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Alam M, Harikumar V, Kang BY, Ibrahim SA, Kibbi N, Owen JL, Maher IA, Cartee TV, Sobanko JF, Reynolds KA, Bolotin D, Waldman AH, Minkis K, Petersen B, Council ML, Nehal KS, Xu YG, Jiang SB, Somani AK, Bichakjian CK, Huang CC, Eisen DB, Ozog DM, Lee EH, Samie FH, Neuhaus IM, Bordeaux JS, Wang JV, Leitenberger JJ, Mann MW, Lawrence N, Zeitouni NC, Golda N, Behshad R, Ibrahim SF, Yu SS, Shin TM, Stebbins WG, Worley B. Development of international clinical practice guidelines: benefits, limitations, and alternative forms of international collaboration. Arch Dermatol Res 2020; 314:483-486. [PMID: 33216212 DOI: 10.1007/s00403-020-02166-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
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Alam M, Harikumar V, Ibrahim SA, Kang BY, Maher IA, Cartee TV, Sobanko JF, Kibbi N, Owen JL, Reynolds KA, Bolotin D, Waldman AH, Minkis K, Petersen B, Council ML, Nehal KS, Xu YG, Jiang SB, Somani AK, Bichakjian CK, Huang CC, Eisen DB, Ozog DM, Lee EH, Samie FH, Neuhaus IM, Bordeaux JS, Wang JV, Leitenberger JJ, Mann MW, Lawrence N, Zeitouni NC, Golda N, Behshad R, Ibrahim SF, Yu SS, Shin TM, Stebbins WG, Worley B. Principles for developing and adapting clinical practice guidelines and guidance for pandemics, wars, shortages, and other crises and emergencies: the PAGE criteria. Arch Dermatol Res 2020; 314:393-398. [PMID: 33206210 DOI: 10.1007/s00403-020-02167-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
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Strom MA, Trager MH, Timerman D, Coromilas AJ, Burris K, Belsito DV, Eber A, Greenberg S, Husain S, Lewin JM, Naka F, Patrone CC, Coulon A, Cooper C, Bartholomew FB, Beck M, Dowd ML, Ensslin C, Gallitano SM, Loesch E, Malajian DM, Melnick L, Niedt GW, Uwakwe LN, Vu HL, Walther RR, Samie FH, Geskin LJ. Cutaneous findings in hospitalized and critically ill patients with COVID-19: A case series of 15 patients. J Am Acad Dermatol 2020; 84:510-511. [PMID: 33068643 PMCID: PMC7554488 DOI: 10.1016/j.jaad.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
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Behbahani S, Malerba S, Warren CJ, Pomeranz MK, Samie FH. Melanoma in situ and invasive melanoma of the vulva: An analysis of the National Cancer Database. J Am Acad Dermatol 2020; 84:1744-1749. [PMID: 32950551 DOI: 10.1016/j.jaad.2020.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
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Ensslin CJ, Fisher J, Samie FH. Modification of the Staged Retroauricular Flap for Repair of Midhelical Defects. Facial Plast Surg 2020; 36:493-494. [PMID: 32866984 DOI: 10.1055/s-0039-3401021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Queen D, Shen Y, Trager MH, Lopez AT, Samie FH, Lewin JM, Niedt GW, Geskin LJ, Liu L. UV biomarker genes for classification and risk stratification of cutaneous actinic keratoses and squamous cell carcinoma subtypes. FASEB J 2020; 34:13022-13032. [PMID: 32776588 DOI: 10.1096/fj.202001412r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/27/2020] [Indexed: 11/11/2022]
Abstract
Currently, there is no sensitive molecular test for identifying transformation-prone actinic keratoses (AKs) and aggressive squamous cell carcinoma (SCC) subtypes. Biomarker-based molecular testing represents a promising tool for risk stratifying these lesions. We evaluated the utility of a panel of ultraviolet (UV) radiation-biomarker genes in distinguishing between benign and transformation-prone AKs and SCCs. The expression of the UV-biomarker genes in 31 SCC and normal skin (NS) pairs and 10 AK/NS pairs was quantified using the NanoString nCounter system. Biomarker testing models were built using logistic regression models with leave-one-out cross validation in the training set. The best model to classify AKs versus SCCs (area under curve (AUC) 0.814, precision score 0.833, recall 0.714) was constructed using a top-ranked set of 13 UV-biomarker genes. Another model based on a 15-gene panel was developed to differentiate histologically concerning from less concerning SCCs (AUC 1, precision score 1, recall 0.714). Finally, 12 of the UV-biomarker genes were differentially expressed between AKs and SCCs, while 10 genes were uniquely expressed in the more concerning SCCs. UV-biomarker gene subsets demonstrate dynamic utility as molecular tools to classify and risk stratify AK and SCC lesions, which will complement histopathologic diagnosis to guide treatment of high-risk patients.
