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Maddineni S, Dizon MP, Muralidharan V, Young LA, Sunwoo JB, Baik FM, Swetter SM. ASO Visual Abstract: Validation of the Melanoma Institute of Australia's Sentinel Lymph Node Biopsy Risk Prediction Tool for Cutaneous Melanoma. Ann Surg Oncol 2024; 31:2751-2752. [PMID: 38315333 DOI: 10.1245/s10434-024-14996-5] [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: 02/07/2024]
Affiliation(s)
- Sainiteesh Maddineni
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew P Dizon
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA
| | - Lexi A Young
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John B Sunwoo
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Fred M Baik
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA.
- Dermatology/Cutaneous Oncology, Stanford Medicine and Cancer Center, Stanford, CA, USA.
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Maddineni S, Dizon MP, Muralidharan V, Young LA, Sunwoo JB, Baik FM, Swetter SM. Validation of the Melanoma Institute of Australia's Sentinel Lymph Node Biopsy Risk Prediction Tool for Cutaneous Melanoma. Ann Surg Oncol 2024; 31:2737-2746. [PMID: 38216800 DOI: 10.1245/s10434-023-14862-w] [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: 10/24/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND For patients with cutaneous melanoma, sentinel lymph node biopsy (SLNB) is used to stage regional lymph nodes pathologically and inform prognosis, treatment, and surveillance. To reduce unnecessary surgeries, predictive tools aim to identify those at lowest risk for node-positive disease. The Melanoma Institute of Australia (MIA)'s Prediction Tool for Sentinel Node Metastasis Risk estimates risk of a positive SLNB using patient age and primary melanoma Breslow depth, histologic subtype, ulceration, mitotic rate, and lymphovascular invasion. METHODS A single-institution validation was performed of the MIA Calculator with 982 cutaneous melanoma patients that included all relevant clinicopathologic factors and SLNB pathology outcomes. The study evaluated discrimination via receiver operating characteristic (ROC) curves, calibration via calibration plots, and clinical utility via decision curve analysis of the MIA model in various subgroups. The data were fit to MIA model parameters via a generalized linear model to assess the odds ratio of parameters in our dataset. RESULTS The Calculator demonstrated limited discrimination based on ROC curves (C-statistic, 0.709) and consistently underestimated risk of SLN positivity. It did not provide a net benefit over SLNB performed on all patients or reduce unnecessary procedures in the risk domain of 0% to 16%. Compared with the original development and validation cohorts, the current study cohort had thinner tumors and a larger proportion of acral melanomas. CONCLUSIONS The Calculator generally underestimated SLN positivity risk, including assessment in patients who would be counseled to forego SLNB based on a predicted risk lower than 5%. Recognition of the tool's current limitations emphasizes the need to refine it further for use in medical decision-making.
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Affiliation(s)
- Sainiteesh Maddineni
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew P Dizon
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA
| | - Lexi A Young
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John B Sunwoo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA.
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Kim DY, Swetter SM, Huhmann L, Dizon MP, Ferguson JM, Osborne TF, Spence AC, Ziad A, Fillmore N, Hartman RI. Real-world effectiveness of immune checkpoint inhibitors and BRAF/MEK inhibitors among veteran patients with cutaneous melanoma. J Am Acad Dermatol 2024; 90:620-623. [PMID: 37924953 DOI: 10.1016/j.jaad.2023.10.051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Daniel Y Kim
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Linden Huhmann
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Matthew P Dizon
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Thomas F Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Radiology, Stanford University School of Medicine, Palo Alto, California
| | - Allyson C Spence
- Department of Medical Oncology, Stanford University Medical Center, Palo Alto, California
| | - Amina Ziad
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nathanael Fillmore
- Harvard Medical School, Boston, Massachusetts; Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts
| | - Rebecca I Hartman
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dermatology Section, VA Integrated Service Network 1 (VISN-1), Jamaica Plain, Massachusetts.
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Gyurdzhyan S, Muralidharan V, Liu LY, Sunwoo JB, Zaba LC, Swetter SM. Nodal ultrasound for regional recurrence detection in sentinel lymph node biopsy-positive cutaneous melanoma patients undergoing cross-sectional imaging. Skin Health Dis 2024; 4:e305. [PMID: 38312253 PMCID: PMC10831564 DOI: 10.1002/ski2.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Affiliation(s)
- Samvel Gyurdzhyan
- Department of DermatologyPigmented Lesion and Melanoma ProgramStanford University Medical Center and Cancer InstituteStanfordCaliforniaUSA
- Stanford University School of MedicineStanfordCaliforniaUSA
| | - Vijaytha Muralidharan
- Department of DermatologyPigmented Lesion and Melanoma ProgramStanford University Medical Center and Cancer InstituteStanfordCaliforniaUSA
| | - Lucy Y. Liu
- Department of DermatologyPigmented Lesion and Melanoma ProgramStanford University Medical Center and Cancer InstituteStanfordCaliforniaUSA
| | - John B. Sunwoo
- Department of Otolaryngology – Head and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Lisa C. Zaba
- Department of DermatologyPigmented Lesion and Melanoma ProgramStanford University Medical Center and Cancer InstituteStanfordCaliforniaUSA
| | - Susan M. Swetter
- Department of DermatologyPigmented Lesion and Melanoma ProgramStanford University Medical Center and Cancer InstituteStanfordCaliforniaUSA
- Dermatology ServiceVeterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
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Dizon MP, Linos E, Swetter SM. Estimating remaining life expectancy in veterans with basal cell carcinoma using an automated electronic health record scoring system: A retrospective cohort study. J Am Acad Dermatol 2024; 90:98-105. [PMID: 37742837 DOI: 10.1016/j.jaad.2023.09.029] [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: 07/31/2023] [Revised: 08/26/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Active surveillance may be considered for low-risk basal cell carcinomas (BCCs) in patients with limited life expectancy; however, estimates of life expectancy are not readily available. Veterans Health Administration's Care Assessment Need (CAN) score may address this problem. OBJECTIVE We examined the CAN score's performance in predicting 1-, 3-, and 5-year mortality in US veterans with BCC. METHODS This retrospective cohort study used national Veterans Health Administration's electronic medical record data. The CAN score's performance in the prediction of mortality in veterans with BCC was evaluated based on tests of goodness-of-fit, discrimination, and calibration. RESULTS For 54,744 veterans with BCC treatment encounters between 2013 and 2018, the CAN score performed well in the prediction of mortality based on multiple tests. A threshold CAN score of 90 had a positive predictive value of 55% for 3-year mortality, clinically useful in identifying patients with intermediate-term survival. LIMITATIONS The study relied upon the combination of diagnosis codes and procedure codes to identify BCC cases. CONCLUSION The CAN score has the potential to improve the quality of cancer care for veterans by providing clinicians with an estimate of life expectancy and facilitating conversations in cases where active surveillance can be considered.
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Affiliation(s)
- Matthew P Dizon
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Health Policy, Stanford University School of Medicine, Palo Alto, California.
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
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Abstract
Cutaneous melanoma is a malignancy arising from melanocytes of the skin. Incidence rates are rising, particularly in White populations. Cutaneous melanoma is typically driven by exposure to ultraviolet radiation from natural sunlight and indoor tanning, although there are several subtypes that are not related to ultraviolet radiation exposure. Primary melanomas are often darkly pigmented, but can be amelanotic, with diagnosis based on a combination of clinical and histopathological findings. Primary melanoma is treated with wide excision, with margins determined by tumour thickness. Further treatment depends on the disease stage (following histopathological examination and, where appropriate, sentinel lymph node biopsy) and can include surgery, checkpoint immunotherapy, targeted therapy, or radiotherapy. Systemic drug therapies are recommended as an adjunct to surgery in patients with resectable locoregional metastases and are the mainstay of treatment in advanced melanoma. Management of advanced melanoma is complex, particularly in those with cerebral metastasis. Multidisciplinary care is essential. Systemic drug therapies, particularly immune checkpoint inhibitors, have substantially increased melanoma survival following a series of landmark approvals from 2011 onward.
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Affiliation(s)
- Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia.
| | - Susan M Swetter
- Department of Dermatology and Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA; Department of Dermatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander M Menzies
- Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology and Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; NSW Health Pathology, Sydney, NSW, Australia
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Winge MCG, Kellman LN, Guo K, Tang JY, Swetter SM, Aasi SZ, Sarin KY, Chang ALS, Khavari PA. Advances in cutaneous squamous cell carcinoma. Nat Rev Cancer 2023:10.1038/s41568-023-00583-5. [PMID: 37286893 DOI: 10.1038/s41568-023-00583-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
Human malignancies arise predominantly in tissues of epithelial origin, where the stepwise transformation from healthy epithelium to premalignant dysplasia to invasive neoplasia involves sequential dysregulation of biological networks that govern essential functions of epithelial homeostasis. Cutaneous squamous cell carcinoma (cSCC) is a prototype epithelial malignancy, often with a high tumour mutational burden. A plethora of risk genes, dominated by UV-induced sun damage, drive disease progression in conjunction with stromal interactions and local immunomodulation, enabling continuous tumour growth. Recent studies have identified subpopulations of SCC cells that specifically interact with the tumour microenvironment. These advances, along with increased knowledge of the impact of germline genetics and somatic mutations on cSCC development, have led to a greater appreciation of the complexity of skin cancer pathogenesis and have enabled progress in neoadjuvant immunotherapy, which has improved pathological complete response rates. Although measures for the prevention and therapeutic management of cSCC are associated with clinical benefit, the prognosis remains poor for advanced disease. Elucidating how the genetic mechanisms that drive cSCC interact with the tumour microenvironment is a current focus in efforts to understand, prevent and treat cSCC.
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Affiliation(s)
- Mårten C G Winge
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Laura N Kellman
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Stanford Program in Cancer Biology, Stanford University, Stanford, CA, USA
| | - Konnie Guo
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA
| | - Jean Y Tang
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Redwood City, CA, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | - Paul A Khavari
- Program in Epithelial Biology, Stanford University, Stanford, CA, USA.
