1
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Kassotis AS, Grimes J, Samie FH, Lewin JM, Levenson JA, Glass LRD. Risk factors for developing depressive symptoms in the immediate postoperative period after Mohs micrographic surgery. Orbit 2024; 43:22-27. [PMID: 36847522 DOI: 10.1080/01676830.2023.2179639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a highly efficacious, tissue sparing method of skin cancer removal. Nevertheless, in the months to years after MMS, psychosocial distress has been described. The present study addressed the immediate period after MMS and assessed the frequency and risk factors for development of depressive symptoms. METHODS Subjects undergoing MMS at two physician practices (JL, FS) were included in this prospective cohort study. Preoperatively, a standardized depression screening, the Patient Health Questionnaire-8 (PHQ-8), was administered. After MMS, the PHQ-8 was readministered at weeks 1, 2, 4, 6, and 12. Average PHQ-8 score by week and change from baseline PHQ-8 score were the primary outcomes. RESULTS Sixty-three subjects were included of which 49 (78%) had a facial site. Twenty-two subjects (35%) had some increase in score during the 12-week follow-up period, of which 18 had a facial site. The oldest subjects (83-99 years, n = 14) had significantly higher PHQ-8 scores at week 4 (p < 0.01) and week 6 (p = 0.02) than all other age groups. There were no differences in scores between location groups. CONCLUSIONS One-third of subjects had some increase in score during the follow-up period. Those in the oldest age cohort were at highest risk of increased score. In contrast to prior literature, those with facial sites were not at higher risk. This difference may be explained by increased masking during the ongoing COVID-19 pandemic. Ultimately, consideration of patients' psychologic status in the immediate postoperative period after MMS, particularly in the elderly population, may enhance perceived patient outcomes.
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Affiliation(s)
- Alexis S Kassotis
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Grimes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Ichan School of Medicine at Mt. Sinai, New York, NY, USA
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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2
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Talebi-Liasi F, Lewin JM. A Cross-Sectional Analysis of Sharps Injuries Among Dermatologic Surgeons: A Survey of American College of Mohs Surgery Members. Dermatol Surg 2023; 49:985-988. [PMID: 37643220 DOI: 10.1097/dss.0000000000003907] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND There is a paucity of data on sharps injuries and bloodborne pathogen exposure among Dermatologic Surgeons. OBJECTIVE Quantify occupational risks from sharps injuries among Mohs surgeons. Determine rate of injury, reporting, and confidence in staff's sharps handling. METHODS A cross-sectional analysis performed using survey responses from Mohs surgeons with membership in the American College of Mohs Surgery (ACMS). RESULTS A total of 60 ACMS members completed the survey. Overall, 56.7% reported at least 1 sharps injury within the past year, of which 14.7% resulted in a bloodborne exposure (odds of exposure: 7.5% per year). The most common type of injury was self-inflicted suture needlestick (76.5%). Forty-four-point-one percent did not report their injuries. Ninety-five percent reported access to postexposure prophylaxis at their workplace. In addition, respondents in academic and single-specialty practices were more likely to report high or moderate confidence in staff sharps handling knowledge and in injury reporting compared with respondents from multispecialty and solo practices (88% vs 54% p = .02, 76%-81% vs 27% p = .0004, respectively). CONCLUSION Sharps injuries and under-reporting of these injuries are common among Mohs surgeons. Despite reporting of higher confidence in staff knowledge and training in academic and single-specialty practices, there was no correlation with surgeon's rate of injury.