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Trager MH, Geskin LJ, Samie FH, Liu L. Biomarkers in melanoma and non‐melanoma skin cancer prevention and risk stratification. Exp Dermatol 2020; 31:4-12. [DOI: 10.1111/exd.14114] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
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Fisher J, Zeitouni N, Fan W, Samie FH. Immune checkpoint inhibitor therapy in solid organ transplant recipients: A patient-centered systematic review. J Am Acad Dermatol 2020; 82:1490-1500. [DOI: 10.1016/j.jaad.2019.07.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023]
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Grimes JM, Shah NV, Samie FH, Carvajal RD, Marr BP. Conjunctival Melanoma: Current Treatments and Future Options. Am J Clin Dermatol 2020; 21:371-381. [PMID: 31965542 DOI: 10.1007/s40257-019-00500-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conjunctival melanoma is a rare tumor of the conjunctival epithelium with a heterogenous clinical presentation and a propensity for regional and distant metastatic spread. Guidelines for the treatment of local conjunctival melanoma are well-established, but there are no standard efficacious therapies for metastatic disease. Given that conjunctival melanoma is genetically similar to cutaneous melanoma and mucosal melanomas, targeted therapies effective in the treatment of these diseases, such as BRAF inhibitors and KIT inhibitors, may be effective in the treatment of patients with metastatic conjunctival melanoma. Other targeted small-molecule drugs in the drug development pipeline for the treatment of more prevalent melanomas could also be applicable to conjunctival melanoma. Furthermore, systemic immunotherapy treatments that are now a mainstay in the treatment of cutaneous melanoma, such as programmed cell death-1 and cytotoxic T lymphocyte-associated antigen-4 inhibitors, could also stand to benefit patients with metastatic conjunctival melanoma. Limited case reports provide clues about the effectiveness of both targeted small-molecule inhibitors and immunotherapy in patients with advanced local and metastatic conjunctival melanoma and give credence to the argument that conjunctival melanoma patients should be included in major trials studying new therapies in both cutaneous and mucosal melanomas where applicable.
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Trager MH, Ensslin CE, Fan W, Samie FH. Factors impacting patient ratings of Mohs micrographic surgeons: Lessons gleaned from analysis of 17,527 online reviews. J Am Acad Dermatol 2020; 83:1825-1827. [PMID: 32450101 DOI: 10.1016/j.jaad.2020.05.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/20/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
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Geskin LJ, Trager MH, Aasi SZ, Bickers DR, Carvajal RD, Nghiem P, Taback B, Zeitouni NC, Samie FH. Perspectives on the recommendations for skin cancer management during the COVID-19 pandemic. J Am Acad Dermatol 2020; 83:295-296. [PMID: 32387656 PMCID: PMC7202818 DOI: 10.1016/j.jaad.2020.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/04/2022]
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Trager MH, Queen D, Samie FH, Carvajal RD, Bickers DR, Geskin LJ. Advances in Prevention and Surveillance of Cutaneous Malignancies. Am J Med 2020; 133:417-423. [PMID: 31712100 PMCID: PMC7709483 DOI: 10.1016/j.amjmed.2019.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022]
Abstract
Skin cancer affects 1 in 5 Americans, resulting in significant morbidity and mortality. Treatment costs and rates of skin cancer and melanoma continue to rise, making preventative measures increasingly important. However, there is conflicting evidence about efficacy of primary and secondary prevention strategies in decreasing incidence and improving early diagnosis. The US Preventative Services Task Force 2016 guidelines did not endorse routine skin cancer screening because of "insufficient evidence." Yet, countries like Australia have shown the feasibility and cost-effectiveness of primary sun safety interventions and secondary prevention measures such as routine skin cancer surveillance. Additional emerging evidence shows that regular skin cancer screening in high-risk populations improves early detection and decreases melanoma mortality. New technology may enhance prevention, promote accurate diagnoses, and improve management of melanoma and nonmelanoma skin cancers. Here, we place rising rates of melanoma within historical context, review costs, efficacy, and evidence for primary and secondary skin cancer prevention and examine the evolving role of novel technologies in the field.