- Department of Dermatology, Stanford University, Redwood City, CA, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
- Stanford Program in Cancer Biology, Stanford University, Stanford, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA.
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Dizon MP, Nord KM, Swetter SM. Clinical outcomes of squamous cell carcinomas following complete saucerization with negative margins: Retrospective case series from 2010-2022. JAAD Int 2023; 11:83-84. [PMID: 36941916 PMCID: PMC10023896 DOI: 10.1016/j.jdin.2023.01.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Affiliation(s)
- Matthew P. Dizon
- Health Services Research & Development, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Kristin M. Nord
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Susan M. Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California
- Correspondence to: Susan M. Swetter, MD, Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, 900 Blake Wilbur Drive, Room W3045, Stanford, CA 94305
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Cai ED, Swetter SM, Sarin KY. Association of multiple primary melanomas with malignancy risk: A population-based analysis of entries from the Surveillance, Epidemiology, and End Results program database during 1973-2014. J Am Acad Dermatol 2023; 88:e211-e219. [PMID: 30287320 PMCID: PMC9132559 DOI: 10.1016/j.jaad.2018.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Genetic and environmental risk factors have been associated with the development of multiple primary melanomas (MPMs). We hypothesized that individuals with MPMs might have an increased incidence of internal malignancies. OBJECTIVE To identify the risk for subsequent malignancies in MPM patients. METHODS Multiple primary standardized incidence ratios were analyzed for individuals with ≥1, ≥2 and ≥3 primary melanomas (PMs) recorded in the Surveillance, Epidemiology, and End Results database during 1973-2014. RESULTS We identified 223,799 individuals with ≥1 PM, 19,709 with ≥2 PMs, and 3,995 with ≥3 PMs. Risks of subsequent internal malignancy increased with number of PMs, with observed:expected ratios of 0.99, 1.14, and 1.23 (P < .05) for patients with ≥1 PM, ≥2 PMs, and ≥3 PMs, respectively. Internal malignancy was higher in younger MPM patients and those with superficial spreading melanoma. The most common malignancies among MPM patients included breast, prostate, thyroid, soft tissue, brain, kidney, non-Hodgkin lymphoma, and chronic lymphocytic leukemia. Risk for subsequent cutaneous melanoma increased with observed:expected ratios of 8.09, 22.52, 41.03 (P < .05) for patients with ≥1 PM, ≥2 PMs, and ≥3 PMs, respectively. LIMITATIONS Surveillance, Epidemiology, and End Results records limited information about pigmentation phenotypes, histology, and treatments. CONCLUSION Patients with MPMs have an increased risk for subsequent internal and cutaneous malignancies and might benefit from tight adherence to age-specific cancer screening.
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Affiliation(s)
- Emily D Cai
- Department of Dermatology, Stanford University Medical Center, Redwood City, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Redwood City, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Redwood City, California.
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Huerta T, Swetter SM, Nehal KS, Coit DG, Bichakjian CK, Durham AB. Current evidence does not support Mohs micrographic surgery or staged excision as equivalent to wide excision for primary cutaneous melanoma. J Am Acad Dermatol 2023; 88:959-960. [PMID: 36535532 DOI: 10.1016/j.jaad.2022.12.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Tomas Huerta
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Alison B Durham
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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Abstract
This JAMA Patient Page describes melanoma, its risk factors, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Jennifer Y Wang
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University, Stanford, California
| | - Erica B Wang
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University, Stanford, California
| | - Susan M Swetter
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University, Stanford, California
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Qian MF, Betancourt NJ, Pineda A, Maloney NJ, Nguyen KA, Reddy SA, Hall ET, Swetter SM, Zaba LC. Health Care Utilization and Costs in Systemic Therapies for Metastatic Melanoma from 2016 to 2020. Oncologist 2023; 28:268-275. [PMID: 36302223 PMCID: PMC10020812 DOI: 10.1093/oncolo/oyac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Widespread implementation of immune checkpoint inhibitors (ICI) and targeted therapies for metastatic melanoma has led to a decline in melanoma-related mortality but increased healthcare costs. We aimed to determine how healthcare utilization varied by systemic, non-adjuvant melanoma treatment from 2016 to 2020. PATIENTS AND METHODS Adults with presumed stage IV metastatic melanoma receiving systemic therapy from 2016 to 2020 were identified in Optum, a nationwide commercial claims database. Treatment groups were nivolumab, pembrolizumab, ipilimumab+nivolumab (combination-ICI), or BRAF+MEK inhibitor (BRAFi+MEKi) therapy. Outcomes included hospitalizations, days hospitalized, emergency room (ER) visits, outpatient visits, and healthcare costs per patient per month (pppm). Multivariable regression models were used to analyze whether cost and utilization outcomes varied by treatment group, with nivolumab as reference. RESULTS Among 2018 adult patients with metastatic melanoma identified, mean (SD) age was 67 (15) years. From 2016 to 2020, nivolumab surpassed pembrolizumab as the most prescribed systemic melanoma therapy while combination-ICI and BRAFi+MEKi therapies remained stable. Relative to nivolumab, all other therapies were associated with increased total healthcare costs (combination-ICI: β = $47 600 pppm, 95%CI $42 200-$53 100; BRAFi+MEKi: β = $3810, 95%CI $365-$7260; pembrolizumab: β = $6450, 95%CI $4420-$8480). Combination-ICI and BRAFi+MEKi therapies were associated with more inpatient hospital days. CONCLUSIONS Amid the evolving landscape of systemic therapy for advanced melanoma, nivolumab monotherapy emerged as the most used and least costly systemic treatment from 2016 to 2020. Its sharp increase in use in 2018 and lower costs relative to pembrolizumab may in part be due to earlier adoption of less frequent dosing intervals.
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Affiliation(s)
- Mollie F Qian
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Alain Pineda
- Department of Economics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nolan J Maloney
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin A Nguyen
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sunil A Reddy
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Evan T Hall
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
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Kashani-Sabet M, Leachman SA, Stein JA, Arbiser JL, Berry EG, Celebi JT, Curiel-Lewandrowski C, Ferris LK, Grant-Kels JM, Grossman D, Kulkarni RP, Marchetti MA, Nelson KC, Polsky D, Seiverling EV, Swetter SM, Tsao H, Verdieck-Devlaeminck A, Wei ML, Bar A, Bartlett EK, Bolognia JL, Bowles TL, Cha KB, Chu EY, Hartman RI, Hawryluk EB, Jampel RM, Karapetyan L, Kheterpal M, Lawson DH, Leming PD, Liebman TN, Ming ME, Sahni D, Savory SA, Shaikh SS, Sober AJ, Sondak VK, Spaccarelli N, Usatine RP, Venna S, Kirkwood JM. Early Detection and Prognostic Assessment of Cutaneous Melanoma: Consensus on Optimal Practice and the Role of Gene Expression Profile Testing. JAMA Dermatol 2023; 159:545-553. [PMID: 36920356 DOI: 10.1001/jamadermatol.2023.0127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Importance Therapy for advanced melanoma has transformed during the past decade, but early detection and prognostic assessment of cutaneous melanoma (CM) remain paramount goals. Best practices for screening and use of pigmented lesion evaluation tools and gene expression profile (GEP) testing in CM remain to be defined. Objective To provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM. Evidence Review Case scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45). Findings The panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status. Conclusions and Relevance For this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.
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Affiliation(s)
- Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco
| | - Sancy A Leachman
- Departments of Dermatology and Family Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Jennifer A Stein
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Jack L Arbiser
- Department of Dermatology, Emory University School of Medicine, Winship Cancer Institute, Atlanta Veterans Administration Health Center, Atlanta, Georgia
| | - Elizabeth G Berry
- Departments of Dermatology and Family Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Julide T Celebi
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Clara Curiel-Lewandrowski
- UA Cancer Center Skin Cancer Institute, Division of Dermatology, College of Medicine, University of Arizona, Tucson
| | - Laura K Ferris
- Departments of Dermatology and Medicine, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington.,Department of Dermatology, University of Florida College of Medicine, Gainesville
| | | | - Rajan P Kulkarni
- Departments of Dermatology and Family Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - David Polsky
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | | | - Susan M Swetter
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Palo Alto, California.,Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | | | - Maria L Wei
- Dermatology Department, University of California, San Francisco.,Dermatology Service, San Francisco VA Health Care System, San Francisco, California
| | - Anna Bar
- Departments of Dermatology and Family Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Edmund K Bartlett
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jean L Bolognia
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Kelly B Cha
- Department of Dermatology, Michigan Medicine, Ann Arbor
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Rebecca I Hartman
- Department of Dermatology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Risa M Jampel
- Department of Dermatology, University of Maryland, Baltimore, Maryland
| | - Lilit Karapetyan
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Meenal Kheterpal
- Department of Dermatology, Duke University, Durham, North Carolina
| | - David H Lawson
- Department of Dermatology, Emory University School of Medicine, Winship Cancer Institute, Atlanta Veterans Administration Health Center, Atlanta, Georgia
| | | | - Tracey N Liebman
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Michael E Ming
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Stephanie A Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Saba S Shaikh
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Vernon K Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | | | - Suraj Venna
- Inova Schar Cancer Institute, Inova Fairfax Hospital, University of Virginia School of Medicine, Charlottesville
| | - John M Kirkwood
- Departments of Dermatology and Medicine, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
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14
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Gao DX, Swetter SM, Hawryluk EB, Geller AC, Beaulieu D. Screening motivations among participants of the American Academy of Dermatology's SPOT Skin Cancer screening program from 2018 to 2019: A cross-sectional analysis. J Am Acad Dermatol 2023; 88:674-676. [PMID: 35803403 DOI: 10.1016/j.jaad.2022.06.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022]
Affiliation(s)
- David X Gao
- Department of Dermatology, University of Illinois College of Medicine, Peoria, Illinois. https://twitter.com/xdxgx
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Dermatology, Stanford University Medical Center, Redwood City, California
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Derek Beaulieu
- Department of Dermatology, Stanford University Medical Center, Redwood City, California.