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Affiliation(s)
- Faezeh Talebi-Liasi
- All authors are affiliated with The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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3
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Shah A, Chennareddy S, Sharma S, Sanghvi J, Tassavor B, Lewin JM. Surgical and non-surgical treatment modalities for lymphangioma circumscriptum. Dermatol Online J 2022; 28. [DOI: 10.5070/d328458536] [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] [Received: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
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4
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Affiliation(s)
- Neha Kinariwalla
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Correspondence to: Neha Kinariwalla, MPhil, Columbia University Vagelos College of Physicians and Surgeons, 161 Fort Washington Avenue, Herbert Irving Pavilion, 12th Floor, New York, NY 10032.
| | - Meera Tarazi
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jesse M. Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Syed A. Husain
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stephanie M. Gallitano
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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5
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Ensslin CJ, Samie FH, Lewin JM. Repair of a Full-Thickness Defect of the Nasal Root and Sidewall. Dermatol Surg 2021; 47:1651-1653. [PMID: 33038104 DOI: 10.1097/dss.0000000000002821] [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: 11/25/2022]
Affiliation(s)
- Courtney J Ensslin
- All authors are affiliated with the Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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]
Affiliation(s)
- Mark A Strom
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Megan H Trager
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Dmitriy Timerman
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Alexandra J Coromilas
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Katy Burris
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Ariel Eber
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sophie Greenberg
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Fludiona Naka
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Christina C Patrone
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Aaron Coulon
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Chelsea Cooper
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | | | - Melissa Beck
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Margaret L Dowd
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Courtney Ensslin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Eric Loesch
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Dana M Malajian
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Laura Melnick
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Laura N Uwakwe
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Ha Linh Vu
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Robert R Walther
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York.
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Dawn Queen
- Department of Medicine, Lankenau Medical Center, Philadelphia, PA, USA
| | - Yao Shen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Megan H Trager
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Adriana T Lopez
- Department of Dermatology, New York University, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - George W Niedt
- Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Liang Liu
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.,The Hormel Institute, University of Minnesota, Austin, MN, USA
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8
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Timerman D, Antonov NK, Dana A, Gallitano SM, Lewin JM. Facial lesion triangulation using anatomic landmarks and augmented reality. J Am Acad Dermatol 2020; 83:1481-1483. [PMID: 32222445 DOI: 10.1016/j.jaad.2020.03.040] [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] [Received: 11/27/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Dmitriy Timerman
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York.
| | - Nina K Antonov
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Ali Dana
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Gallitano
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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9
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Abbott-Frey AM, Coromilas AJ, Niedt GW, Lewin JM. Recurrent Squamous Cell Carcinoma Arising Within a Linear Porokeratosis. J Drugs Dermatol 2020; 19:205-206. [PMID: 32155019 DOI: 10.36849/jdd.2020.4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Here we report a case of linear porokeratosis with recurrent malignant degeneration to squamous cell carcinoma (SCC) recurring six years after excision of initial SCC. A 79-year-old woman presented with a friable tumor located within a longstanding lesion on her posterior thigh. Six years prior, she was diagnosed with SCC arising within the same lesion, which had been surgically excised with negative margins. Physical examination revealed a 3.5 x 2.7 cm friable tumor on the left proximal posterior thigh. The tumor was located within a hyperpigmented and erythematous scaly linear plaque within a line of Blaschko, extending from the left buttock to the left distal posterior thigh. Two 4 mm punch biopsies were performed: one of the erythematous plaque on the left buttock and one from the friable tumor on the left posteromedial thigh. Histology from the left buttock revealed a cornoid lamella consistent with porokeratosis and the left posteromedial thigh revealed SCC. The patient underwent Mohs micrographic surgery with negative margins, followed by a linear repair. Porokeratosis is a disorder of epidermal keratinization that has been associated with malignant degeneration, although such cases are rare. The risk of recurrence of SCC arising within a porokeratosis is unknown. This case emphasizes the importance of ongoing monitoring for malignant degeneration within these lesions.