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McLawhorn JM, Stephany MP, Bruhn WE, Crow LD, Coldiron BM, Hruza GJ, Leach BC, Soon SL, Friedmann DP, Stebbins WG, Blalock TW, Graves MS, Billingsley EM, Knackstedt TJ, Miller SJ, Yob EH, Albertini JG, Zeitouni N, Krathen RA, Bichakjian CK, Jellinek NJ, Hanke CW, Samie FH, Mann MW, Carucci JA, Kakar R, Saylor DK, Fosko SW, Ortiz AE, Henghold WB, Jennings TA, Davis DS, Maloney ME, Curcio NM, Behshad R, Tope WD, McCoppin H, Levin JI, Collins L, Stasko T. An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures. J Am Acad Dermatol 2020; 82:700-708. [DOI: 10.1016/j.jaad.2019.09.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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Behbahani S, Malerba S, Karanfilian KM, Warren CJ, Alhatem A, Samie FH. Demographics and outcomes of eccrine porocarcinoma: results from the National Cancer Database. Br J Dermatol 2020; 183:161-163. [PMID: 31954060 DOI: 10.1111/bjd.18874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Owen JL, Kibbi N, Worley B, Kelm RC, Wang JV, Barker CA, Behshad R, Bichakjian CK, Bolotin D, Bordeaux JS, Bradshaw SH, Cartee TV, Chandra S, Cho NL, Choi JN, Council ML, Demirci H, Eisen DB, Esmaeli B, Golda N, Huang CC, Ibrahim SF, Jiang SB, Kim J, Kuzel TM, Lai SY, Lawrence N, Lee EH, Leitenberger JJ, Maher IA, Mann MW, Minkis K, Mittal BB, Nehal KS, Neuhaus IM, Ozog DM, Petersen B, Rotemberg V, Samant S, Samie FH, Servaes S, Shields CL, Shin TM, Sobanko JF, Somani AK, Stebbins WG, Thomas JR, Thomas VD, Tse DT, Waldman AH, Wong MK, Xu YG, Yu SS, Zeitouni NC, Ramsay T, Reynolds KA, Poon E, Alam M. Sebaceous carcinoma: evidence-based clinical practice guidelines. Lancet Oncol 2019; 20:e699-e714. [DOI: 10.1016/s1470-2045(19)30673-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
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Crow LD, Jambusaria‐Pahlajani A, Chung CL, Baran DA, Lowenstein SE, Abdelmalek M, Ahmed RL, Anadkat MJ, Arcasoy SM, Berg D, Bibee KP, Billingsley E, Black WH, Blalock TW, Bleicher M, Brennan DC, Brodland DG, Brown MR, Carroll BT, Carucci JA, Chang TW, Chaux G, Cusack CA, Dilling DF, Doyle A, Emtiazjoo AM, Ferguson NH, Fosko SW, Fox MC, Goral S, Gray AL, Griffin JR, Hachem RR, Hall SA, Hanlon AM, Hayes D, Hickey GW, Holtz J, Hopkins RS, Hu J, Huang CC, Brian Jiang SI, Kapnadak SG, Kraus ES, Lease ED, Leca N, Lee JC, Leitenberger JJ, Lim MA, Longo MI, Malik SM, Mallea JM, Menter A, Myers SA, Neuburg M, Nijhawan RI, Norman DJ, Otley CC, Paek SY, Parulekar AD, Patel MJ, Patel VA, Patton TJ, Pugliano‐Mauro M, Ranganna K, Ravichandran AK, Redenius R, Roll GR, Samie FH, Shin T, Singer JP, Singh P, Soon SL, Soriano T, Squires R, Stasko T, Stein JA, Taler SJ, Terrault NA, Thomas CP, Tokman S, Tomic R, Twigg AR, Wigger MA, Zeitouni NC, Arron ST. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 2019; 32:1268-1276. [DOI: 10.1111/tri.13520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/25/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
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Queen D, Fisher J, Husain S, Linos K, Niedt GW, Samie FH. Cutaneous metastasis of hepatocellular carcinoma following liver transplantation. J Cutan Pathol 2019; 47:47-51. [PMID: 31381162 DOI: 10.1111/cup.13555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/09/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Abstract
Cutaneous metastases from hepatocellular carcinoma (HCC) are extremely rare and can represent a sign of an underlying malignancy or relapse/progression from an existing tumor. We report a case of a cutaneous metastasis arising in a patient with metastatic HCC following orthotopic liver transplantation. Diagnosis is a multistep process as cutaneous HCC metastases must be differentiated from primary cutaneous malignancies as well as other cutaneous metastases. Making this even more challenging, HCC metastases have heterogeneous clinical and histologic appearances. Therefore, the use of immunohistochemical stains, including hepatocyte paraffin-1, arginase-1, and glypican-3, and correlation with the clinical context are essential for a correct diagnosis.
