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Zhang Y, Ostrowski SM, Fisher DE. Nevi and Melanoma. Hematol Oncol Clin North Am 2024:S0889-8588(24)00054-6. [PMID: 38880666 DOI: 10.1016/j.hoc.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Cutaneous melanoma is an aggressive form of skin cancer derived from skin melanocytes and is associated with significant morbidity and mortality. A significant fraction of melanomas are associated with precursor lesions, benign clonal proliferations of melanocytes called nevi. Nevi can be either congenital or acquired later in life. Identical oncogenic driver mutations are found in benign nevi and melanoma. While much progress has been made in our understanding of nevus formation and the molecular steps required for transformation of nevi into melanoma, the clinical diagnosis of benign versus malignant lesions remains challenging.
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Affiliation(s)
- Yifan Zhang
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen M Ostrowski
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David E Fisher
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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2
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Barnhill RL, Elder DE, Piepkorn MW, Knezevich SR, Reisch LM, Eguchi MM, Bastian BC, Blokx W, Bosenberg M, Busam KJ, Carr R, Cochran A, Cook MG, Duncan LM, Elenitsas R, de la Fouchardière A, Gerami P, Johansson I, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Messina J, Mihic-Probst D, Parker DC, Schmidt B, Shea CR, Scolyer RA, Tetzlaff M, Xu X, Yeh I, Zembowicz A, Elmore JG. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement. JAMA Netw Open 2023; 6:e2250613. [PMID: 36630138 PMCID: PMC10375511 DOI: 10.1001/jamanetworkopen.2022.50613] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE The implementation of the newly revised MPATH-Dx version 2.0 schema into clinical practice is anticipated to provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients.
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Affiliation(s)
- Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris, Paris, France
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle
- Dermatopathology Northwest, Bellevue, Washington
| | | | - Lisa M Reisch
- Department of Biostatistics, University of Washington School of Medicine, Seattle
| | - Megan M Eguchi
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Boris C Bastian
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus Bosenberg
- Departments of Dermatology, Pathology, and Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Carr
- Cellular Pathology, South Warwickshire NHS Trust, Warwick, United Kingdom
| | - Alistair Cochran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Martin G Cook
- Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Arnaud de la Fouchardière
- Department of Biopathology, Centre Léon Bérard, Lyon, France
- University of Lyon, Université Claude Bernard Lyon 1, National Center for Scientific Research, Mixed Research Unit 5286, National Institute of Health and Medical Research U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Iva Johansson
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher R Shea
- Department of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Richard A Scolyer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Michael Tetzlaff
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Iwei Yeh
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Artur Zembowicz
- Tufts University, Boston, Massachusetts
- Lahey Clinic, Burlington, Massachusetts
- Dermatopathology Consultations, Needham, Massachusetts
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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A Single-Institution Cohort Study With Nevi of Special Site: Recurrence, Progression to Melanoma, and Patterns of Management. Am J Dermatopathol 2023; 45:28-39. [PMID: 36484604 DOI: 10.1097/dad.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Nevi of specialized sites (NOSS) occur on the scalp, ears, flexural, acral, and genital areas and display atypical clinical and histologic features. We assessed NOSS recurrence and progression to melanoma, management patterns, and associations between histologic features and treatment recommendations. We queried all histologic diagnoses of NOSS (n = 275) from 2012 to 2017 from a large U.S. academic medical center with reference dermatopathology laboratory and matched these to clinical records. A blinded panel of dermatopathologists re-evaluated lesions, catalogued histologic findings, and gave management recommendation. Associations with dermatopathologist decision and concordance between new and original recommendations were assessed. Of 117 cases with follow-up, 2 locally recurred (1.46%) and none eventuated in melanoma. Clinical features were not associated with original treatment recommendations. After histopathologic review, large melanocytes [odds ratio ratio (ORR) = 8.00, 95% CI, 1.35-47.4] and junctional mitotic figures (ORR = 65.0, 6.5-650) predicted excision recommendation. Likewise, accumulation of many (>9) high-risk features was associated with excision recommendation. Panel review changed treatment recommendation in 27% of cases. Fair concordance existed between original and panel recommendations (κ = 0.29, 0.15-0.44). The low rate of recurrence and lack of melanoma occurrence suggest that despite an atypical clinical and histopathologic appearance, these nevi have limited potential for malignant transformation. Histopathologic findings seem to be principal drivers behind the recommendation for excision in this analysis. Variability existed in treatment recommendations; the panel's consensus recommendation tended to downgrade treatment. This highlights the importance of further outcomes-based studies to identify true high-risk features and refine management guidelines.