J Drugs Dermatol. 2020;19(2)205-206. doi:10.36849/JDD.2020.4640
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10
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Queen D, Richards LE, Bordone L, Bickers DR, Husain S, Lewin JM. Multiple keratoacanthomas arising within red tattoo pigment. Cutis 2019; 104:E15-E17. [PMID: 31774898 PMCID: PMC7726741] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Dawn Queen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Lindsey Bordone
- Department of Dermatology, Columbia University Irving Medical Center, USA
| | - David R Bickers
- Department of Dermatology, Columbia University Irving Medical Center, USA
| | - Sameera Husain
- Department of Dermatology, Columbia University Irving Medical Center, USA
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Irving Medical Center, USA
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11
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Richards LE, Samie F, Troob S, Lewin JM. The use of a tympanoplasty blade for tumor extirpation of the auricle. J Am Acad Dermatol 2018; 80:e121-e122. [PMID: 29969698 DOI: 10.1016/j.jaad.2018.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Lindsey E Richards
- Columbia University Irving Medical Center, Dermatology, New York, New York
| | - Faramarz Samie
- Columbia University Irving Medical Center, Dermatology, New York, New York
| | - Scott Troob
- Columbia University Irving Medical Center, Dermatology, New York, New York
| | - Jesse M Lewin
- Columbia University Irving Medical Center, Dermatology, New York, New York.
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12
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Khanna T, Yang CC, Yamany T, Silvers DN, Lauren CT, Lewin JM. Atypical Still disease with necrotic keratinocytes: A histologic mimicker of erythema multiforme. JAAD Case Rep 2018; 4:301-304. [PMID: 29693054 PMCID: PMC5911978 DOI: 10.1016/j.jdcr.2017.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Trisha Khanna
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christine C Yang
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Tarek Yamany
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - David N Silvers
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Christine T Lauren
- Department of Dermatology, Columbia University Medical Center, New York, New York.,Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Medical Center, New York, New York
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13
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Khanna T, Vance SL, Silvers DN, Husain S, Lewin JM. Bullous drug eruption with leukemic cell infiltrate in the setting of new-onset acute myeloid leukemia. JAAD Case Rep 2017; 3:529-531. [PMID: 29264384 PMCID: PMC5728715 DOI: 10.1016/j.jdcr.2017.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Trisha Khanna
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Stephen L Vance
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - David N Silvers
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Medical Center, New York, New York
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Nicole W Kittler
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Larisa Geskin
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - George Niedt
- Department of Dermatopathology, Columbia University Medical Center, New York, New York
| | - Thomas Imahiyerobo
- Department of Plastic Surgery, Columbia University Medical Center, New York, New York
| | - Gary Schwartz
- Department of Medicine, Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Matt Ingham
- Department of Medicine, Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University Medical Center, New York, New York
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15
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Gareau DS, Krueger JG, Hawkes JE, Lish SR, Dietz MP, Mülberger AG, Mu EW, Stevenson ML, Lewin JM, Meehan SA, Carucci JA. Line scanning, stage scanning confocal microscope (LSSSCM). Biomed Opt Express 2017; 8:3807-3815. [PMID: 28856051 PMCID: PMC5560842 DOI: 10.1364/boe.8.003807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 05/24/2023]
Abstract
For rapid pathological assessment of large surgical tissue excisions with cellular resolution, we present a line scanning, stage scanning confocal microscope (LSSSCM). LSSSCM uses no scanning mirrors. Laser light is focused with a single cylindrical lens to a line of diffraction-limited width directly into the (Z) sample focal plane, which is parallel to and near the flattened specimen surface. Semi-confocal optical sections are derived from the linear array distribution (Y) and a single mechanical drive that moves the sample parallel to the focal plane and perpendicular to the focused line (X). LSSSCM demonstrates cellular resolution in the conditions of high nuclear density within micronodular basal cell carcinoma.