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Lopez AT, Fisher J, Samie FH. Fall risk assessment and injury prevention in the Mohs surgery clinic: a review of the literature and recommendations for improving patient safety. Dermatol Online J 2019; 25:13030/qt19h4m2kg. [PMID: 31553857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023] Open
Abstract
UNLABELLED Patient falls remain a major cause of adverse events in the medical setting. Many patients receiving Mohs micrographic surgery are at high risk, both for falling and resultant injuries. Although the incidence of patient falls in dermatologic surgery is low, falls can have significant consequences for both patient and provider. Therefore, effective interventions to improve organizational safety are critical. Though there is a considerable amount of research pertaining to fall prevention strategies, the majority of studies have been confined to the inpatient setting and long-term care facilities. Implementation of fall prevention initiatives in the outpatient setting has rarely been evaluated and no studies have focused on the Mohs patient population to date. METHODS We reviewed the literature pertaining to fall risk and prevention guidelines in the inpatient and outpatient settings as it applies to the dermatologic surgery environment. RESULTS Herein we will discuss patient risk factors for falling relevant to the Mohs setting and review existing validated fall risk assessment tools and strategies for fall prevention. CONCLUSION Identifying fall risk factors can improve patient safety and reduce falls in the dermatologic surgery clinic.
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Samie FH. JAAD Game Changers∗: Surgeon error and slide quality during Mohs micrographic surgery: Is there a relationship with tumor recurrence? J Am Acad Dermatol 2019; 85:538. [PMID: 31129221 DOI: 10.1016/j.jaad.2019.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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Samie FH. JAAD Game Changers∗: Acute toxicity and risk of infection during total skin electron beam therapy for mycosis fungoides. J Am Acad Dermatol 2019; 85:537. [PMID: 31129220 DOI: 10.1016/j.jaad.2019.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022]
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Lopez AT, Fisher J, Samie FH. Fall risk assessment and injury prevention in the Mohs surgery clinic: a review of the literature and recommendations for improving patient safety. Dermatol Online J 2019. [DOI: 10.5070/d3258045122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Queen D, Knackstedt T, Polacco MA, Collins LK, Lee K, Samie FH. Characteristics of non-melanoma skin cancers of the cutaneous perioral and vermilion lip treated by Mohs micrographic surgery. J Eur Acad Dermatol Venereol 2018; 33:305-311. [PMID: 30284728 DOI: 10.1111/jdv.15263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The lip and surrounding perioral region are susceptible to non-melanoma skin cancer, but the distribution of basal cell and squamous cell carcinoma on the cutaneous and vermilion lips has not been fully elucidated. OBJECTIVE To investigate the distribution of cutaneous and vermilion lip non-melanoma skin cancer and to better describe risk factors, anatomic location, treatment characteristics and oncologic outcomes. METHODS A retrospective comparative case series of patients undergoing Mohs micrographic surgery (MMS) at a single academic centre for lip and perioral basal cell and squamous cell carcinoma was performed over a 5-year period. Demographics, medical comorbidities, surgical characteristics and recurrence status were extracted. RESULTS Forty-five vermilion and 116 cutaneous lip cancers were identified. Basal cell carcinoma (BCC) was more common in the cutaneous perioral region, while squamous cell carcinoma (SCC) was more common on the vermilion lip (P < 0.001). BCCs were more common on the upper vermilion lip and SCCs were more common on the lower vermilion lip (P < 0.001). Within the cutaneous perioral region, both BCCs and SCCs were more common on the upper perioral surface (P = 0.002). Male gender was associated with lower lip SCC (P = 0.015). Smoking, immunosuppression, anticoagulant use and hydrochlorothiazide use were not associated with cancer type or location. Recurrences were rare, but more common in vermilion lip cancers (6.6%) compared to perioral cutaneous cancers (0.8%). Outcomes for all groups were similar; BCCs of the vermilion lip had significantly greater mean MMS stages (P < 0.001) as did SCCs (P = 0.05). CONCLUSION Basal cell carcinoma is more commonly encountered on the cutaneous lip, whereas SCC is more common on the vermilion lip. Within the vermilion lip, BCC favours the upper lip, while SCC favours the lower lip. Within the cutaneous perioral region, both BCC and SCC favour the upper cutaneous tissue. Early stage lip cancers are curable by Mohs micrographic surgery with rare recurrences.