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15
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Mesia RJ, Espinosa PR, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, Rosas LG, Swetter SM. Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration. Cancer Med 2022; 12:7438-7449. [PMID: 36433634 PMCID: PMC10067099 DOI: 10.1002/cam4.5457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/03/2022] [Revised: 09/26/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.
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Affiliation(s)
- Rachel J Mesia
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hayden Hutchison
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nadia Safaeinili
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Laurel J Finster
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
| | - Beth A Glenn
- UCLA Fielding School of Public Health, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California, USA
| | - Robert W Haile
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Lisa Goldman Rosas
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
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16
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Trepanowski N, Chang MS, Zhou G, Ahmad M, Berry EG, Bui K, Butler WH, Chu EY, Curiel-Lewandrowski C, Dellalana LE, Ellis DL, Freeman SC, Gorrepati PL, Grossman D, Gyurdzhyan S, Kanetsky PA, King ALO, Kolla AM, Lian CG, Lin JY, Liu V, Lowenthal A, McCoy KN, Munjal A, Myrdal CN, Perkins S, Powers JG, Rauck C, Smart TC, Stein JA, Venna S, Walsh ME, Wang JY, Leachman SA, Swetter SM, Hartman RI. Delays in melanoma presentation during the COVID-19 pandemic: A nationwide multi-institutional cohort study. J Am Acad Dermatol 2022; 87:1217-1219. [PMID: 35738513 PMCID: PMC9212700 DOI: 10.1016/j.jaad.2022.06.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael S Chang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maham Ahmad
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Katherine Bui
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William H Butler
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona; The University of Arizona Cancer Center, Tucson, Arizona
| | - Laura E Dellalana
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darrel L Ellis
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Dermatology, Nashville VA Medical Centers, Nashville, Tennessee
| | - S Caleb Freeman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | | | - Douglas Grossman
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Amber Loren Ong King
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Avani M Kolla
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Lin
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vincent Liu
- Departments of Dermatology and Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Annie Lowenthal
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Ananya Munjal
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Caitlyn N Myrdal
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona
| | - Sara Perkins
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer G Powers
- Department of Dermatology, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Corinne Rauck
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tristan C Smart
- Department of Dermatology and Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Suraj Venna
- University of Virginia School of Medicine, Charlottesville, Virginia; Inova Melanoma and Skin Cancer Center, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Madalyn E Walsh
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Jennifer Y Wang
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Palo Alto, California
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon; Knight Cancer Institute at Oregon Health & Science University, Portland, Oregon
| | - Susan M Swetter
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Palo Alto, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Dermatology, VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts.
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17
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Savage DJ, Tushla LA, Guenin K, Gross I, Kanakarajavelu N, Young R, Merino-Gonzalez D, Stamm N, Swetter SM, Boiko S, Mofid MZ, Guild S, Quandt SA, Arcury T. ReUnidos: Farmworker Skin Cancer Health Navigation Program. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
113 Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Susan M. Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, CA
| | - Susan Boiko
- University of California San Diego, La Jolla, CA
| | | | | | - Sara A Quandt
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Thomas Arcury
- Wake Forest University School of Medicine, Winston-Salem, NC
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18
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Bartlett EK, Grossman D, Swetter SM, Leachman SA, Curiel-Lewandrowski C, Dusza SW, Gershenwald JE, Kirkwood JM, Tin AL, Vickers AJ, Marchetti MA. Clinically Significant Risk Thresholds in the Management of Primary Cutaneous Melanoma: A Survey of Melanoma Experts. Ann Surg Oncol 2022; 29:5948-5956. [PMID: 35583689 PMCID: PMC10091118 DOI: 10.1245/s10434-022-11869-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Risk-based thresholds to guide management are undefined in the treatment of primary cutaneous melanoma but are essential to advance the field from traditional stage-based treatment to more individualized care. METHODS To estimate treatment risk thresholds, hypothetical clinical melanoma scenarios were developed and a stratified random sample was distributed to expert melanoma clinicians via an anonymous web-based survey. Scenarios provided a defined 5-year risk of recurrence and asked for recommendations regarding clinical follow-up, imaging, and adjuvant therapy. Marginal probability of response across the spectrum of 5-year recurrence risk was estimated. The risk at which 50% of respondents recommended a treatment was defined as the risk threshold. RESULTS The overall response rate was 56% (89/159). Three separate multivariable models were constructed to estimate the recommendations for clinical follow-up more than twice/year, for surveillance cross-sectional imaging at least once/year, and for adjuvant therapy. A 36% 5-year risk of recurrence was identified as the threshold for recommending clinical follow-up more than twice/year. The thresholds for recommending cross-sectional imaging and adjuvant therapy were 30 and 59%, respectively. Thresholds varied with the age of the hypothetical patient: at younger ages they were constant but increased rapidly at ages 60 years and above. CONCLUSIONS To our knowledge, these data provide the first estimates of clinically significant treatment thresholds for patients with cutaneous melanoma based on risk of recurrence. Future refinement and adoption of thresholds would permit assessment of the clinical utility of novel prognostic tools and represents an early step toward individualizing treatment recommendations.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Douglas Grossman
- Department of Dermatology and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Clara Curiel-Lewandrowski
- Department of Dermatology and University of Arizona Cancer Center Skin Cancer Institute, University of Arizona, Tucson, AZ, USA
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Kirkwood
- Department of Internal Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Gao DX, Swetter SM, Hawryluk EB. 32381 Analysis of utilization of skin cancer screenings and screening motivations among national SPOT Skin Cancer program screenees from 2018 to 2019. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Daneshjou R, Vodrahalli K, Novoa RA, Jenkins M, Liang W, Rotemberg V, Ko J, Swetter SM, Bailey EE, Gevaert O, Mukherjee P, Phung M, Yekrang K, Fong B, Sahasrabudhe R, Allerup JAC, Okata-Karigane U, Zou J, Chiou AS. Disparities in dermatology AI performance on a diverse, curated clinical image set. Sci Adv 2022; 8:eabq6147. [PMID: 35960806 PMCID: PMC9374341 DOI: 10.1126/sciadv.abq6147] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 06/10/2023]
Abstract
An estimated 3 billion people lack access to dermatological care globally. Artificial intelligence (AI) may aid in triaging skin diseases and identifying malignancies. However, most AI models have not been assessed on images of diverse skin tones or uncommon diseases. Thus, we created the Diverse Dermatology Images (DDI) dataset-the first publicly available, expertly curated, and pathologically confirmed image dataset with diverse skin tones. We show that state-of-the-art dermatology AI models exhibit substantial limitations on the DDI dataset, particularly on dark skin tones and uncommon diseases. We find that dermatologists, who often label AI datasets, also perform worse on images of dark skin tones and uncommon diseases. Fine-tuning AI models on the DDI images closes the performance gap between light and dark skin tones. These findings identify important weaknesses and biases in dermatology AI that should be addressed for reliable application to diverse patients and diseases.
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Affiliation(s)
- Roxana Daneshjou
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Kailas Vodrahalli
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Roberto A. Novoa
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
- Department of Pathology, Stanford School of Medicine, Stanford, CA, USA
| | - Melissa Jenkins
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Weixin Liang
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Ko
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Susan M. Swetter
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Elizabeth E. Bailey
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Pritam Mukherjee
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Phung
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Kiana Yekrang
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Bradley Fong
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Rachna Sahasrabudhe
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | - Johan A. C. Allerup
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
| | | | - James Zou
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
- Chan-Zuckerberg Biohub, San Francisco, CA, USA
| | - Albert S. Chiou
- Department of Dermatology, Stanford School of Medicine, Redwood City, CA, USA
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21
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Swetter SM, Mesia RJ, Rodriguez Espinosa P, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, G. Rosas L. A qualitative exploration of melanoma awareness and prevention among Latinx and non-Latinx White populations in urban and rural California. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9588 Background: Melanoma mortality rates remain high among individuals of lower socioeconomic (SES) status, and racial/ethnic minorities, despite rates declining in non-Latinx whites (NLW). To improve understanding about the factors contributing to inequities in melanoma prevention and care, a qualitative exploratory study was conducted in Northern and Southern California regarding awareness, prevention, and early detection of melanoma in lower SES NLW and Latinx populations living in urban and semi-rural areas. Methods: Nineteen focus group (n = 176 individuals: 77% female, 59% self-identified Latinx/Hispanic, and 40% Medi-Cal/state insurance recipients) were conducted with adult participants, stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). The interview topics included: 1) awareness and views of melanoma risk, prevention, and early detection screening practices; 2) acceptability of primary and secondary prevention strategies in their respective community; and 3) barriers and facilitators of engagement in melanoma prevention and care. Using a hybrid inductive and deductive approach, thematic analysis was used for data analysis. Findings were organized within a socioecological model (individual, interpersonal, community and health system/policy level). Results: Individual level findings revealed that many participants were not familiar about melanoma yet were willing to learn through trusted sources. Brown or darker skin tones were perceived as having less risk for skin cancer. Interpersonally, social relationships were important influences for individuals practicing skin cancer prevention. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for dermatology care access. Healthcare systems barriers included burdens of additional medical care costs and obtaining dermatology referral. Many participants were in support of health regulations and education that reduce skin cancer risks for outdoor workers and children. Conclusions: Varying and intersecting factors influence melanoma awareness, and behaviors associated with knowledge, prevention, and early detection of melanoma in low-income NLW and Latinx individuals and in those living in semi-rural areas. Our findings promote understanding of how barriers across the socioecological spectrum may affect melanoma prevention and early detection particularly among men, individuals of lower socioeconomic status, and Latinx individuals. The study results have implications for health education interventions, which can involve health navigation strategies for individuals and families.