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Affiliation(s)
- Daniel S. Gareau
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - James G. Krueger
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Jason E. Hawkes
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Samantha R. Lish
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Michael P. Dietz
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Alba Guembe Mülberger
- Investigative Dermatology, The Rockefeller University, 1230 York Ave., New York, NY 10065,
USA
| | - Euphemia W. Mu
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - Mary L. Stevenson
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - Jesse M. Lewin
- Department of Dermatology, Columbia University Medical Center, 161 Fort Washington Avenue, 12th Floor, New York, NY 10032,
USA
| | - Shane A. Meehan
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
| | - John A. Carucci
- Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016,
USA
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16
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Mu EW, Lewin JM, Stevenson ML, Meehan SA, Carucci JA, Gareau DS. Use of Digitally Stained Multimodal Confocal Mosaic Images to Screen for Nonmelanoma Skin Cancer. JAMA Dermatol 2017; 152:1335-1341. [PMID: 27603676 DOI: 10.1001/jamadermatol.2016.2997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Confocal microscopy has the potential to provide rapid bedside pathologic analysis, but clinical adoption has been limited in part by the need for physician retraining to interpret grayscale images. Digitally stained confocal mosaics (DSCMs) mimic the colors of routine histologic specimens and may increase adaptability of this technology. Objective To evaluate the accuracy and precision of 3 physicians using DSCMs before and after training to detect basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Mohs micrographic surgery fresh-tissue specimens. Design This retrospective study used 133 DSCMs from 64 Mohs tissue excisions, which included clear margins, residual BCC, or residual SCC. Discarded tissue from Mohs surgical excisions from the dermatologic surgery units at Memorial Sloan Kettering Cancer Center and Oregon Health & Science University were collected for confocal imaging from 2006 to 2011. Final data analysis and interpretation took place between 2014 and 2016. Two Mohs surgeons and a Mohs fellow, who were blinded to the correlating gold standard frozen section diagnoses, independently reviewed the DSCMs for residual nonmelanoma skin cancer (NMSC) before and after a brief training session (about 5 minutes). The 2 assessments were separated by a 6-month washout period. Main Outcomes and Measures Diagnostic accuracy was characterized by sensitivity and specificity of detecting NMSC using DSCMs vs standard frozen histopathologic specimens. The diagnostic precision was calculated based on interobserver agreement and κ scores. Paired 2-sample t tests were used for comparative means analyses before and after training. Results The average respective sensitivities and specificities of detecting NMSC were 90% (95% CI, 89%-91%) and 79% (95% CI, 52%-100%) before training and 99% (95% CI, 99%-99%) (P = .001) and 93% (95% CI, 90%-96%) (P = .18) after training; for BCC, they were 83% (95% CI, 59%-100%) and 92% (95% CI, 81%-100%) before training and 98% (95% CI, 98%-98%) (P = .18) and 97% (95% CI, 95%-100%) (P = .15) after training; for SCC, they were 73% (95% CI, 65%-81%) and 89% (95% CI, 72%-100%) before training and 100% (P = .004) and 98% (95% CI, 95%-100%) (P = .21) after training. The pretraining interobserver agreement was 72% (κ = 0.58), and the posttraining interobserver agreement was 98% (κ = 0.97) (P = .04). Conclusions and Relevance Diagnostic use of DSCMs shows promising correlation to frozen histologic analysis, but image quality was affected by variations in image contrast and mosaic-stitching artifact. With training, physicians were able to read DSCMs with significantly improved accuracy and precision to detect NMSC.
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Affiliation(s)
- Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Jesse M Lewin
- Department of Dermatology, Columbia University, New York, New York
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Shane A Meehan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York3Department of Pathology, Dermatopathology Section, New York University School of Medicine, New York
| | - John A Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Daniel S Gareau
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
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Schwartzberg BS, Abdelatif OMA, Lewin JM, Bernard JM, Brehm JL, Bu-Ali HM, Cawthorn SJ, Chen-Seeto M, Feldman SM, Govindarajulu S, Jones LI, Juette A, Kavia S, Maganini RO, Pain SJ, Shere MH, Shriver CD, Smith SG, Valencia A, Whitacre EB, Whitney R. Abstract P3-13-03: Multicenter clinical trial of percutaneous laser ablation for early stage primary breast cancer. Results of 49 cases with radiographic and pathological correlation. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-13-03] [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: 11/16/2022]
Abstract
Abstract
Introduction: Percutaneous laser ablation of early stage primary breast cancer remains investigational. A multicenter, international clinical trial (NCT01478438) was completed to determine feasibility of this technique.
Methods: Patients with a single focus of biopsy proven infiltrating ductal carcinoma measuring 20 mm or less by pre-ablation MRI were treated by image-guided percutaneous laser ablation. A laser diode source (805 nominal nanometer wavelength) was used to perform the thermal ablation. Thermal sensors placed at the periphery of the tumor measured achievement of predefined temperature levels, indicating successful ablation. The patients were evaluated by post-ablation mammogram, ultrasound and MRI at 4 weeks post-ablation, after which they underwent surgical excision. Pathology specimens were evaluated by hematoxylin & eosin, CK 8/18, Ki-67 and estrogen receptor staining.