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Spaccarelli N, Drozdowski R, Peters MS, Grant-Kels JM. Dysplastic nevus part II: Dysplastic nevi: Molecular/genetic profiles and management. J Am Acad Dermatol 2023; 88:13-20. [PMID: 36252690 DOI: 10.1016/j.jaad.2022.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
Abstract
Dermatologists frequently see patients with clinically atypical nevi and dermatopathologists interpret histologically dysplastic nevi on a near-daily basis, but there is great variability in the definition and management of such lesions. This part of the CME review focuses on information published since the previous comprehensive review (2012), with emphasis on molecular and genetic attributes of histologically dysplastic nevi and clinical management.
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Affiliation(s)
- Natalie Spaccarelli
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columubs, Ohio
| | - Roman Drozdowski
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Margot S Peters
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jane M Grant-Kels
- Departments of Dermatology, Pathology and Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida.
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Fractal Dimension Analysis of Melanocytic Nevi and Melanomas in Normal and Polarized Light-A Preliminary Report. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071008. [PMID: 35888097 PMCID: PMC9318244 DOI: 10.3390/life12071008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022]
Abstract
Clinical diagnosis of pigmented lesions can be a challenge in everyday practice. Benign and dysplastic nevi and melanomas may have similar clinical presentations, but completely different prognoses. Fractal dimensions of shape and texture can describe the complexity of the pigmented lesion structure. This study aims to apply fractal dimension analysis to differentiate melanomas, dysplastic nevi, and benign nevi in polarized and non-polarized light. A total of 87 Eighty-four patients with 97 lesions were included in this study. All examined lesions were photographed under polarized and non-polarized light, surgically removed, and examined by a histopathologist to establish the correct diagnosis. The obtained images were then processed and analyzed. Area, perimeter, and fractal dimensions of shape and texture were calculated for all the lesions under polarized and non-polarized light. The fractal dimension of shape in polarized light enables differentiating melanomas, dysplastic nevi, and benign nevi. It also makes it possible to distinguish melanomas from benign and dysplastic nevi under non-polarized light. The fractal dimension of texture allows distinguishing melanomas from benign and dysplastic nevi under polarized light. All examined parameters of shape and texture can be used for developing an automatic computer-aided diagnosis system. Polarized light is superior to non-polarized light for imaging texture details.
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Fomina LV, Aslanyan SA, Gumeniuk KV, Fomin OO, Trutyak I. PERFECT BIOPSY METHODS FOR THE DIAGNOSIS OF MALIGNANT MELANOCYTIC SKIN NEOPLASMS (A LITERATURE REVIEW). BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-4-167-92-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | | | | | - O. O. Fomin
- National Pirogov Memorial Medical University
| | - I.R. Trutyak
- Danylo Halytsky Lviv National Medical University
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Iacullo J, Barriera-Silvestrini P, Knackstedt TJ. Dermatologic Follow-up and Assessment of Suspicious Lesions. Clin Plast Surg 2021; 48:617-629. [PMID: 34503722 DOI: 10.1016/j.cps.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As our knowledge and understanding of melanoma evolve, melanoma surveillance guidelines will reflect these findings. Currently, there is no consensus across international guidelines for melanoma follow-up. However, it is accepted that more aggressive surveillance is recommended for more advanced disease. When examining high-risk individuals, a systematic approach should be followed. Future considerations include the use of noninvasive imaging techniques, 'liquid biopsies,' and artificial intelligence to enhance detection of melanomas.
