screening examinations. Standard and advanced photographic methods designed to improve reliability and reproducibility of the clinical examination will also be reviewed. Devices that magnify and/or enhance malignant features of individual melanocytic lesions (and algorithms that are available to interpret the results obtained from these devices) will be compared and contrasted. In vivo confocal microscopy and other cellular-level in vivo technologies will be compared to traditional tissue biopsy, and the role of a noninvasive "optical biopsy" in the clinical setting will be discussed. Finally, cellular and molecular methods that have been applied to the diagnosis of melanoma, such as comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), will be discussed.
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Affiliation(s)
- Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health and Science University, 3303 SW Bond Avenue, CH16D, Portland, OR, 97239, USA.
| | - Pamela B Cassidy
- Department of Dermatology and Knight Cancer Institute, Oregon Health and Science University, 3125 SW Sam Jackson Park Road, L468R, Portland, OR, 97239, USA.
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, 1st Floor, Atlanta, GA, 30322, USA.
| | - Clara Curiel
- Department of Dermatology and Arizona Cancer Center, University of Arizona, 1515 N Campbell Avenue, Tucson, AZ, 85721, USA.
| | - Alan Geller
- Department of Dermatology, Harvard School of Public Health and Massachusetts General Hospital, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.
| | - Daniel Gareau
- Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA.
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy.
| | - James M Grichnik
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Room 912, BRB (R-125), 1501 NW 10th Avenue, Miami, FL, 33136, USA.
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Jeffrey North
- University of California, San Francisco, 1701 Divisadero Street, Suite 280, San Francisco, CA, 94115, USA.
| | - Steven L Jacques
- Department of Biomedical Engineering and Dermatology, Oregon Health and Science University, 3303 SW Bond Avenue, CH13B, Portland, OR, 97239, USA.
| | - Tracy Petrie
- Department of Biomedical Engineering, Oregon Health and Science University, 3303 SW Bond Avenue, CH13B, Portland, OR, 97239, USA.
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology, Stanford University, 900 Blake Wilbur Drive, W3045, Stanford, CA, 94305, USA.
| | - Susan Tofte
- Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Avenue, CH16D, Portland, OR, 97239, USA.
| | - Martin A Weinstock
- Departments of Dermatology and Epidemiology, Brown University, V A Medical Center 111D, 830 Chalkstone Avenue, Providence, RI, 02908, USA.
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99
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Pomerantz H, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob SE, Warshaw EM, Stricklin G, Dellavalle RP, Sidhu-Malik N, Konnikov N, Werth VP, Keri J, Lew R, Weinstock MA. Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis: A Randomized Clinical Trial. JAMA Dermatol 2015; 151:952-60. [PMID: 25950503 DOI: 10.1001/jamadermatol.2015.0502] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Topical fluorouracil was demonstrated to be effective in reducing the number of actinic keratoses (AKs) for up to 6 months, but no randomized trials studied its long-term efficacy. OBJECTIVE To evaluate the long-term efficacy of a single course of fluorouracil cream, 5%, for AK treatment. DESIGN, SETTING, AND PARTICIPANTS The Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) trial was a randomized, double-blinded, placebo-controlled trial with patients from dermatology clinics at 12 VA medical centers recruited from 2009 to 2011 and followed up until 2013. Our study population comprised 932 veterans with 2 or more keratinocyte carcinomas in the 5 years prior to enrollment. The mean follow-up duration was 2.6 years in both treatment and control groups. INTERVENTIONS Participants applied either topical fluorouracil cream, 5% (n = 468), or vehicle control cream (n = 464) to the face and ears twice daily for up to 4 weeks. MAIN OUTCOMES AND MEASURES This study reports on AK counts and treatments, which were secondary outcomes of the VAKCC trial. Actinic keratoses on the face and ears were counted by study dermatologists at enrollment and at study visits every 6 months. The number of spot treatments for AKs on the face and ears at semiannual study visits and in between study visits was recorded. RESULTS The number of AKs on the face and ears per participant was not different between the fluorouracil and control groups at randomization (11.1 vs 10.6, P > .10). After randomization, the fluorouracil group had fewer AKs compared with the control group at 6 months (3.0 vs 8.1, P < .001) and for the overall study duration (P < .001). The fluorouracil group also had higher complete AK clearance rates (38% vs 17% at 6 months) and fewer spot treatments at 6-month intervals, at study visits, and in between study visits during the trial (P < .01 for all). The fluorouracil group took longer to require the first spot AK treatment (6.2 months) compared with the control group (6.0 months) (hazard ratio, 0.69; 95% CI, 0.60-0.79). The number of hypertrophic AKs was not different between the 2 groups overall (P = .60), although there were fewer hypertrophic AKs in the fluorouracil group at 6 months (0.23 vs 0.41) (P = .05). CONCLUSIONS AND RELEVANCE Our results indicate that a single course of fluorouracil cream, 5%, effectively reduces AK counts and the need for spot treatments for longer than 2 years. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00847912.