Results: Forty-nine of the 61 enrolled patients (ages 42-77, mean age 64 years) undergoing percutaneous laser ablation have finished protocol analysis and are reported in this series. Ablation was considered complete by the treating physician in all cases. The mean tumor size was 11.3 mm. The mean laser time was 15.7 minutes. There were no serious adverse events. Seven patients (14%) reported mild adverse events (pain, blisters, lump). Post-ablation cell viability was determined by MRI and by changes in CK 8/18, Ki67 and estrogen receptor staining. A post-ablation discordance between MRI and pathology was found in evaluation of 4 patients (8%). Three patients (6%) were considered "false negative" with a post-ablation residual tumor burden of less than 2mm which was not detected by MRI. One patient (2%) had a complete pathologic ablation but positive MRI ("false positive"). One patient (2%) had adjacent residual DCIS, visible in retrospect on the pre-ablation MRI and was considered a screening failure. Eight patients (16%) were found to have residual invasive cancer by both post-ablation MRI and pathologic analysis. Complete ablation was confirmed in 36 patients (73%) when evaluated by both post-ablation MRI and pathologic analysis.
Conclusion: Percutaneous laser ablation holds promise as an alternative to lumpectomy in the treatment of early stage breast cancer. There is a strong correlation (92%) between findings on post-ablation MRI and changes in CK 8/18, Ki67 and estrogen receptor staining in this series. Additional trials are necessary to determine the long-term curative potential of this technique.
Citation Format: Schwartzberg BS, Abdelatif OMA, Lewin JM, Bernard JM, Brehm JL, Bu-Ali HM, Cawthorn SJ, Chen-Seeto M, Feldman SM, Govindarajulu S, Jones LI, Juette A, Kavia S, Maganini RO, Pain SJ, Shere MH, Shriver CD, Smith SG, Valencia A, Whitacre EB, Whitney R. Multicenter clinical trial of percutaneous laser ablation for early stage primary breast cancer. Results of 49 cases with radiographic and pathological correlation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-03.
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Affiliation(s)
- BS Schwartzberg
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - OMA Abdelatif
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JM Lewin
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JM Bernard
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JL Brehm
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - HM Bu-Ali
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SJ Cawthorn
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - M Chen-Seeto
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SM Feldman
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - S Govindarajulu
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - LI Jones
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - A Juette
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - S Kavia
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - RO Maganini
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SJ Pain
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - MH Shere
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - CD Shriver
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SG Smith
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - A Valencia
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - EB Whitacre
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - R Whitney
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
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Abstract
Basal cell carcinoma (BCC), a malignant neoplasm derived from non-keratinizing cells that originate in the basal layer of the epidermis, is the most common cancer in humans. Several factors such as anatomic location, histologic features, primary or recurrent tumors, and patient characteristics influence the choice of treatment modality for BCC. Mohs micrographic surgery (MMS) facilitates optimal margin control and conservation of normal tissue for the management of BCC; however, other treatment modalities may also be implemented in the correct clinical scenario. Other treatment modalities that will be reviewed include simple excision, electrodesiccation and curettage, cryotherapy, topical immunotherapy and chemotherapy, photodynamic therapy, and radiation therapy. In addition, targeted molecular therapeutic options for the treatment of advanced or metastatic BCC will be discussed in this informal review based on recent literature obtained by using PubMed with relevant search terms.