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Affiliation(s)
- Susan M. Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, CA
| | - Rachel J. Mesia
- Stanford University School of Medicine, Stanford Cancer Institute, Redwood City, CA
| | | | | | - Nadia Safaeinili
- University of California Berkeley, School of Public Health, Berkeley, CA
| | - Laurel J. Finster
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Vijaytha Muralidharan
- Stanford University Medical Center, Department of Dermatology/Cutaneous Oncology, Stanford, CA
| | - Beth A Glenn
- University of California-Los Angeles, Los Angeles, CA
| | | | - Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
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22
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Beaulieu D, Gao DX, Swetter SM, Hawryluk EB, Geller AC. Association between income and suspected nonmelanoma and melanoma skin cancers among participants of the American Academy of Dermatology's SPOT Skin Cancer screening program: A cross-sectional analysis. J Am Acad Dermatol 2022; 86:1401-1403. [PMID: 34089798 DOI: 10.1016/j.jaad.2021.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Derek Beaulieu
- Department of Dermatology, Stanford University, Redwood City, California
| | - David X Gao
- University of Illinois College of Medicine, Peoria, Illinois
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Redwood City, California; Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, and Boston Children's Hospital, Boston, Massachusetts
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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23
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Bartlett EK, Grossman D, Swetter SM, Leachman SA, Curiel-Lewandrowski C, Dusza SW, Gershenwald JE, Kirkwood JM, Tin AL, Vickers AJ, Marchetti MA. ASO Visual Abstract: Clinically Significant Risk Thresholds in the Management of Primary Cutaneous Melanoma: A Survey of Melanoma Experts. Ann Surg Oncol 2022. [PMID: 35616750 DOI: 10.1245/s10434-022-11903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Douglas Grossman
- Department of Dermatology, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Dermatology Service, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sancy A Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Clara Curiel-Lewandrowski
- Department of Dermatology, University of Arizona Cancer Center Skin Cancer Institute, University of Arizona, Tucson, AR, USA
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Kirkwood
- Department of Internal Medicine, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Chen ML, de Vere Hunt IJ, John EM, Weinstock MA, Swetter SM, Linos E. Differences in Thickness-Specific Incidence and Factors Associated With Cutaneous Melanoma in the US From 2010 to 2018. JAMA Oncol 2022; 8:755-759. [PMID: 35323844 PMCID: PMC8949752 DOI: 10.1001/jamaoncol.2022.0134] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
Importance The recent incidence of cutaneous melanoma of different thicknesses in the US is not well described. Objective To evaluate recent patterns in the incidence of melanoma by tumor thickness and examine associations of sex, race and ethnicity, and socioeconomic status with melanoma thickness-specific incidence. Design, Setting, and Participants This population-based cohort study analyzed data for 187 487 patients with a new diagnosis of invasive cutaneous melanoma from the Surveillance, Epidemiology, and End Results Registry from January 1, 2010, to December 31, 2018. The study was conducted from May 27 to December 29, 2021. Data were analyzed from June 21 to October 24, 2021. Main Outcomes and Measures Age-adjusted incidence rates of melanoma were calculated by tumor thickness (categorized by Breslow thickness) and annual percentage change (APC) in incidence rates. Analyses were stratified by sex and race and ethnicity. The associations with socioeconomic status were evaluated in 134 359 patients diagnosed with melanoma from 2010 to 2016. Results This study included 187 487 patients with a median (IQR) age of 62 (52-72) years and 58.4% men. Melanoma incidence was higher in men compared with women across all tumor thickness groups. Individuals in lower socioeconomic status quintiles and members of minority groups were more likely to be diagnosed with thicker (T4) tumors (20.7% [169 of 816] among non-Hispanic Black patients, 11.2% [674 of 6042] among Hispanic patients, and 6.3% [10 774 of 170 155] among non-Hispanic White patients). Between 2010 and 2018, there was no significant increase in incidence of cutaneous melanoma across the full population (APC, 0.39%; 95% CI, -0.40% to 1.18%). The incidence of the thickest melanomas (T4, >4.0 mm) increased between 2010 and 2018, with an APC of 3.32% (95% CI, 2.06%-4.60%) overall, 2.50% (95% CI, 1.27%-3.73%) in men, and 4.64% (95% CI, 2.56%-6.75%) in women. Conclusions and Relevance In this population-based cohort study, the incidence of the thickest cutaneous melanoma tumors increased from 2010 to 2018, in contrast with the incidence patterns for thinner melanomas. The findings suggest potential stabilization of overall melanoma incidence rates in the US after nearly a century of continuous increase in incidence. Patients with low socioeconomic status and Hispanic patients were more likely to be diagnosed with thick melanoma. The continued rise in incidence of thick melanoma is unlikely to be attributable to overdiagnosis given the stability of thin melanoma rates.
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Affiliation(s)
- Michael L. Chen
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Isabella Joy de Vere Hunt
- Program for Clinical Research and Technology, Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Esther M. John
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
| | - Martin A. Weinstock
- Center for Dermatoepidemiology, Providence Veterans Affairs Medical Center, Providence, Rhode Island
- Department of Dermatology, Brown University, Providence, Rhode Island
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Susan M. Swetter
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Stanford, California
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
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25
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Fried LJ, Tan A, Berry EG, Braun RP, Curiel-Lewandrowski C, Curtis J, Ferris LK, Hartman RI, Jaimes N, Kawaoka JC, Kim CC, Lallas A, Leachman SA, Levin A, Lucey P, Marchetti MA, Marghoob AA, Miller D, Nelson KC, Prodanovic E, Seiverling EV, Swetter SM, Savory SA, Usatine RP, Wei ML, Polsky D, Stein JA, Liebman TN. Dermoscopy Proficiency Expectations for US Dermatology Resident Physicians: Results of a Modified Delphi Survey of Pigmented Lesion Experts. JAMA Dermatol 2021; 157:189-197. [PMID: 33404623 DOI: 10.1001/jamadermatol.2020.5213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Dermoscopy education in US dermatology residency programs varies widely, and there is currently no existing expert consensus identifying what is most important for resident physicians to know. Objectives To identify consensus-based learning constructs representing an appropriate foundational proficiency in dermoscopic image interpretation for dermatology resident physicians, including dermoscopic diagnoses, associated features, and representative teaching images. Defining these foundational proficiency learning constructs will facilitate further skill development in dermoscopic image interpretation to help residents achieve clinical proficiency. Design, Setting, and Participants A 2-phase modified Delphi surveying technique was used to identify resident learning constructs in 3 sequential sets of surveys-diagnoses, features, and images. Expert panelists were recruited through an email distributed to the 32 members of the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group. Twenty-six (81%) opted to participate. Surveys were distributed using RedCAP software. Main Outcomes and Measures Consensus on diagnoses, associated dermoscopic features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for US dermatology resident physicians. Results Twenty-six pigmented lesion and dermoscopy specialists completed 8 rounds of surveys, with 100% (26/26) response rate in all rounds. A final list of 32 diagnoses and 116 associated dermoscopic features was generated. Three hundred seventy-eight representative teaching images reached consensus with panelists. Conclusions and Relevance Consensus achieved in this modified Delphi process identified common dermoscopic diagnoses, associated features, and representative teaching images reflective of a foundational proficiency in dermoscopic image interpretation for dermatology residency training. This list of validated objectives provides a consensus-based foundation of key learning points in dermoscopy to help resident physicians achieve clinical proficiency in dermoscopic image interpretation.
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Affiliation(s)
- Lauren J Fried
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Ralph P Braun
- Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | - Clara Curiel-Lewandrowski
- The Skin Cancer Institute-University of Arizona Cancer Center, Tucson.,Division of Dermatology at the University of Arizona College of Medicine, Tucson
| | - Julia Curtis
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Melanoma Program, Dana-Farber Cancer Institute, Boston, Massachusetts.,VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
| | - Natalia Jaimes
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami, Florida
| | - John C Kawaoka
- Department of Dermatology, Brown Medical School, Providence, Rhode Island
| | - Caroline C Kim
- Melanoma and Pigmented Lesion Program, Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Alan Levin
- Division of Dermatology, University of Arizona College of Medicine, Tucson
| | - Patricia Lucey
- Inova Schar Cancer Institute Melanoma Center, Fairfax, Virginia
| | - Michael A Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debbie Miller
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward Prodanovic
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Elizabeth V Seiverling
- Tufts University School of Medicine, Department of Dermatology, Portland, Maine.,Maine Medical Center Division of Dermatology, Portland, Maine
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Medical Center and Cancer Institute, Stanford, California
| | - Stephanie A Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Richard P Usatine
- Department of Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio
| | - Maria L Wei
- Department of Dermatology, University of California-San Francisco, San Francisco.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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26
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Chambers M, Swetter SM, Baker C, Saunders E, Chapman MS. Topical Imiquimod for Lentigo Maligna: Survival Analysis of 103 Cases With 17 Years Follow-up. J Drugs Dermatol 2021; 20:346-348. [PMID: 33683087 DOI: 10.36849/jdd.5660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Topical imiquimod 5% cream has been investigated as off-label primary or adjuvant treatment for melanoma in situ, lentigo maligna type (LM). Herein, we present the largest known case series of lentigo maligna treated with topical imiquimod, with up to 17 years of follow-up, and include a recurrence-free survival analysis. In this case series, 103 lesions were retrospectively evaluated for treatment response and recurrence following a course of topical imiquimod with or without tazarotene gel 0.1% pretreatment between January 1, 2002 and March 31, 2019, and prospectively followed through November 15, 2019. Over median follow-up of 5.1 years (mean = 6.2 years, S = 5.2 years, range, 0.08–17.1 years), including 29.1% LM with >10 years follow-up, we observed a response rate of 97.1% (100/103), with 8 local recurrences (8/100, 8.0%) developing at mean 2.9 years (SD: 2.7 years). Local recurrence was significantly associated with a history of failed excision (P= 0.001), <60 applications of imiquimod (P= 0.04) and partial clinical clearance (P= 0.0003). Recurrence-free survival analysis demonstrated significant risk-stratification for low and high-risk groups (P= 0.0001). Long term risk for recurrence showed significant differences among low- and high-risk cases, with low-risk cases demonstrating favorable long-term outcomes, comparable to conventional and staged surgery. Our observed low recurrence in a large case series with long-term follow-up suggests the efficacy of topical 5% imiquimod for LM and emphasizes the need for randomized control trials comparing imiquimod with, or as an adjunct to, surgical treatment. J Drugs Dermatol. 2021;20(3):346-348. doi:10.36849/JDD.5660.