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Affiliation(s)
- Julie Iacullo
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | | | - Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA; Case Western Reserve University, School of Medicine, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
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8
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McDonald L, Clarke C, O’Neill V, Houghton J, Dolan O, McCourt C. Incidence of cutaneous melanoma in patients with histologically confirmed dysplastic naevus: A follow‐up study in a large UK Healthcare Trust. SKIN HEALTH AND DISEASE 2021; 1:e44. [PMID: 35663136 PMCID: PMC9060082 DOI: 10.1002/ski2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- L. McDonald
- Department of Dermatology Royal Victoria Hospital Belfast Health and Social Care Trust Belfast UK
| | - C. Clarke
- Department of Histopathology Royal Victoria Hospital Belfast Health and Social Care Trust Belfast UK
| | - V. O’Neill
- School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - J. Houghton
- Department of Histopathology Royal Victoria Hospital Belfast Health and Social Care Trust Belfast UK
- School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - O. Dolan
- Department of Dermatology Royal Victoria Hospital Belfast Health and Social Care Trust Belfast UK
| | - C. McCourt
- Department of Dermatology Royal Victoria Hospital Belfast Health and Social Care Trust Belfast UK
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9
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Ma Y, Xia R, Ma X, Judson-Torres RL, Zeng H. Mucosal Melanoma: Pathological Evolution, Pathway Dependency and Targeted Therapy. Front Oncol 2021; 11:702287. [PMID: 34350118 PMCID: PMC8327265 DOI: 10.3389/fonc.2021.702287] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 12/16/2022] Open
Abstract
Mucosal melanoma (MM) is a rare melanoma subtype that originates from melanocytes within sun-protected mucous membranes. Compared with cutaneous melanoma (CM), MM has worse prognosis and lacks effective treatment options. Moreover, the endogenous or exogenous risk factors that influence mucosal melanocyte transformation, as well as the identity of MM precursor lesions, are ambiguous. Consequently, there remains a lack of molecular markers that can be used for early diagnosis, and therefore better management, of MM. In this review, we first summarize the main functions of mucosal melanocytes. Then, using oral mucosal melanoma (OMM) as a model, we discuss the distinct pathologic stages from benign mucosal melanocytes to metastatic MM, mapping the possible evolutionary trajectories that correspond to MM initiation and progression. We highlight key areas of ambiguity during the genetic evolution of MM from its benign lesions, and the resolution of which could aid in the discovery of new biomarkers for MM detection and diagnosis. We outline the key pathways that are altered in MM, including the MAPK pathway, the PI3K/AKT pathway, cell cycle regulation, telomere maintenance, and the RNA maturation process, and discuss targeted therapy strategies for MM currently in use or under investigation.
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Affiliation(s)
- Yanni Ma
- Department of Oncology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Precision Medicine, Shanghai, China
| | - Ronghui Xia
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuhui Ma
- Department of Oral & Maxillofacial - Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Robert L Judson-Torres
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States.,Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Hanlin Zeng
- Department of Oncology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Institute of Precision Medicine, Shanghai, China
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10
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Helm TN, Helm MF, Helm KF. Melanoma arising in a persistent nevus: Melanoma where 'pseudomelanoma' is expected. JAAD Case Rep 2021; 12:5-7. [PMID: 33997217 PMCID: PMC8102720 DOI: 10.1016/j.jdcr.2021.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Matthew F Helm
- Department of Dermatology, Hershey Medical Center, Hershey, Pennsylvania
| | - Klaus F Helm
- Department of Dermatology, Hershey Medical Center, Hershey, Pennsylvania
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Ji‐Xu A, Dinnes J, Matin R. Total body photography for the diagnosis of cutaneous melanoma in adults: a systematic review and meta‐analysis*. Br J Dermatol 2021; 185:302-312. [DOI: 10.1111/bjd.19759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 01/10/2023]
Affiliation(s)
- A. Ji‐Xu
- Department of Dermatology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - J. Dinnes
- Test Evaluation Research Group Institute of Applied Health Research University of Birmingham Birmingham UK
- NIHR Birmingham Biomedical Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham Birmingham UK
| | - R.N. Matin
- Department of Dermatology Oxford University Hospitals NHS Foundation Trust Oxford UK
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12
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Zhang H, Wang Y, Zheng Q, Tang K, Fang R, Wang Y, Sun Q. Research Interest and Public Interest in Melanoma: A Bibliometric and Google Trends Analysis. Front Oncol 2021; 11:629687. [PMID: 33680968 PMCID: PMC7930473 DOI: 10.3389/fonc.2021.629687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Melanoma is a severe skin cancer that metastasizes quickly. Bibliometric analysis can quantify hotspots of research interest. Google Trends can provide information to address public concerns. METHODS The top 15 most frequently cited articles on melanoma each year from 2015 to 2019, according to annual citations, were retrieved from the Web of Science database. Original articles, reviews, and research letters were included in this research. For the Google Trends analysis, the topic "Melanoma" was selected as the keyword. Online search data from 2004 to 2019 were collected. Four countries (New Zealand, Australia, the United States and the United Kingdom) were selected for seasonal analysis. Annual trends in relative search volume and seasonal variation were analyzed, and the top related topics and rising related topics were also selected and analyzed. RESULTS The top 15 most frequently cited articles each year were all original articles that focused on immunotherapy (n=8), omics (n=5), and the microbiome (n=2). The average relative search volume remained relatively stable across the years. The seasonal variation analysis revealed that the peak appeared in summer, and the valley appeared in winter. The diseases associated with or manifestations of melanoma, treatment options, risk factors, diagnostic tools, and prognosis were the topics in which the public was most interested. Most of the topics revealed by bibliometric and Google Trends analyses were consistent, with the exception of issues related to the molecular biology of melanoma. CONCLUSION This study revealed the trends in research interest and public interest in melanoma, which may pave the way for further research.