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Yu WY, Lewin JM, Miller KK. A healthy man with persistent lip swelling. J Am Acad Dermatol 2015. [DOI: 10.1016/j.jaad.2014.09.031] [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: 10/24/2022]
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Trufant JW, Lewin JM, Hale CS, Meehan SA, Pomeranz MK. New world cutaneous leishmaniasis. Dermatol Online J 2014; 20:13030/qt6bc5398b. [PMID: 25526331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023] Open
Abstract
A 24-year-old Bangladeshi man presented with a 12-week history of a pruritic papule on his left elbow that had enlarged and ulcerated. He was without any constitutional or systemic symptoms. He reported a history of extensive travel in the two years prior to presentation that included Bangladesh, South and Central America, and Mexico. Histopathologic features were consistent with leishmaniasis. Speciation by the Centers for Disease Control showed L. brasiliensis.
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Korta DZ, Lewin JM, Meehan SA, Ramachandran SM. Metastatic squamous cell carcinoma presenting as an erythematous nodule in a man with lung adenocarcinoma. J Drugs Dermatol 2014; 13:1277-1279. [PMID: 25607566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Skin metastases from visceral malignancies have been well documented in the literature, and may be the presenting sign of an occult internal malignancy. Lung cancer in particular is a relatively common cause of skin metastases, which are considered a poor prognostic sign. Rarely, patients with lung cancer develop a second primary lung cancer that may require a novel chemotherapeutic regimen. The frequency of second primary malignancies presenting with metastatic skin lesions is not documented in the literature. We present a case of a 50-year-old man with a history of metastatic lung adenocarcinoma who was referred for evaluation of a nodule overlying his right mandible, which had been progressively enlarging for two weeks. Biopsy demonstrated metastatic squamous cell carcinoma. Subsequent CT-guided biopsy of a left retroperitoneal lymph node was conducted and notable for squamous cell carcinoma. Therefore, this patient's skin lesion was the presenting sign of a second primary visceral tumor, likely originating in the lung. We present this case to raise clinical awareness of the rare phenomenon that cutaneous metastasis may be the first sign of a visceral cancer, even in the setting of a previous distinct primary malignancy.
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Quay ER, Mundi JP, Latkowski JAM, Kamino H, Lewin JM. A variant of palpable migratory arciform erythema. J Drugs Dermatol 2014; 13:1288-1289. [PMID: 25607568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Palpable migratory arciform erythema is a T-cell pseudolymphoma with no well-established treatment. The disease is rarely reported in the literature, perhaps because it is difficult to diagnose. We present a case of a variant of PMAE in a 30-year-old healthy man with no history of medication use and erythematous to violaceous annular and arciform plaques on his face, scalp and trunk. This case is of particular significance because gene rearrangement studies and histopathologic findings are concerning for folliculotropic mycosis fungoides while the clinical course does not support this diagnosis. The authors' emphasize that clinical history is imperative for definitive diagnosis of palpable migratory arciform erythema as it can clinically and histopathologically resemble other cutaneous lymphocytic diseases.
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Lewin JM, Farley-Loftus R, Pomeranz MK. Herpes simplex virus-associated pseudolymphoma. Cutis 2013; 92:E1-E2. [PMID: 24416749] [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: 06/03/2023]
Affiliation(s)
- Jesse M Lewin
- New York University Langone Medical Center, The Ronald O. Perelman Department of Dermatology, 240 E 38th Ave, New York, NY 10016, USA.
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Lewin JM, Ostad A, Brauer JA. Surgical corner:a poliglecaprone 25-only approach to wound closure:cosmetic and financial advantages. J Drugs Dermatol 2013; 12:341-342. [PMID: 23545919] [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: 06/02/2023]
Abstract
The primary concerns when performing surgical excisions include adequate control of surgical margins and cosmetic outcome. The ideal repair combines perfect wound approximation, tensile strength, and minimal scarring. Various techniques and suture materials are utilized by dermatologic surgeons to achieve this goal. We describe a Monocryl-only bilayered repair, which can lead to excellent cosmetic results and may reduce the burden of return visits for patients. In this paper, we describe the technique used to place deep Monocryl sutures, as well as a running subcuticular suture, and illustrate this technique with photographs.
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Affiliation(s)
- Jesse M Lewin
- Ronald O Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY, USA.