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27
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Swetter SM, Liu LY, Gyurdzhyan S, Zaba LC. Efficacy of regional nodal ultrasound surveillance for metastatic detection in sentinel- and complete lymph node dissection-eligible melanoma patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21568 Background: Nodal ultrasound (US) is the preferred method for regional surveillance of clinically node-negative (cN0) primary cutaneous melanoma (CM) when sentinel lymph node biopsy (SLNB) is not performed or unsuccessful, and for pathologically node-positive (pN+) disease without completion lymph node dissection (CLND). Methods: Retrospective review was performed of nodal US surveillance from 2011-2021 in SLNB-eligible cN0 CM patients when SLNB was deferred or technically not feasible ( i.e., from failure of lymphoscintigraphic dye migration) or those with pN+ disease on SLNB, without subsequent CLND. Patients were followed for at least 2 years or until recurrence. The primary endpoints were US detection of regional nodal recurrence and comparison to clinical exam or cross-sectional imaging (PET-CT and/or CT). Results: In total, 67 patients met inclusion criteria and underwent a median of 4 nodal US exams (interquartile range, IQR 3-5) over 2-3 years of follow-up. Thirty-two (47.8%) patients declined or had unsuccessful SLNB, and 35 (52.2%) deferred CLND in favor of nodal US surveillance. Sixteen (23.9%) patients had clinical stage IA/IB (cIA/IB) CM, 15 (22.3%) had clinical stage II (cII) disease, and 36 (53.7%) had pathologic stage III (pIII) disease. Three (4.5%) patients developed satellite/in-transit metastasis, 6 (8.9%) had regional nodal recurrence, 4 (6.0%) had both local and regional recurrence, and 7 (10.4%) developed distant metastasis. Eighteen (26.9%) patients underwent tissue sampling, with 10 positive for melanoma. Nodal recurrence was observed in patients with initial cIB (1), cIIA (1), cIIB (1), cIIC (2), pIIIA (1), and pIIIC (4) disease. Three patients (cIIA, cIIB, and pIIIC due to microsatellites) had abnormal clinical exams with concurrent palpable regional adenopathy and in-transit metastasis. One patient (pIIIC) developed local satellite metastasis followed by palpable regional adenopathy. The most common surveillance method for metastatic detection was US (6/10), followed by clinical exam (3/10) and PET-CT (1/10). All metastatic nodes on US were metabolically active on subsequent PET-CT. One patient in whom PET-CT was the initial method of detection had no confirmatory US. Conclusions: Nodal US for CM requires specific radiologic expertise and is gaining traction as a cost-effective imaging modality in the United States. Our findings support the effectiveness of nodal US surveillance in cN0 or pN+ CM patients in whom SLNB or CLND is not performed.[Table: see text]
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Affiliation(s)
- Susan M. Swetter
- Stanford University Medical Center and Cancer Institute, Dept Dermatology/Cutaneous Oncology, Stanford, CA
| | - Lucy Y. Liu
- Stanford University Medical Center, Department of Dermatology, Redwood City, CA
| | | | - Lisa C. Zaba
- Stanford University Medical Center and Cancer Institute, Dept Dermatology/Cutaneous Oncology, Palo Alto, CA
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28
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Johnson DB, Swetter SM, Salama AK, Wuthrick E. Cutaneous Melanoma: Management of Melanoma Brain Metastases and Molecular Testing. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2021.5021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several advances in diagnosis and treatment of cutaneous melanoma were discussed at the NCCN 2021 Virtual Annual Conference. First, advances in immunotherapies and targeted agents have enhanced the role of systemic therapies in the up-front management of brain metastases in melanoma while improving survival. With dual-agent immune checkpoint inhibitors, more than half of patients with asymptomatic brain metastases that are not in high-risk anatomic areas of the brain respond to treatment, and these responses appear to be durable, sparing many patients from neurosurgery and/or stereotactic radiosurgery. In addition, molecular tests increasingly have implications for clinical decision-making in later-stage disease. The most important genetic mutation in melanoma is the BRAF V600 mutation, which can be found in approximately 40% to 50% of cutaneous melanomas.
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29
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Chang MS, Leachman SA, Berry EG, Curiel-Lewandrowski C, Geller AC, Grossman D, Kim CC, Stein JA, Swetter SM, Hartman RI. Changes in melanoma care practices during the COVID-19 pandemic: a multi-institutional cross-sectional survey. Dermatol Online J 2021; 27:13030/qt4sc3k9r0. [PMID: 33999590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023] Open
Affiliation(s)
- Michael S Chang
- Harvard Medical School, Boston, MA Department of Dermatology, Brigham and Women's Hospital, Boston, MA
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30
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Coroiu A, Moran C, Davine JA, Brophy K, Bergeron C, Tsao H, Körner A, Swetter SM, Geller AC. Patient-identified early clinical warning signs of nodular melanoma: a qualitative study. BMC Cancer 2021; 21:371. [PMID: 33827477 PMCID: PMC8028760 DOI: 10.1186/s12885-021-08072-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nodular (NM) and superficial spreading melanoma (SSM) show different disease trajectories, with more rapid development in NM and fewer opportunities for early detection often resulting in worse outcomes. Our study described the patient-identified early signs of thin NM via comparisons to thin (≤ 2 mm) SSM and thick (> 2 mm) NM. METHODS We conducted semi-structured interviews with NM and SSM patients and analyzed the data using thematic analysis. RESULTS We enrolled 34 NM and 32 SSM patients. Melanoma early signs uniquely identified by patients with thin NM included white, blue or black coloration, "dot-like" size, fast changes in shape and color observed over 2 weeks, elevation and texture or "puffiness" over 6-12 months, and the sensation that the mole "did not feel right". Early signs reported by both thin NM and thin SSM patients included round or oblong shape, "jagged" border, pink/red, brown/reddish or dark coloration, "elevated like a pimple" or "tiny bump", fast color darkening, diameter growth, and border irregularity, and mole feeling "really itchy". CONCLUSIONS We found evidence that early signs of NM can be self-identified, which has important implications for the earlier detection of this most aggressive type of melanoma by both health professionals and patients.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
| | - Kyla Brophy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Hensin Tsao
- Harvard Medical School, Boston, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, USA
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
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31
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Swetter SM, Thompson JA, Albertini MR, Barker CA, Baumgartner J, Boland G, Chmielowski B, DiMaio D, Durham A, Fields RC, Fleming MD, Galan A, Gastman B, Grossmann K, Guild S, Holder A, Johnson D, Joseph RW, Karakousis G, Kendra K, Lange JR, Lanning R, Margolin K, Olszanski AJ, Ott PA, Ross MI, Salama AK, Sharma R, Skitzki J, Sosman J, Wuthrick E, McMillian NR, Engh AM. NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2021. J Natl Compr Canc Netw 2021; 19:364-376. [PMID: 33845460 DOI: 10.6004/jnccn.2021.0018] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past few years, the NCCN Guidelines for Melanoma: Cutaneous have been expanded to include pathways for treatment of microscopic satellitosis (added in v2.2020), and the following Principles sections: Molecular Testing (added in v2.2019), Systemic Therapy Considerations (added in v2.2020), and Brain Metastases Management (added in v3.2020). The v1.2021 update included additional modifications of these sections and notable revisions to Principles of: Pathology, Surgical Margins for Wide Excision of Primary Melanoma, Sentinel Lymph Node Biopsy, Completion/Therapeutic Lymph Node Dissection, and Radiation Therapy. These NCCN Guidelines Insights discuss the important changes to pathology and surgery recommendations, as well as additions to systemic therapy options for patients with advanced disease.
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Affiliation(s)
| | - John A Thompson
- 2Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Ryan C Fields
- 10Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Martin D Fleming
- 11St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Brian Gastman
- 13Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | - Kari Kendra
- 20The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Julie R Lange
- 21The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | - Rohit Sharma
- 28UT Southwestern Simmons Comprehensive Cancer Center
| | | | - Jeffrey Sosman
- 30Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Orfaly VE, Berry EG, Stoos ER, Latour E, Becevic M, Black SM, Ferris LK, Geller A, Jacobe H, Nelson KC, Prasad S, Savory S, Smith EH, Swetter SM, Weinstock MA, Xu S, Leachman SA. Melanoma toolkit for early detection for primary care providers: A pilot study. Pigment Cell Melanoma Res 2021; 34:984-986. [PMID: 33638298 PMCID: PMC8647840 DOI: 10.1111/pcmr.12968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/14/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Victoria E Orfaly
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth R Stoos
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Emile Latour
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Mirna Becevic
- Department of Dermatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Samantha M Black
- Department of Dermatology, University of Texas Southwestern Medical Center, Houston, TX, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan Geller
- Department of Public Health Practice, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Smriti Prasad
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie Savory
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily H Smith
- Department of Dermatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, CA, USA
| | - Martin A Weinstock
- Department of Dermatology, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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Rao PK, Barker C, Coit DG, Joseph RW, Materin M, Rengan R, Sosman J, Thompson JA, Albertini MR, Boland G, Carson Iii WE, Contreras C, Daniels GA, DiMaio D, Durham A, Fields RC, Fleming MD, Galan A, Gastman B, Grossman K, Guild V, Johnson D, Karakousis G, Lange JR, Margolin K, Nath S, Olszanski AJ, Ott PA, Ross MI, Salama AK, Skitzki J, Swetter SM, Wuthrick E, McMillian NR, Engh A. NCCN Guidelines Insights: Uveal Melanoma, Version 1.2019. J Natl Compr Canc Netw 2021; 18:120-131. [PMID: 32023525 DOI: 10.6004/jnccn.2020.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Uveal Melanoma include recommendations for staging, treatment, and follow-up of patients diagnosed with uveal melanoma of the choroid or ciliary body. In addition, because distinguishing between uveal melanoma and benign uveal nevi is in some cases difficult, these guidelines also contain recommendations for workup of patients with suspicious pigmented uveal lesions, to clarify the tests needed to distinguish between those who should have further workup and treatment for uveal melanoma versus those with uncertain diagnosis and low risk who should to be followed and later reevaluated. These NCCN Guidelines Insights describe recommendations for treatment of newly diagnosed nonmetastatic uveal melanoma in patients who have already undergone a complete workup.