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Affiliation(s)
- Hyemin Pomerantz
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island2Department of Dermatology, Brown University, Providence, Rhode Island
| | - Daniel Hogan
- Dermatology, Bay Pines VA Healthcare System, Bay Pines, Florida4Department of Internal Medicine (Dermatology), NOVA Southeastern University College of Osteopathic Medicine, Davie, Florida
| | - David Eilers
- Dermatology, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Susan M Swetter
- Dermatology, VA Palo Alto Health Care System, Palo Alto, California7Department of Dermatology, Stanford University Medical Center, Palo Alto, California
| | - Suephy C Chen
- Dermatology, Atlanta VA Medical Center, Atlanta, Georgia9Department of Dermatology, Emory University, Atlanta, Georgia
| | - Sharon E Jacob
- Dermatology, VA San Diego Healthcare System, San Diego, California
| | - Erin M Warshaw
- Dermatology, Minneapolis VA Health Care System, Minneapolis, Minnesota12Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - George Stricklin
- Dermatology, Tennessee Valley Healthcare System, Nashville, Tennessee14Division of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | - Navjeet Sidhu-Malik
- Dermatology, Durham VA Medical Center, Durham, North Carolina17Department of Dermatology, Duke University, Durham, North Carolina
| | - Nellie Konnikov
- Dermatology, Boston VA Medical Center, Boston, Massachusetts
| | - Victoria P Werth
- Dermatology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania20Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonette Keri
- Dermatology, Miami VA Hospital, Miami, Florida22Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami
| | - Robert Lew
- VA Cooperative Studies Coordinating Center, Boston, Massachusetts
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island2Department of Dermatology, Brown University, Providence, Rhode Island24Department of Dermatology, Rhode Island Hospital, Providence25Department of Epidemiology
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Lang UE, Cheung C, Vladar EK, Swetter SM, Kim J. Loss of primary cilia correlates with cytologic severity in dysplastic melanocytic nevi. J Cutan Pathol 2015; 43:113-9. [DOI: 10.1111/cup.12612] [Citation(s) in RCA: 9] [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: 05/14/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Ursula E. Lang
- Section of Dermatopathology, Department of Dermatology and Pathology; Stanford University Medical Center; Stanford CA USA
| | - Christine Cheung
- Section of Dermatopathology, Department of Dermatology and Pathology; Stanford University Medical Center; Stanford CA USA
| | - Eszter K. Vladar
- Section of Dermatopathology, Department of Dermatology and Pathology; Stanford University Medical Center; Stanford CA USA
| | - Susan M. Swetter
- Department of Dermatology; Pigmented Lesion and Melanoma Program, Stanford University Medical Center; Stanford CA USA
- Dermatology Service; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
| | - Jinah Kim
- Section of Dermatopathology, Department of Dermatology and Pathology; Stanford University Medical Center; Stanford CA USA
- Department of Dermatology; Pigmented Lesion and Melanoma Program, Stanford University Medical Center; Stanford CA USA
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