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Lewin JM, Hunt R, Fischer M, Kamino H, Franks AG. Hypergammaglobulinemic purpura of Waldenström. Dermatol Online J 2012; 18:2. [PMID: 23286792] [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: 06/01/2023] Open
Abstract
We report a case of a 33-year-old-woman with a one-year history of bilateral lower extremity vasculitis and laboratory evidence of hypergammaglobulinemia with otherwise unremarkable routine laboratory and rheumatologic studies. Her clinical picture, together with histopathologic evidence of leukocytoclastic vasculitis, favor a diagnosis of hypergammaglobulinemic purpura of Waldenström.
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Affiliation(s)
- Jesse M Lewin
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, USA
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Allec N, Abbaszadeh S, Scott CC, Lewin JM, Karim KS. Including the effect of motion artifacts in noise and performance analysis of dual-energy contrast-enhanced mammography. Phys Med Biol 2012. [DOI: 10.1088/0031-9155/57/24/8405] [Citation(s) in RCA: 9] [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] [Indexed: 11/12/2022]
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Lewin JM, Brauer JA, Ostad A. Surgical smoke and the dermatologist. J Am Acad Dermatol 2011; 65:636-641. [DOI: 10.1016/j.jaad.2010.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/27/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Lewin JM, Hendrick RE, D'Orsi CJ, Isaacs PK, Moss LJ, Karellas A, Sisney GA, Kuni CC, Cutter GR. Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations. Radiology 2001; 218:873-80. [PMID: 11230669 DOI: 10.1148/radiology.218.3.r01mr29873] [Citation(s) in RCA: 233] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare full-field digital mammography (FFDM) with screen-film mammography (SFM) for cancer detection in a screening population. MATERIALS AND METHODS At two institutions, 4,945 FFDM examinations were performed in women aged 40 years and older presenting for SFM. Two views of each breast were acquired with each modality. SFM and FFDM images were interpreted independently. Findings detected with either SFM or FFDM were evaluated with additional imaging and, if warranted, biopsy. RESULTS Patients in the study underwent 152 biopsies, which resulted in the diagnosis of 35 breast cancers. Twenty-two cancers were detected with SFM and 21 with FFDM. Four were interval cancers that became palpable within 1 year of screening and were considered false-negative findings with both modalities. The difference in cancer detection rate was not significant. FFDM had a significantly lower recall rate (11.5%; 568 of 4,945) than SFM (13.8%; 685 of 4,945) (P <.001, McNemar chi(2) model; P <.03, generalized estimating equations model). The positive biopsy rate for findings detected with FFDM (30%; 21 of 69) was higher than that for findings detected with SFM (19%; 22 of 114), but this difference was not significant. CONCLUSION No difference in cancer detection rate has yet been observed between FFDM and SFM. FFDM has so far led to fewer recalls than SFM.
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Affiliation(s)
- J M Lewin
- Dept of Radiology, Univ of Colorado Health Sciences Ctr, CB E-030, 4200 E Ninth Ave, Denver, CO 80262, USA.
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Lewin JM, Isaacs P, Vanoyan A. Self-cannulation for ductography of the breast. AJR Am J Roentgenol 2001; 176:420. [PMID: 11159085 DOI: 10.2214/ajr.176.2.1760420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J M Lewin
- Department of Radiology, Campus Box E030, University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Denver, CO 80262, USA
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Attoub S, Levasseur S, Buyse M, Goïot H, Laigneau JP, Moizo L, Hervatin F, Le Marchand-Brustel Y, Lewin JM, Bado A. Physiological role of cholecystokinin B/gastrin receptor in leptin secretion. Endocrinology 1999; 140:4406-10. [PMID: 10499492 DOI: 10.1210/endo.140.10.7079] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the present study, we investigated whether cholecystokinin (CCK) or its structurally related peptide gastrin participates in long term regulation of adipocyte leptin secretion. The levels of circulating leptin observed after 2 and 6 h of refeeding in 18-h fast rats were significantly lowered by injection of the specific gastrin/CCK-B receptor antagonist YM022 at doses that did not affect feeding behavior. Moreover, in normally fed animals, circulating leptin was markedly decreased by chronic injection of YM022 (from 4 +/- 0.6 to 2.1 +/- 0.5 ng/ml). Consistent with these observations, YM022 treatment decreased leptin messenger RNA (mRNA) levels and increased the leptin content in rat epididymal fat tissue. Rat adipocytes exclusively contain gastrin/CCK-B receptor mRNA, but not CCK-A receptor mRNA. Furthermore, adipocyte membranes bound [125I]CCK-8 in a saturable manner, with kinetics consistent with a single class of high affinity sites with a Kd of 0.2 nM. These data argue for a physiological role for the CCK-B/gastrin receptor in adipocyte leptin regulation. We therefore propose that gastrin is involved in long term regulation of leptin expression and secretion in rat fat tissues through activation of an adipocyte gastrin/CCK-B receptor.