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Affiliation(s)
- P Kumar Rao
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ramesh Rengan
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Jeffrey Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - John A Thompson
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - William E Carson Iii
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Ryan C Fields
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Brian Gastman
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Atkins MB, Curiel-Lewandrowski C, Fisher DE, Swetter SM, Tsao H, Aguirre-Ghiso JA, Soengas MS, Weeraratna AT, Flaherty KT, Herlyn M, Sosman JA, Tawbi HA, Pavlick AC, Cassidy PB, Chandra S, Chapman PB, Daud A, Eroglu Z, Ferris LK, Fox BA, Gershenwald JE, Gibney GT, Grossman D, Hanks BA, Hanniford D, Hernando E, Jeter JM, Johnson DB, Khleif SN, Kirkwood JM, Leachman SA, Mays D, Nelson KC, Sondak VK, Sullivan RJ, Merlino G. The State of Melanoma: Emergent Challenges and Opportunities. Clin Cancer Res 2021; 27:2678-2697. [PMID: 33414132 DOI: 10.1158/1078-0432.ccr-20-4092] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/26/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
Five years ago, the Melanoma Research Foundation (MRF) conducted an assessment of the challenges and opportunities facing the melanoma research community and patients with melanoma. Since then, remarkable progress has been made on both the basic and clinical research fronts. However, the incidence, recurrence, and death rates for melanoma remain unacceptably high and significant challenges remain. Hence, the MRF Scientific Advisory Council and Breakthrough Consortium, a group that includes clinicians and scientists, reconvened to facilitate intensive discussions on thematic areas essential to melanoma researchers and patients alike, prevention, detection, diagnosis, metastatic dormancy and progression, response and resistance to targeted and immune-based therapy, and the clinical consequences of COVID-19 for patients with melanoma and providers. These extensive discussions helped to crystalize our understanding of the challenges and opportunities facing the broader melanoma community today. In this report, we discuss the progress made since the last MRF assessment, comment on what remains to be overcome, and offer recommendations for the best path forward.
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Affiliation(s)
- Michael B Atkins
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C.
| | - Clara Curiel-Lewandrowski
- Department of Dermatology, The University of Arizona Cancer Center Skin Cancer Institute, College of Medicine, University of Arizona, Tucson, Arizona
| | - David E Fisher
- Department of Dermatology & Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion & Melanoma Program, Stanford University Medical Center & Cancer Institute, VA Palo Alto Health Care System, Palo Alto, California
| | - Hensin Tsao
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julio A Aguirre-Ghiso
- Division of Hematology & Oncology, Departments of Medicine, Otolaryngology, & Oncological Sciences, Precision Immunology Institute, Black Family Stem Cell Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria S Soengas
- Molecular Oncology Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Ashani T Weeraratna
- Department of Biochemistry & Molecular Biology, Johns Hopkins Bloomberg School of Public Health & Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Keith T Flaherty
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Hussein A Tawbi
- Division of Cancer Medicine, Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Pamela B Cassidy
- Knight Cancer Institute & Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Sunandana Chandra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Paul B Chapman
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College, New York, New York
| | - Adil Daud
- University of California, San Francisco, California
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bernard A Fox
- Department of Molecular Microbiology & Immunology, Oregon Health & Science University, Laboratory of Molecular & Tumor Immunology, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, Oregon
| | - Jeffrey E Gershenwald
- Departments of Surgical Oncology & Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey T Gibney
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C
| | - Douglas Grossman
- Huntsman Cancer Institute & Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Brent A Hanks
- Division of Medical Oncology, Department of Medicine, Department of Pharmacology & Cancer Biology, Center for Cancer Immunotherapy, Duke University Medical Center, Durham, North Carolina
| | - Douglas Hanniford
- Department of Pathology, NYU Grossman School of Medicine, Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, New York, New York
| | - Eva Hernando
- Department of Pathology, NYU Grossman School of Medicine, Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, New York, New York
| | - Joanne M Jeter
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samir N Khleif
- The Loop Laboratory for Immuno-Oncology Lombardi Cancer Center, Georgetown School of Medicine, Georgetown University, Washington, D.C
| | | | - Sancy A Leachman
- Knight Cancer Institute & Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Darren Mays
- Department of Internal Medicine, College of Medicine, The Ohio State University, Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ryan J Sullivan
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Chang MS, Leachman SA, Berry EG, Curiel-Lewandrowski C, Geller AC, Grossman D, Kim CC, Stein JA, Swetter SM, Hartman RI. Changes in melanoma care practices during the COVID-19 pandemic: a multi-institutional cross-sectional survey. Dermatol Online J 2021. [DOI: 10.5070/d3274053169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Grossman D, Okwundu N, Bartlett EK, Marchetti MA, Othus M, Coit DG, Hartman RI, Leachman SA, Berry EG, Korde L, Lee SJ, Bar-Eli M, Berwick M, Bowles T, Buchbinder EI, Burton EM, Chu EY, Curiel-Lewandrowski C, Curtis JA, Daud A, Deacon DC, Ferris LK, Gershenwald JE, Grossmann KF, Hu-Lieskovan S, Hyngstrom J, Jeter JM, Judson-Torres RL, Kendra KL, Kim CC, Kirkwood JM, Lawson DH, Leming PD, Long GV, Marghoob AA, Mehnert JM, Ming ME, Nelson KC, Polsky D, Scolyer RA, Smith EA, Sondak VK, Stark MS, Stein JA, Thompson JA, Thompson JF, Venna SS, Wei ML, Swetter SM. Prognostic Gene Expression Profiling in Cutaneous Melanoma: Identifying the Knowledge Gaps and Assessing the Clinical Benefit. JAMA Dermatol 2020; 156:1004-1011. [PMID: 32725204 PMCID: PMC8275355 DOI: 10.1001/jamadermatol.2020.1729] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Use of prognostic gene expression profile (GEP) testing in cutaneous melanoma (CM) is rising despite a lack of endorsement as standard of care. Objective To develop guidelines within the national Melanoma Prevention Working Group (MPWG) on integration of GEP testing into the management of patients with CM, including (1) review of published data using GEP tests, (2) definition of acceptable performance criteria, (3) current recommendations for use of GEP testing in clinical practice, and (4) considerations for future studies. Evidence Review The MPWG members and other international melanoma specialists participated in 2 online surveys and then convened a summit meeting. Published data and meeting abstracts from 2015 to 2019 were reviewed. Findings The MPWG members are optimistic about the future use of prognostic GEP testing to improve risk stratification and enhance clinical decision-making but acknowledge that current utility is limited by test performance in patients with stage I disease. Published studies of GEP testing have not evaluated results in the context of all relevant clinicopathologic factors or as predictors of regional nodal metastasis to replace sentinel lymph node biopsy (SLNB). The performance of GEP tests has generally been reported for small groups of patients representing particular tumor stages or in aggregate form, such that stage-specific performance cannot be ascertained, and without survival outcomes compared with data from the American Joint Committee on Cancer 8th edition melanoma staging system international database. There are significant challenges to performing clinical trials incorporating GEP testing with SLNB and adjuvant therapy. The MPWG members favor conducting retrospective studies that evaluate multiple GEP testing platforms on fully annotated archived samples before embarking on costly prospective studies and recommend avoiding routine use of GEP testing to direct patient management until prospective studies support their clinical utility. Conclusions and Relevance More evidence is needed to support using GEP testing to inform recommendations regarding SLNB, intensity of follow-up or imaging surveillance, and postoperative adjuvant therapy. The MPWG recommends further research to assess the validity and clinical applicability of existing and emerging GEP tests. Decisions on performing GEP testing and patient management based on these results should only be made in the context of discussion of testing limitations with the patient or within a multidisciplinary group.
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Affiliation(s)
- Douglas Grossman
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
- Department of Oncological Sciences, University of Utah, Salt Lake City
| | | | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca I Hartman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Elizabeth G Berry
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Larissa Korde
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Sandra J Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Data Sciences, Harvard Medical School, Boston, Massachusetts
| | - Menashe Bar-Eli
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston
| | - Marianne Berwick
- Departments of Dermatology and Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque
| | - Tawnya Bowles
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Elizabeth I Buchbinder
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M Burton
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | | | - Julia A Curtis
- Department of Dermatology, University of Utah, Salt Lake City
| | - Adil Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Hematology/Oncology, University of California, San Francisco
| | - Dekker C Deacon
- Department of Dermatology, University of Utah, Salt Lake City
| | - Laura K Ferris
- Department of Dermatology and University of Pittsburgh Clinical and Translational Science Institute, Pittsburgh, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth F Grossmann
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Medicine, Division of Oncology, University of Utah, Salt Lake City
| | - John Hyngstrom
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Surgery, Division of Surgical Oncology, University of Utah, Salt Lake City
| | - Joanne M Jeter
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Robert L Judson-Torres
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Dermatology, University of Utah, Salt Lake City
| | - Kari L Kendra
- Department of Internal Medicine and The Ohio State University Comprehensive Cancer Center, Columbus
| | - Caroline C Kim
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
- Partners Healthcare, Newton Wellesley Dermatology Associates, Wellesley, Massachusetts
| | - John M Kirkwood
- Department of Internal Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Janice M Mehnert
- Department of Medical Oncology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine University of Pennsylvania, Philadelphia
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston
| | - David Polsky
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Eric A Smith
- Department of Pathology, University of Utah, Salt Lake City
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa
| | - Mitchell S Stark
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Jennifer A Stein
- Department of Dermatology, Ronald O. Perelman Department of Dermatology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York University School of Medicine, New York, New York
| | - John A Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Oncology, University of Washington, Seattle
- Seattle Cancer Care Alliance, Seattle, Washington
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Suraj S Venna
- Inova Schar Cancer Institute, Department of Medicine, Virginia Commonwealth University, Fairfax
| | - Maria L Wei
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
- Department of Dermatology, University of California, San Francisco
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California
| | - Susan M Swetter
- Stanford University Medical Center and Cancer Institute, Stanford, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Affiliation(s)
- M Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA
| | - C Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - H P Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Ransohoff KJ, Nord KM, Bailey EE, Ransohoff JD, Li S, Swetter SM. Local recurrence of clinically observed basal cell carcinomas following complete saucerization or punch removal with negative margins: Retrospective case series from 2010 to 2020. J Am Acad Dermatol 2020; 83:1763-1765. [PMID: 32234307 DOI: 10.1016/j.jaad.2020.03.061] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Katherine J Ransohoff
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, California; Department of Dermatology, Stanford University Medical Center, California
| | - Kristin M Nord
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, California; Department of Dermatology, Stanford University Medical Center, California
| | - Elizabeth E Bailey
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, California; Department of Dermatology, Stanford University Medical Center, California
| | - Julia D Ransohoff
- Department of Dermatology, Stanford University Medical Center, California
| | - Shufeng Li
- Department of Dermatology, Stanford University Medical Center, California
| | - Susan M Swetter
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, California; Department of Dermatology, Stanford University Medical Center, California.