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FR-Nevus con displasia moderada extirpados con márgenes quirúrgicos afectados. ¿Se deben reextirpar? ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:688-689. [DOI: 10.1016/j.ad.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/01/2019] [Indexed: 11/22/2022] Open
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Morgado-Carrasco D, Feola H, Fustà-Novell X, Martinez N. RF-Nevi With Moderate Dysplasia Excised With Positive Surgical Margins: Should We Re-Excise? ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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E Lang U. Primary cilia: putting a sensor on the underlying melanocytic tumor cell state. Melanoma Manag 2020; 7:MMT40. [PMID: 32821372 PMCID: PMC7426744 DOI: 10.2217/mmt-2020-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ursula E Lang
- Department of Pathology, Dermatopathology Service, University of California - San Francisco, San Francisco, CA 94115, USA.,Department of Pathology, Zuckerberg San Francisco General Hospital - San Francisco, San Francisco, CA 94110, USA
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Affiliation(s)
- Philip E LeBoit
- Departments of Pathology and Dermatology, and the Helen Diller Cancer Center, University of California, San Francisco
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17
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Flint ND, Bishop MD, Smart TC, Strunck JL, Boucher KM, Grossman D, Secrest AM. Low accuracy of self-reported family history of melanoma in high-risk patients. Fam Cancer 2020; 20:41-48. [PMID: 32436000 DOI: 10.1007/s10689-020-00187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Family history of melanoma is a major melanoma risk factor. However, self-reported family histories for some cancers, including melanoma, are commonly inaccurate. We used a unique database, the Utah Population Database (UPDB), as well as the Utah Cancer Registry to determine the accuracy of self-reported family history of melanoma in a large cohort of high-risk patients. Patient charts were reviewed and compared to records in the UPDB and the UCR to confirm personal and family history of melanoma in 1780 patients enrolled in a total body photography monitoring program. Self-reported family history of melanoma in first-degree relatives had an overall sensitivity of 71%, specificity of 79%, PPV of 31%, and NPV of 95%, with decreased accuracy (PPV) for second-degree relatives. A personal history of melanoma was the only factor significantly associated with accuracy in self-reported family history of melanoma. Patient age, sex, estimated nevus count, and number of prior personal melanomas were not significant predictors. Dermatologists should educate patients on the differences between melanomas, keratinocyte carcinomas, and pre-cancers. Confirming self-reported family history of melanoma may improve risk assessment for patients undergoing screening.
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Affiliation(s)
| | | | - Tristan C Smart
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA.
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Predictive Value of Positive Margins in Diagnostic Biopsies of Dysplastic Nevi. Dermatol Res Pract 2020; 2020:6716145. [PMID: 32180806 PMCID: PMC7066399 DOI: 10.1155/2020/6716145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 11/17/2022] Open
Abstract
Dysplastic nevi (DN) are common and controversial and the best choice for management of DN after diagnosis is not always clear. The presence of positive margins found on diagnostic biopsy is used by many dermatologists when deciding whether to re-excise these lesions. In order to quantify the predictive value of positive margins in diagnostic biopsies of DN, we performed a review and analysis of the concordance between the histological findings of biopsies and their subsequent excisions. A total of 122 pathology reports from diagnostic biopsies of DN with nevus cells present at the tissue margin were reviewed. Within this sample, 68 total postbiopsy excisions had been performed. The excisional pathology reports were reviewed for the presence of residual or recurrent nevus cells. Residual nevus cells were reported in 29 of 63 available excisional pathology reports illustrating a positive predictive value (PPV) of positive margins in diagnostic biopsies of DN of 46.0%. We present this value along with PPVs from the very few existing similar studies. The quantified predictive value of positive margins in diagnostic biopsies is useful information for providers who must make decisions regarding the best treatment options for patients with DN. The low PPV of positive margins lends further evidence that DN of moderate severity or less may simply be monitored.