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Affiliation(s)
- S Attoub
- INSERM, U-10, Institut Federatif de Recherche 2, Cellules Epithéliales, Hôpital Bichat, Paris, France
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Lewin JM. Full-field digital mammography. A candid assessment. Diagn Imaging (San Franc) 1999; 21:40-5. [PMID: 10623316] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J M Lewin
- University of Colorado Health Sciences Center in Denver, USA
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Foley SJ, Lewin JM, Adamson A. Is the timing of post vasectomy seminal analysis important? Br J Urol 1998; 82:166. [PMID: 9698690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Johnston RJ, Stamm ER, Lewin JM, Hendrick RE, Archer PG. Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements. Abdom Imaging 1998; 23:409-15. [PMID: 9663278 DOI: 10.1007/s002619900370] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We investigated whether liver-minus-spleen (L-S) attenuation differences can accurately diagnose fatty infiltration of the liver on contrast-enhanced computed tomography (CT). METHODS A group of 78 patients administered a fast injection (90-s duration) of 150 mL 60% ionic contrast was compared with 81 patients given a slow injection (152.5 s). The presence or absence of fatty infiltration of the liver was diagnosed by noncontrast CT. RESULTS The L-S attenuation differences varied significantly, depending on both injection rate and timing of measurements. For the fast-injection group, the optimal L-S threshold for diagnosing fatty infiltration ranged from -43 to -33 Hounsfield units (HU) for early (79 s) and late measurements (106 s), respectively. For the slow-injection group, the optimal threshold ranged from -31 to -25 HU (80 and 112 s, respectively). In addition, sensitivity was not very high (range = 0.54-0.71) for either injection protocol at any measurement time because of significant overlap of L-S values between normal and fatty infiltration patients. Moderate and severe fatty infiltration were more reliably diagnosed than mild fatty infiltration by this method. CONCLUSIONS Contrast injection rate and timing of measurements significantly influence the optimal L-S threshold for diagnosing fatty liver. This limits the clinical usefulness of such measurements.
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Affiliation(s)
- R J Johnston
- Department of Radiology, Veterans Affairs Medical Center, Denver, CO 80220, USA
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Abstract
Pulmonary thromboembolism (PTE) is a common cause of morbidity and mortality in an emergency department patient population. The advent of ventilation/perfusion (V/Q) lung scanning and the more recent publication of well- controlled analysis of results, such as the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) data, have provided the clinician with effective diagnostic algorithms to use in suggestive cases. However, there are disorders other than PTE, such as bronchogenic carcinoma, that can cause characteristic abnormalities in V/Q scanning. One such case is described in this report.
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Affiliation(s)
- M D Veatch
- Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO, USA
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Abstract
Postoperative pain following day surgery is a common problem. The prescription of appropriate analgesia with clear instructions for the patient is crucial. This article examines the effect of changing prescribing practice, backed up by a patient information leaflet, on the effectiveness of take-home analgesia after day case surgery.
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Mignon M, Lewin JM, Vatier J. [Pharmacology of gastric antisecretory agents and of modifying drugs of the digestive motility. Current methodological developments; introductory discussion]. Therapie 1992; 47:91-2. [PMID: 1412148] [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: 12/26/2022]
Affiliation(s)
- M Mignon
- Service d'Hépato-Gastro-Entérologie, Hôpital Bichat, Paris
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