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Sodji QH, Gutkin PM, Swetter SM, Reddy SA, Hiniker SM, Knox SJ. Durability of response in metastatic melanoma patients after combined treatment with radiation therapy and ipilimumab. Melanoma Manag 2020; 7:MMT36. [PMID: 32399174 PMCID: PMC7212514 DOI: 10.2217/mmt-2019-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
AIM We previously reported a prospective trial evaluating the safety and efficacy of combining ipilimumab and radiation therapy in patients with metastatic melanoma. Herein, we provide a long-term update on patients with complete response (CR) or partial response (PR). PATIENTS & METHODS We continued to follow these patients with serial imaging including computed tomography, PET or MRI. RESULTS Two of the three patients with CR are still alive and without evidence of melanoma but with chronic treatment-induced hypophysitis. The third patient died of hepatocellular carcinoma, but with no evidence of melanoma. Among the three patients with PR, two achieved CR after pembrolizumab monotherapy. CONCLUSION This long-term follow up reveals the striking durability of the CRs, which appears to correlate with a grade 2-3 hypophysitis.
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Affiliation(s)
- Quaovi H Sodji
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Paulina M Gutkin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Dermatology Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Sunil A Reddy
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
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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] [What about the content of this article? (0)] [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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Grossman D, Kim CC, Hartman RI, Berry E, Nelson KC, Okwundu N, Curiel-Lewandrowski C, Leachman SA, Swetter SM. Prognostic gene expression profiling in melanoma: necessary steps to incorporate into clinical practice. Melanoma Manag 2019; 6:MMT32. [PMID: 31871621 PMCID: PMC6920745 DOI: 10.2217/mmt-2019-0016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Prognostic gene expression profiling (GEP) tests for cutaneous melanoma (CM) are not recommended in current guidelines outside of a clinical trial. However, their use is becoming more prevalent and some practitioners are using GEP tests to guide patient management. Thus, there is an urgent need to bridge this gap between test usage and clinical guideline recommendations by obtaining high-quality evidence to guide us toward best practice use of GEP testing in CM patients. We focus here on the opportunities and uncertainties associated with prognostic GEP testing in CM, review how GEP testing was incorporated into clinical care guidelines for uveal melanoma and breast cancer and discuss the role of clinical trials to determine best use in patients with CM.
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Affiliation(s)
- Douglas Grossman
- Dermatology, Huntsman Cancer Institute & University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA
| | - Caroline C Kim
- Dermatology, Tufts Medical Center, Boston & Newton Wellesley Hospital, Wellesley, MA 02111, USA
| | - Rebecca I Hartman
- Dermatology, Brigham & Women's Hospital, Harvard Medical School, & Veterans Affairs Boston Healthcare System, Boston, MA 02446, USA
| | - Elizabeth Berry
- Dermatology, Oregon Health & Sciences University & Knight Cancer Institute, Portland, OR 97239, USA
| | - Kelly C Nelson
- Dermatology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nwanneka Okwundu
- Dermatology, Huntsman Cancer Institute & University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA
| | | | - Sancy A Leachman
- Dermatology, Oregon Health & Sciences University & Knight Cancer Institute, Portland, OR 97239, USA
| | - Susan M Swetter
- Dermatology, Stanford University Medical Center & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94305, USA
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Chen R, Hipp JA, Morrison L, Henriksen L, Swetter SM, Linos E. Association of Number of Indoor Tanning Salons With Neighborhoods With Higher Concentrations of Male-Male Partnered Households. JAMA Netw Open 2019; 2:e1912443. [PMID: 31584678 PMCID: PMC6784810 DOI: 10.1001/jamanetworkopen.2019.12443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Both indoor tanning and skin cancer are more common among sexual-minority men, defined as gay and bisexual men, than among heterosexual men. Convenient access to indoor tanning salons may influence use patterns. OBJECTIVE To investigate whether indoor tanning salons are disproportionately located in areas with higher concentrations of gay men. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used geographic information systems to integrate census data and business location data obtained from ArcGIS and Google Maps for the 10 US cities with the largest lesbian, gay, bisexual, and transgender populations in 2010, ie, Los Angeles, California; Chicago, Illinois; San Francisco, California; Seattle, Washington; San Diego, California; Dallas, Texas; Phoenix, Arizona; Washington, DC; Portland, Oregon; and Denver, Colorado. The association of indoor tanning salon locations with proportions of gay men, using the concentration of male-male partnered households as a proxy measure for the latter, was examined. Data analysis was performed in October 2018. EXPOSURES Census tracts with at least 1%, 5%, or 10% male-male partnered households, adjusting for median household income, percentage young women, and percentage non-Hispanic white residents. MAIN OUTCOMES AND MEASURES Presence of 1 or more indoor tanning salons within census tracts. RESULTS Across the 10 cities and 4091 census tracts in this study, there were 482 823 unmarried partnered households, of which 35 164 (7.3%) were male-male. The median (interquartile range) percentage of male-male partnered households per census tract was 0% (0%-10.6%). Odds of indoor tanning salon presence in areas with at least 10% male-male households were more than twice those of areas with less than 10% male-male households (odds ratio, 2.17; 95% CI, 1.59-2.97). When sensitivity analyses using a 1-mile euclidian buffer around each tanning salon were conducted, this association remained significant (odds ratio, 2.48; 95% CI, 2.14-2.88). After adjusting for median household income, percentage young women, and percentage non-Hispanic white residents, the odds of an indoor tanning salon being within 1 mile of a census tract with at least 10% male-male households remained twice that of census tracts with less than 10% male-male households (odds ratio, 2.00; 95% CI, 1.71-2.35). CONCLUSIONS AND RELEVANCE In this study, indoor tanning salons were more likely to be located near neighborhoods with higher concentrations of male-male partnered households, possibly contributing to the disproportionate use of indoor tanning by sexual-minority men.
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Affiliation(s)
- Rebecca Chen
- Weill Cornell Medical College, New York, New York
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
| | - J. Aaron Hipp
- Center for Geospatial Analytics, North Carolina State University, Raleigh
| | - Lily Morrison
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford School of Medicine, Palo Alto, California
| | - Susan M. Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eleni Linos
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Palo Alto, California
- Stanford Health Research and Policy, Stanford School of Medicine, Palo Alto, California
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Nelson KC, Swetter SM, Saboda K, Chen SC, Curiel-Lewandrowski C. Evaluation of the Number-Needed-to-Biopsy Metric for the Diagnosis of Cutaneous Melanoma: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1167-1174. [PMID: 31290958 DOI: 10.1001/jamadermatol.2019.1514] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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 To date, no concerted effort has been made to date to evaluate the literature on number-needed-to-biopsy (NNB) metrics, particularly to account for the differences in clinician type and melanoma prevalence in certain geographic locations. Objective To review and synthesize worldwide data for NNB for the diagnosis of cutaneous melanoma. Data Source MEDLINE, Embase, and PubMed databases were searched for English-language articles published worldwide from January 1, 2000, to November 28, 2018. Study Selection A total of 46 studies were included that addressed NNB for at least 3681 clinicians worldwide and included 455 496 biopsied tumors and 29 257 melanomas; primary care practitioner (PCP) data were only available from Australia. Data Extraction and Synthesis Articles were screened for eligibility, and possible overlapping data sets were resolved. Data extracted included clinician specialization, use of dermoscopy, geographic region and location-specific health care system, study design, number of benign tumors, number of melanomas, and NNB. The review followed the PRISMA guidelines. Main Outcome and Measures The NNB for the diagnosis of cutaneous melanoma. Results A total of 46 studies were included that addressed NNB for at least 3681 clinicians worldwide and included 455 496 biopsied tumors and 29 257 melanomas; primary care practitioner (PCP) data were only available from Australia. The reported NNB ranged from 2.2 to 287, and the weighted mean NNB for all included publications was 15.6. The exclusion of publications structured as all biopsied tumors, owing to variable data characterization, resulted in reported NNB ranging from 2.2 to 30.5, with a global weighted mean NNB of 14.8 for all clinicians, 7.5 for all dermatologists, 14.6 for Australian PCPs, and 13.2 for all US-based dermatological practitioners, including dermatologists and advanced practice professionals. The summary effect size (ES) demonstrates that a mean 4% of biopsies demonstrated melanoma for study stratum A (all biopsied skin tumors, ES, 0.04; 95% CI, 0.03-0.05), and a mean 12% of biopsies demonstrated melanoma for study strata B (melanocytic tumors on pathology review, ES, 0.12; 95% CI, 0.10-0.14) and C (clinical concern for melanoma, ES; 0.12; 95% CI, 0.09-0.14). Conclusions and Relevance The existing NNB for cutaneous melanoma appeared to vary widely worldwide, lacking standardization in the metric and its reporting, and according to clinician characteristics as well; the NNB of US-based clinicians may warrant further exploration.