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Adequacy of conservative 2- to 3-mm surgical margins for complete excision of biopsy-proven severely dysplastic nevi: Retrospective case series at a tertiary academic institution. J Am Acad Dermatol 2020; 83:254-255. [PMID: 31972255 DOI: 10.1016/j.jaad.2019.12.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/11/2019] [Accepted: 12/28/2019] [Indexed: 11/20/2022]
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20
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Fleming NH, Shaub AR, Bailey E, Swetter SM. Outcomes of surgical re-excision versus observation of severely dysplastic nevi: A single-institution, retrospective cohort study. J Am Acad Dermatol 2020; 82:238-240. [DOI: 10.1016/j.jaad.2019.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022]
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21
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Pournamdari AB, Tkachenko E, Barbieri J, Adamson AS, Mostaghimi A. A State-of-the-Art Review Highlighting Medical Overuse in Dermatology, 2017-2018. JAMA Dermatol 2019; 155:1410-1415. [DOI: 10.1001/jamadermatol.2019.3064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ashley B. Pournamdari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Medicine, University of California, San Francisco
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Adewole S. Adamson
- Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Rodriguez‐Diaz E, Manolakos D, Christman H, Bonning MA, Geisse JK, A'Amar OM, Leffell DJ, Bigio IJ. Optical Spectroscopy as a Method for Skin Cancer Risk Assessment. Photochem Photobiol 2019; 95:1441-1445. [DOI: 10.1111/php.13140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Holly Christman
- Department of Dermatology University of California, San Francisco San Francisco CA
- DermaSensor, Inc. Miami FL
| | - Michael A. Bonning
- DermaSensor, Inc. Miami FL
- Department of Health Systems and Populations Macquarie University Sydney NSW Australia
| | - John K. Geisse
- Department of Dermatology University of California, San Francisco San Francisco CA
- Department of Pathology University of California, San Francisco San Francisco CA
| | - Ousama M. A'Amar
- Department of Biomedical Engineering Boston University Boston MA
| | | | - Irving J. Bigio
- Department of Biomedical Engineering Boston University Boston MA
- Departments of Electrical & Computer Engineering, Physics, Medicine Boston University Boston MA
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23
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Duncan JR, Purnell JC, Stratton MS, Pavlidakey PG, Huang C, Phillips CB. Negative predictive value of biopsy margins of dysplastic nevi: A single-institution retrospective review. J Am Acad Dermatol 2019; 82:87-93. [PMID: 31326466 DOI: 10.1016/j.jaad.2019.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biopsies of dysplastic nevi processed by bread-loafing allow for limited margin assessment; however, reported biopsy margins often influence management. OBJECTIVE To evaluate the negative predictive value of biopsy margins of dysplastic nevi. METHODS A retrospective search of a single academic institution's pathology database was conducted to identify all biopsy specimens of dysplastic nevi between January 1, 2015, and December 31, 2017. Biopsy specimen margin assessments were compared with excision pathology reports to calculate negative predictive value and to assess the frequency of residual nevus on excision after positive biopsy margins. RESULTS A total of 1245 dysplastic nevi from 934 patients were identified. Clear biopsy margins had a negative predictive value for the absence of residual nevus on excision of 87.3% for dysplastic nevi of moderate atypia or greater. Residual nevus was identified on excision in 29.41% of cases of dysplastic nevi of moderate atypia or greater when initial biopsy margins were positive. LIMITATIONS This was a retrospective, single-institution study. The calculations likely overestimate the true negative predictive value of biopsy margins because of processing of excision specimens by bread-loafing. CONCLUSIONS This study provides additional evidence that reported biopsy margins are not representative of true margin status.
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Affiliation(s)
- James Robert Duncan
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama.
| | - Joseph Chase Purnell
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | | | - Peter G Pavlidakey
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | - Conway Huang
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
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24
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Varedi A, Bishop MD, Boucher KM, Kim CC, Grossman D. Powering a prospective melanoma chemoprevention trial in high-risk cohorts. Int J Dermatol 2019; 58:e232-e234. [PMID: 31206619 DOI: 10.1111/ijd.14538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/18/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Amir Varedi
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael D Bishop
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Oncological Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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25
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Affiliation(s)
- Kanade Shinkai
- Department of Dermatology, University of California–San Francisco, San Francisco
- Editor, JAMA Dermatology
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26
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Helm TN, Chung CG, Helm KF. Note to dermatopathologists: When it comes to moderately atypical nevi, leave the treatment plan to clinicians. J Am Acad Dermatol 2019; 80:e169. [PMID: 30654073 DOI: 10.1016/j.jaad.2018.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas N Helm
- Department of Dermatology, Buffalo Medical Group, Buffalo, New York.
| | - Catherine G Chung
- Department of Dermatology, Wexner Medical Center, The Ohio State University, Columbus, Ohio; Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Klaus F Helm
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania; Department of Pathology, Penn State Hershey Medical Center, Hershey, Pennsylvania
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