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Filitis DC, Fisher J, Samie FH. Reconstruction of a surgical defect in the popliteal fossa: A case report. Int J Surg Case Rep 2018; 53:228-230. [PMID: 30428437 PMCID: PMC6232581 DOI: 10.1016/j.ijscr.2018.10.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
Popliteal tumors and their associated defects present the dermatologic surgeon with rare and unique surgical and reconstruction challenges. When planning reconstruction in the popliteal fossa, prolonged wound care and functional impairment are concerns. In such an area with little tissue laxity, a random patterned bilobed with an undersized secondary lobe is an excellent solution to this challenge.
Introduction Surgical defects of the popliteal fossa pose a reconstructive challenge to the surgeon, given the intimate relationship of this area with the knee joint and underlying vital neuro-vasculature. Case presentation An 88-year-old woman was treated for a biopsy proven invasive squamous cell carcinoma of the right popliteal fossa with Mohs micrographic surgery. The resultant defect (4.5 × 4.3 cm) was repaired using a random patterned bilobed flap with an undersized secondary lobe and porcine xenograft with excellent functional and cosmetic outcome. Discussion Numerous approaches to reconstruction of the popliteal fossa have been proposed, including primary closure, secondary intent healing, skin grafting, random flaps, muscle flaps, fasciocutaneous flaps, freeflaps, and tissue expansion. Sub-optimal repair of the popliteal fossa can reduce mobility of the knee joint, carry a high risk of wound dehiscence and may result in significant scarring. Here, we present the use of a bilobed flap with an undersized secondary lobe, in a patient with limited tissue laxity, for the repair of the popliteal fossa. Conclusion Utilizing a random pattern bilobed flap with an undersized secondary lobe is an excellent alternative for the repair of moderate sized popliteal fossa defects.
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Bayan CAY, Khanna T, Rotemberg V, Samie FH, Zeitouni NC. A review of non-invasive imaging in extramammary Paget's disease. J Eur Acad Dermatol Venereol 2018; 32:1862-1873. [PMID: 29763511 DOI: 10.1111/jdv.15072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/30/2018] [Indexed: 01/04/2023]
Abstract
Extramammary Paget's Disease (EMPD) is a rare intraepithelial adenocarcinoma that classically manifests with pruritic, erythematous and scaling plaques. The clinical picture frequently mimics inflammatory or infectious conditions and is thus commonly misdiagnosed. The assessment of tumour margins is equally challenging as tumours have a propensity to spread beyond clinically visible boundaries. Appropriate non-invasive diagnostic tools can assist in the early detection, diagnosis and management of EMPD. This paper will review the literature on non-invasive imaging modalities used in EMPD. Articles from the PubMed database were selected based on relevance to the topic of this review. Articles that were not specific to EMPD and non-invasive imaging were excluded. Search strategy is further described in the methods section below. Eighteen articles were selected for this review: six PET/CT, five reflectance confocal microscopy (RCM), two photodynamic diagnosis (PDD), two dermoscopy, two MRI and one optical coherence tomography (OCT) paper(s). Dermoscopy, PDD, RCM and OCT can help to distinguish malignant conditions, including EMPD, from benign conditions. RCM and OCT can identify atypical cells in real-time, and have the potential to improve the accuracy of surgical margins intraoperatively and overall management. Distinctive confocal characteristics of EMPD have been described using RCM. The sensitivity and specificity of these findings require additional validation. Radiographic techniques also play a central role in the diagnosis of EMPD and assessment of disease spread. PET/CT and MRI can detect primary disease, nodal and distant metastases, with superior delineation of disease spread on MRI. Limitations of PET/CT are mainly related to primary tumour thickness, and size and FDG-avidity of nodal and distant metastases. Limitations of MRI include the fact that few studies have examined its use in EMPD; additional research is warranted. Randomized controlled trials and large prospective studies evaluating the use of non-invasive imaging in EMPD are needed.
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Fontecilla NM, Kittler NW, Geskin L, Samie FH, Niedt G, Imahiyerobo T, Schwartz G, Ingham M, Lewin JM. Recurrent dermatofibrosarcoma protuberans treated with neoadjuvant imatinib mesylate followed by Mohs micrographic surgery. JAAD Case Rep 2017; 3:467-469. [PMID: 28971134 PMCID: PMC5614636 DOI: 10.1016/j.jdcr.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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