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Affiliation(s)
- Kelly C Nelson
- MD Anderson Cancer Center, Department of Dermatology, The University of Texas, Houston
| | - Susan M Swetter
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California.,Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Kathylynn Saboda
- Department of Biostatistics, The University of Arizona Cancer Center, Tucson
| | - Suephy C Chen
- Department of Dermatology, Emory University, Atlanta, Georgia.,Regional Telehealth Services, VISN7, VA Medical Center, Atlanta, Georgia
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Waldman RA, Grant-Kels JM, Curiel CN, Curtis J, Rodríguez SG, Hu S, Kerr P, Marghoob A, Markowitz O, Pellacani G, Rabinovitz H, Rao B, Scope A, Stein JA, Swetter SM. Consensus recommendations for the use of noninvasive melanoma detection techniques based on results of an international Delphi process. J Am Acad Dermatol 2019; 85:745-749. [PMID: 31563644 DOI: 10.1016/j.jaad.2019.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/25/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Reid A Waldman
- Department of Dermatology, University of Connecticut, Farmington
| | | | - Clara N Curiel
- Department of Dermatology, University of Arizona College of Medicine, Tucson
| | - Julia Curtis
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip Kerr
- Department of Dermatology, University of Connecticut, Farmington
| | - Ashfaq Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Orit Markowitz
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
| | | | - Babar Rao
- Department of Dermatology Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alon Scope
- The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Susan M Swetter
- Department of Dermatology Stanford University Medical Center, Stanford, California
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Bailey EE, Mayer JE, Geller AC, Johnson TM, Swetter SM. Role of the partner/spouse in melanoma discovery and related health behaviours and practices. Br J Dermatol 2019; 182:513-514. [PMID: 31487404 DOI: 10.1111/bjd.18478] [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: 11/30/2022]
Affiliation(s)
- E E Bailey
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, CA, U.S.A
| | - J E Mayer
- Department of Dermatology, UCHealth University of Colorado Hospital, Aurora, CO, U.S.A
| | - A C Geller
- Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A
| | - T M Johnson
- Department of Dermatology, University of Michigan Health System and Comprehensive Cancer Center, Ann Arbor, MI, U.S.A
| | - S M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, CA, U.S.A.,Dermatology Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, U.S.A
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Varedi A, Gardner LJ, Kim CC, Chu EY, Ming ME, Leachman SA, Curiel-Lewandrowski C, Swetter SM, Grossman D. Use of new molecular tests for melanoma by pigmented-lesion experts. J Am Acad Dermatol 2019; 82:245-247. [PMID: 31415835 DOI: 10.1016/j.jaad.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Amir Varedi
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City
| | | | - Caroline C Kim
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Michael E Ming
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health Sciences University, Portland
| | | | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City; Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City; Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City.
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47
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Afanasiev OK, Tu JH, Chu DH, Swetter SM. Characteristics of melanoma in white and nonwhite children, adolescents, and young adults: Analysis of a pediatric melanoma institutional registry, 1995-2018. Pediatr Dermatol 2019; 36:448-454. [PMID: 30993772 DOI: 10.1111/pde.13836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To characterize clinical differences among nonwhite/multiethnic vs white children, adolescents, and young adults with melanoma or atypical melanocytic neoplasms, including atypical Spitz tumors. PATIENTS AND METHODS A cohort of 55 patients (< 25 years of age) prospectively followed from 1995 to 2018 in the Stanford Pigmented Lesion and Melanoma Program was analyzed for differences in clinical presentation, including skin phototype, race/ethnicity, age, sex, tumor/melanoma characteristics, and outcome. RESULTS Seventeen patients (9 males and 8 females) were classified as nonwhite (predominantly skin phototype IV) and of Hispanic, Asian, or Black/African American ethnicity, and 38 patients (21 males and 17 females) were classified as white (predominantly phototypes I/II). Ages ranged from 6 months to 24 years, and median follow-up was 36 months (range 1-180 months). Melanomas were diagnosed in 87% of whites in our cohort, compared to 65% of nonwhites, with the remainder representing mainly atypical Spitz tumors. Lesions were usually brought to the attention of a health care provider by the patient or family (P < 0.05). Compared with whites, nonwhites were more likely to present at a younger mean age (10.9 years vs 15.4 years, P < 0.05) and with pink/clinically amelanotic tumors (59% vs 24%, P = 0.02). CONCLUSIONS This long-term prospective institutional study showed clinically relevant differences between nonwhite vs white children, adolescents, and young adults diagnosed with melanoma and atypical melanocytic neoplasms. Nonwhite patients presented at a younger age and had more clinically amelanotic melanocytic tumors. Increased recognition of clinical factors and risk of these tumors in nonwhites could result in earlier diagnosis.
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Affiliation(s)
- Olga K Afanasiev
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Joanna H Tu
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Derek H Chu
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California.,Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California
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Weinstock MA, Thwin SS, Siegel JA, Marcolivio K, Means AD, Leader NF, Shaw FM, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob SE, Warshaw EM, Stricklin GP, Dellavalle RP, Sidhu-Malik N, Konnikov N, Werth VP, Keri JE, Robinson-Bostom L, Ringer RJ, Lew RA, Ferguson R, DiGiovanna JJ, Huang GD. Chemoprevention of Basal and Squamous Cell Carcinoma With a Single Course of Fluorouracil, 5%, Cream: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:167-174. [PMID: 29299592 DOI: 10.1001/jamadermatol.2017.3631] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Keratinocyte carcinoma (ie, cutaneous basal and squamous cell carcinoma) is the most common cancer in the United States. Objective To determine whether topical fluorouracil could prevent surgically treated keratinocyte carcinoma. Design, Setting, and Participants The Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial was a randomized, double-blind, placebo-controlled trial of topical fluorouracil for chemoprevention of keratinocyte carcinoma. Participants were recruited from May 2009 to September 2011 from 12 Veterans Affairs medical centers and followed until June 30, 2013. Participants were veterans (n = 932) with a history of at least 2 keratinocyte carcinomas in the past 5 years; almost all were white males and the median age was 70 years. Interventions Application of fluorouracil, 5%, (n = 468) or vehicle control cream (n = 464) to the face and ears twice daily for 2 to 4 weeks upon randomization. Main Outcomes and Measures Surgically treated keratinocyte, basal cell, and squamous cell carcinoma risk on the face and ears in the first year after enrollment; and time to first surgically treated keratinocyte, basal cell, and squamous cell carcinoma. The a priori hypothesis was that fluorouracil would be effective in preventing these cancers. Results Of 932 participants (916 men [98%]; 926 white [99%]; median age, 70 years), 299 developed a basal cell carcinoma end point (95 in year 1) and 108 developed a squamous cell carcinoma end point (25 in year 1) over 4 years (median follow-up, 2.8 years). Over the entire study, there was no difference between treatment groups in time to first keratinocyte, basal cell, or squamous cell carcinoma. During the first year, however, 5 participants (1%) in the fluorouracil group developed a squamous cell carcinoma vs 20 (4%) in the control group, a 75% (95% CI, 35%-91%) risk reduction (P = .002). The 11% reduction in basal cell carcinoma risk during year 1 (45 [10%] in the fluorouracil group vs 50 [11%] in the control group) was not statistically significant (95% CI, 39% reduction to 31% increase), nor was there a significant effect on keratinocyte carcinoma risk. However, a reduction in keratinocyte carcinomas treated with Mohs surgery was observed. Conclusions and Relevance A conventional course of fluorouracil to the face and ears substantially reduces surgery for squamous cell carcinoma for 1 year without significantly affecting the corresponding risk for basal cell carcinoma. Trial Registration clinicaltrials.gov Identifier: NCT00847912.
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Affiliation(s)
- Martin A Weinstock
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Soe Soe Thwin
- Boston Cooperative Studies Program Coordinating Center, Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston
| | - Julia A Siegel
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island
| | - Kimberly Marcolivio
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alexander D Means
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicholas F Leader
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fiona M Shaw
- Center for Dermatoepidemiology, Veterans Affairs (VA) Medical Center, Providence, Rhode Island
| | - Daniel Hogan
- Bay Pines VA Healthcare System, Bay Pines, Florida
| | | | | | | | | | - Erin M Warshaw
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | | | | | | | | | | | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Robert J Ringer
- VA Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Robert A Lew
- Boston Cooperative Studies Program Coordinating Center, Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston
| | | | - John J DiGiovanna
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Grant D Huang
- Cooperative Studies Program Central Office, Washington, DC
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Dessinioti C, Geller AC, Stergiopoulou A, Swetter SM, Baltás E, Mayer JE, Johnson TM, Stratigos AJ. Nevus Count Associations with Thinner Nodular or Superficial Spreading Melanoma. Acta Derm Venereol 2019; 99:614-615. [PMID: 30734046 DOI: 10.2340/00015555-3142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Clio Dessinioti
- Department of Dermatology, Andreas Sygros Hospital 5, Dragoumi street, GR-16121, Athens, Greece.
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50
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Sargen MR, Cloutier JM, Sarin KY, Rieger KE, Chu P, Swetter SM, Novoa RA. Biomarker discovery analysis: Alterations in p14, p16, p53, and BAP1 expression in nevi, cutaneous melanoma, and metastatic melanoma. Pigment Cell Melanoma Res 2019; 32:474-478. [PMID: 30672662 DOI: 10.1111/pcmr.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michael R Sargen
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Jeffrey M Cloutier
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Kerri E Rieger
- Department of Pathology, Stanford University Medical Center, Stanford, California
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Pauline Chu
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Stanford, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Roberto A Novoa
- Department of Pathology, Stanford University Medical Center, Stanford, California
- Department of Dermatology, Stanford University Medical Center, Stanford, California
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