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Awad JN, Kebaish KM, Donigan J, Cohen DB, Kostuik JP. Analysis of the risk factors for the development of post-operative spinal epidural haematoma. ACTA ACUST UNITED AC 2005; 87:1248-52. [PMID: 16129751 DOI: 10.1302/0301-620x.87b9.16518] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to identify the risk factors and the incidence of post-operative spinal epidural haematoma, we analysed the records of 14 932 patients undergoing spinal surgery between 1984 and 2002. Of these, 32 (0.2%) required re-operation within one week of the initial procedure and had an International Classification of Diseases (ICD)-9 code for haematoma complicating a procedure (998.12). As controls, we selected those who had undergone a procedure of equal complexity by the same surgeon but who had not developed this complication. Risks identified before operation were older than 60 years of age, the use of pre-operative non-steroidal anti-inflammatories and Rh-positive blood type. Those during the procedure were involvement of more than five operative levels, a haemoglobin < 10 g/dL, and blood loss > 1 L, and after operation an international normalised ratio > 2.0 within the first 48 hours. All these were identified as significant (p < 0.03). Well-controlled anticoagulation and the use of drains were not associated with an increased risk of post-operative spinal epidural haematoma.
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Andersen JS, Baumann BC, Bordeaux J, Chen PL, Chin R, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Grekin RC, Harms K, Ho AL, Holder A, Lukens JN, Medina T, Nehal KS, Nghiem P, Park S, Patel T, Puzanov I, Scott J, Sekulic A, Shaha AR, Srivastava D, Stebbins W, Thomas V, Xu YG, McCullough B, Dwyer MA, Nguyen MQ. NCCN Guidelines® Insights: Squamous Cell Skin Cancer, Version 1.2022. J Natl Compr Canc Netw 2021; 19:1382-1394. [PMID: 34902824 DOI: 10.6004/jnccn.2021.0059] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Squamous Cell Skin Cancer provide recommendations for diagnostic workup, clinical stage, and treatment options for patients with cutaneous squamous cell carcinoma. The NCCN panel meets annually to discuss updates to the guidelines based on comments from panel members and the Institutional Review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new surgical recommendation terminology (peripheral and deep en face margin assessment), as well as recent updates on topical prophylaxis, immunotherapy for regional and metastatic disease, and radiation therapy.
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Donigan JM, Hyde MA, Goldgar DE, Hadley ML, Bowling M, Bowen GM. Rate of Recurrence of Lentigo Maligna Treated With Off-Label Neoadjuvant Topical Imiquimod, 5%, Cream Prior to Conservatively Staged Excision. JAMA Dermatol 2019; 154:885-889. [PMID: 29847610 DOI: 10.1001/jamadermatol.2018.0530] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Staged excision of lentigo maligna (LM) often requires multiple stages and can result in significant cosmetic morbidity. Imiquimod cream has been used off-label as monotherapy in the treatment of LM and may be used in the neoadjuvant setting prior to staged excision as a strategy to reduce the size of the surgical margins required to confirm negative histologic margins. Objective To examine the rate of recurrence of LM in patients treated with neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions. Design, Setting, and Participants This was a retrospective medical record review of 334 patients with 345 biopsy-confirmed LM tumors from June 2004 to January 2012 who were treated with imiquimod prior to undergoing staged excisions at the University of Utah Medical Center and Huntsman Cancer Institute, large academic hospitals in Salt Lake City. Interventions Patients were treated with off-label imiquimod, 5%, cream 5 nights per week for 2 to 3 months. Those deemed to have an inadequate inflammatory response were also treated with tazarotene, 0.1%, gel twice weekly. Conservatively staged excisions, beginning with 2-mm margins, were then performed. Main Outcomes and Measures The rate of recurrence of LM after long-term follow-up. Results Patients included 235 men (70%) and 99 women (30%) with a mean (SD) age of 67 (13) years. Patients were treated with imiquimod cream for a mean of 2.5 months prior to undergoing conservatively staged excisions. There were 12 local recurrences (a rate of 3.9%) with a mean time to recurrence of 4.3 years and a mean length of follow-up of 5.5 years. Conclusions and Relevance Neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions for LM allowed for negative histologic margins with a median final margin of 2 mm and a rate of recurrence similar to reported recurrence rates with standard staged excisions by either Mohs surgery or en face permanent sections.
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Journal Article |
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Donigan JM, Pascoe VL, Kimball AB. Psoriasis and herpes simplex virus are highly stigmatizing compared with other common dermatologic conditions: A survey-based study. J Am Acad Dermatol 2015; 73:525-6. [PMID: 26282802 DOI: 10.1016/j.jaad.2015.06.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Research Support, Non-U.S. Gov't |
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Donigan JM, Srivastava D, Maher I, Abdelmalek M, Bar AA, Blalock TW, Bordeaux JS, Brodland DG, Carroll BT, Council ML, Duffy K, Fathi R, Golda N, Johnson-Jahangir H, Konda S, Leitenberger JJ, Moye M, Nelson JL, Patel VA, Shaffer JJ, Soltani-Arabshahi R, Tristani-Firouzi P, Tschetter AJ, Nijhawan RI. Opioid Prescribing Recommendations After Mohs Micrographic Surgery and Reconstruction: A Delphi Consensus. Dermatol Surg 2021; 47:167-169. [PMID: 32769528 DOI: 10.1097/dss.0000000000002551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence. OBJECTIVE To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction. METHODS This was a multi-institutional Delphi consensus study consisting of a panel of members of the American College of Mohs Surgery from various practice settings. Participants were first asked to describe scenarios in which they prescribe opioids at various frequencies. These scenarios then underwent 2 Delphi ratings rounds that aimed to identify situations in which opioid prescriptions should, or should not, be routinely prescribed. Consensus was set at ≥80% agreement. Prescription recommendations were then distributed to the panelists for feedback and approval. RESULTS Twenty-three Mohs surgeons participated in the study. There was no scenario in which consensus was met to routinely provide an opioid prescription. However, there were several scenarios in which consensus were met to not routinely prescribe an opioid. CONCLUSION Opioids should not be routinely prescribed to every patient undergoing MMS. Prescription recommendations for opioids after MMS and reconstruction may decrease the exposure to these drugs and help combat the opioid epidemic.
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Multicenter Study |
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, Bolotin D, Bordeaux J, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Harms K, Ho AL, Lukens JN, Manber S, Mark L, Medina T, Nehal KS, Nghiem P, Olino K, Park S, Patel T, Puzanov I, Rich J, Sekulic A, Shaha AR, Srivastava D, Thomas V, Tomblinson C, Venkat P, Xu YG, Yu S, Yusuf M, McCullough B, Espinosa S. NCCN Guidelines® Insights: Merkel Cell Carcinoma, Version 1.2024. J Natl Compr Canc Netw 2024; 22:e240002. [PMID: 38244274 DOI: 10.6004/jnccn.2024.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
The NCCN Guidelines for Merkel Cell Carcinoma (MCC) provide recommendations for diagnostic workup, clinical stage, and treatment options for patients. The panel meets annually to discuss updates to the guidelines based on comments from expert review from panel members, institutional review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new page for locally advanced disease in the setting of clinical node negative status, entitled "Clinical N0 Disease, Locally Advanced MCC." This new algorithm page addresses locally advanced disease, and the panel clarifies the meaning behind the term "nonsurgical" by further defining locally advanced disease. In addition, the guideline includes the management of in-transit disease and updates to the systemic therapy options.
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Schmults CD, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, Bordeaux J, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Harms K, Ho AL, Lukens JN, Mark L, Medina T, Nehal KS, Nghiem P, Olino K, Park S, Patel T, Puzanov I, Rich J, Sekulic A, Shaha AR, Srivastava D, Thomas V, Tomblinson C, Venkat P, Xu YG, Yu S, Yusuf M, McCullough B, Espinosa S. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:1181-1203. [PMID: 37935106 DOI: 10.6004/jnccn.2023.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Basal cell carcinoma (BCC) is the most common form of skin cancer in the United States. Due to the high frequency, BCC occurrences are not typically recorded, and annual rates of incidence can only be estimated. Current estimated rates are 2 million Americans affected annually, and this continues to rise. Exposure to radiation, from either sunlight or previous medical therapy, is a key player in BCC development. BCC is not as aggressive as other skin cancers because it is less likely to metastasize. However, surgery and radiation are prevalent treatment options, therefore disfigurement and limitation of function are significant considerations. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) outline an updated risk stratification and treatment options available for BCC.
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Donigan JM, Taylor O, Greif C, Srivastava D, Nijhawan RI. Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects. Dermatol Surg 2022; 48:61-66. [PMID: 34750305 DOI: 10.1097/dss.0000000000003273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 × 1.0 to 4.5 × 5.5 cm (mean area = 4.8 cm2). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.
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Jimenez AR, Florell SR, Donigan JM. Encountering Ethylene Vinyl Alcohol in Dimethyl Sulfoxide Embolization Material During Electrodesiccation and Curettage. Dermatol Surg 2021; 47:1405-1406. [PMID: 34559705 DOI: 10.1097/dss.0000000000003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Case Reports |
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Xu YG, Lim Y, Bordeaux JS, Aasi SZ, Alam M, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Grekin RC, Mark L, Nehal KS, Nghiem P, Olino K, Patel T, Scott J, Shaha AR, Srivastava D, Schmults CD. Achieving Adherence With NCCN Guidelines for Nonmelanoma Skin Cancer Regarding Peripheral and Deep En Face Margin Assessment (PDEMA). J Natl Compr Canc Netw 2024; 22:e247037. [PMID: 39536442 DOI: 10.6004/jnccn.2024.7037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/10/2024] [Indexed: 11/16/2024]
Abstract
Peripheral and deep en face margin assessment (PDEMA), formerly termed by NCCN as complete circumferential peripheral and deep margin assessment (CCPDMA), has the advantages of histologic visualization of the entire marginal surface, highly accurate resection of involved tissue, and sparing of uninvolved tissue. Owing to its highest reported cure rates, PDEMA is the NCCN-preferred treatment for dermatofibrosarcoma protuberans, high-risk basal cell carcinoma, and very-high-risk cutaneous squamous cell carcinoma. In the United States, Mohs micrographic surgery (Mohs) is the most common method of PDEMA. In Germany and some other countries, non-Mohs methods of PDEMA referred to as the Tubingen torte and muffin techniques are more widely used. The Tubingen methods of PDEMA require close communication between surgeon and pathologist. This article describes the background of both Mohs and Tubingen PDEMA, reviews what constitutes PDEMA, and provides a protocol for Tubingen PDEMA detailing critical components in a stepwise fashion using illustrative photos and diagrams. We hope to broaden understanding of the NCCN Guidelines and their rationale, align practice, and optimize patient outcomes.
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Wynn DP, Donigan JM, Tkach A. Clinical Reasoning: A 74-year-old woman with bilateral foot pain and a palmar rash. Neurology 2017; 88:e44-e50. [PMID: 28167626 DOI: 10.1212/wnl.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Case Reports |
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Donigan JM. FOCUS ON PSORIASIS: A REPORT FROM THE 73RD ANNUAL MEETING OF THE AMERICAN ACADEMY OF DERMATOLOGYPsoriasis-related topics included targeted therapies, safety of biologies, comorbidities. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2015; 8:8-16. [PMID: 26240675 PMCID: PMC4521138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Review |
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Bordeaux J, Blitzblau R, Aasi SZ, Alam M, Amini A, Bibee K, Bolotin D, Chen PL, Contreras CM, DiMaio D, Donigan JM, Farma JM, Ghosh K, Harms K, LeBoeuf N, Lukens JN, Manber S, Mark L, Medina T, Nehal KS, Nghiem P, Olino K, Paragh G, Park S, Patel T, Rich J, Shaha AR, Sharma B, Sokumbi Y, Srivastava D, Thomas V, Tomblinson C, Venkat P, Xu YG, Yu S, Yusuf M, McCullough B, Espinosa S. Dermatofibrosarcoma Protuberans, Version 1.2025, NCCN Clinical Practice Guidelines In Oncology. J Natl Compr Canc Netw 2025; 23:e250001. [PMID: 39819674 DOI: 10.6004/jnccn.2025.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2025]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous soft tissue sarcoma and affects an estimated 1,500 people annually in the United States. DFSP frequently exhibits extensive local infiltration. Initial treatment is through surgical excision, and care should be taken to ensure that negative margins are achieved to minimize recurrence. Although DFSP has a reported high rate of recurrence, metastasis is more uncommon. Fibrosarcomatous DFSP is an aggressive variant with an increased risk for local recurrence and metastasis. If achieving negative margins or resection is not feasible, radiation therapy or systemic treatment are options that may be considered by a multidisciplinary team. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) outline recommended treatment options available for DFSP.
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Practice Guideline |
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Kenyon CM, Bowen AR, Donigan JM. Mucormycosis Folliculitis Status After Mohs Micrographic Surgery on the Scalp. Dermatol Surg 2025:00042728-990000000-01158. [PMID: 40084716 DOI: 10.1097/dss.0000000000004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2025]
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Donigan JM, Collins ZN, Wada DA. Eruption of Yellow-Brown and Red-Brown Papules in a Young Adult With Polydipsia and Polyuria. JAMA Dermatol 2017; 153:813-814. [PMID: 28403376 DOI: 10.1001/jamadermatol.2017.0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Case Reports |
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Donigan JM, Hawkes JE, Petersen MJ. An unusual follicular eruption in a young adult with new-onset type I diabetes mellitus. JAMA Dermatol 2014; 150:891-2. [PMID: 24898382 DOI: 10.1001/jamadermatol.2013.10421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Case Reports |
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Walker A, Vitale PA, Donigan JM. Treatment of a Cutaneous Solitary Fibrous Tumor With Mohs Micrographic Surgery. Dermatol Surg 2022; 48:465-466. [PMID: 35125440 DOI: 10.1097/dss.0000000000003307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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