Journal of the American Academy of Dermatology, Jan 25, 2016
Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, m... more Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS. We sought to determine if patients experience pain during their MMS visit. In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0-10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day. Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1-8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose. Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesth...
Purpose-To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural l... more Purpose-To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity. Methods-We describe an analysis of cross-sectional data from 443 children enrolled in the prospective study of nevi in children. To evaluate the joint effect, we partitioned the sum of squares due to interaction between sunburn and sun exposure into orthogonal components representing: (i) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends upon sunburn), and (ii) non-monotonic pattern. Results-In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (p-value = 0.08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (p < 0.001), but not among those with sunburn (p = 0.14). Sunburn was independently associated with log nevi (p = 0.02), even though sun sensitivity
Journal of the American Academy of Dermatology, 2015
Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), part... more Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), particularly in the United States. We sought to characterize clinical and histopathologic features of ATLL in patients with skin involvement. We retrospectively identified patients with ATLL from a single institution given a diagnosis during a 15-year period (1998-2013). Patients were categorized by the Shimoyama classification and stratified into skin-first, skin-second, and skin-uninvolved courses. The study population included 17 skin-first, 8 skin-second, and 29 skin-uninvolved cases. Skin-first patients (6 acute, 1 lymphoma, 4 chronic, 6 smoldering) were overwhelmingly of Caribbean origin (94%). They had longer median symptom duration (11.9 vs 1.9 months, P < .001) and overall survival (26.7 vs 10.0 months, P < .001) compared with skin-second/skin-uninvolved patients. Cutaneous lesion morphology at diagnosis included nodulotumoral (35%), multipapular (24%), plaques (24%), patches ...
OBJECTIVES: Early childhood UV light radiation (UVR) exposures have been shown to be associated w... more OBJECTIVES: Early childhood UV light radiation (UVR) exposures have been shown to be associated with melanoma development later in life. The objective of this study was to assess sunburn and changes in sunburn and sun behaviors during periadolescence. METHODS: A prospective, population-based study was conducted in fifth-grade children (∼10 years of age) from Framingham, Massachusetts. Surveys were administered at baseline (September–October 2004) and again 3 years later (September–October 2007). Surveys were analyzed to assess prevalence of reported sunburn and sun behaviors and to examine changes in response over the follow-up period. RESULTS: Data were analyzed from 360 participants who had complete information regarding sunburn at both time points. In 2004, ∼53% of the students reported having at least 1 sunburn during the previous summer, and this proportion did not significantly change by 2007 (55%, P = .79), whereas liking a tan and spending time outside to get a tan significa...
Journal of the American Academy of Dermatology, 2011
Background: Given the expanding role of multiple surgical procedures in dermatology, resident tra... more Background: Given the expanding role of multiple surgical procedures in dermatology, resident training in procedural dermatology must be continually assessed to keep pace with changes in the specialty. Objective: We sought to assess the third-year resident experience in procedural dermatology during residency training. Methods: This survey study was mailed to third-year dermatology residents at 107 Accreditation Council for Graduate Medical Education (ACGME)-approved dermatology residency programs in 2009. Results: A total of 240 residents responded (66%), representing 89% of programs surveyed. Residents assume the role of primary surgeon most commonly in excisional surgery (95%) and flap and graft reconstruction (49%) and least often in Mohs micrographic surgery (18%). In laser and cosmetic procedures, the resident role varies greatly. Residents believed they were most prepared in excisional surgery, botulinum toxin, and laser surgery. Residents believed it was sufficient to have only knowledge of less commonly performed procedures such as hair transplantation, tumescent liposuction, and ambulatory phlebectomy. Of responding residents, 55% were very satisfied with their procedural dermatology training during residency. Limitations: Individual responses from residents may be biased. Neither residency program nor dermatologic surgery directors were surveyed. Conclusion: This survey confirms dermatology residents received broad training in procedural dermatology in 2009, in keeping with ACGME/Residency Review Committee program guidelines. The results provide feedback to dermatology residency programs and are an invaluable tool for assessing, modifying, and strengthening the current procedural dermatology curriculum.
Purpose Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless,... more Purpose Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless, follow-up guidelines have largely been empirical rather than evidence-based. Patients and Methods Clinical records of stage III patients with no evidence of disease seen at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1992 and 2004, who ultimately relapsed, were reviewed retrospectively to evaluate date of first relapse, time to first relapse, method of first relapse detection, and survival. We also determined overall 5-year relapse-free survival (RFS) of all stage III patients seen at MSKCC during this period. Results The overall 5-year RFS for stage IIIA, IIIB, and IIIIC patients was 63%, 32%, and 11%, respectively. Among relapsing patients, 340 had adequate follow-up to be evaluable for all parameters. Site of first relapse was local/in-transit (28%), regional nodal (21%), or systemic (51%). First relapses were detected by the patient or family, physician, or by screening r...
Purpose To evaluate the ability of either oral minocycline, topical tazarotene or both, to reduce... more Purpose To evaluate the ability of either oral minocycline, topical tazarotene or both, to reduce or prevent cetuximab-related acneiform rash when administered starting on day 1 of cetuximab therapy. Patients and Methods Metastatic colorectal cancer patients preparing to initiate cetuximab were randomly assigned to receive daily oral minocycline or placebo, and to receive topical tazarotene application to either left or right side of the face. Both therapies were administered for 8 weeks. Results Forty-eight eligible patients were randomly assigned to minocycline (n = 24) or placebo (n = 24). Total facial lesion counts were significantly lower in patients receiving minocycline at weeks 1 through 4. At week 4, a lower proportion of patients in the minocycline arm reported moderate to severe itch than in the placebo arm (20% v 50%, P = .05). Facial photographs, obtained at week 4, were reviewed for rash global severity. Patients in the minocycline arm trended toward lower frequency of...
Cancer Epidemiology, Biomarkers & Prevention, 2006
This prospective study examines psychosocial mediators of an efficacious skin self-examination (S... more This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months. (Cancer Epidemiol Biomarkers Prev 2006;15(6):1212–6)
Key Points Lenalidomide is effective in refractory advanced cutaneous T-cell lymphoma, with an ov... more Key Points Lenalidomide is effective in refractory advanced cutaneous T-cell lymphoma, with an overall response rate of 28%. Patients demonstrate a transient flare reaction in skin, blood, and/or lymph nodes that may be associated with improvement in disease burden.
To describe the dermoscopic features of congenital melanocytic nevi (CMN) and assess whether pred... more To describe the dermoscopic features of congenital melanocytic nevi (CMN) and assess whether predominant dermoscopic patterns present in CMN are related to an individual's age (Ͻ12 years vs Ն12 years), sex, or lesional site (head, neck, and trunk vs extremities).
To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized... more To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized light dermoscopy (PD).
To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized... more To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy. Design: Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions. Setting: Dermatology clinic specializing in pigmented lesions. Patients: Fifty patients with dermatofibromas. Results: The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images. Conclusions: Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.
Background Results from a single caseâ€"control study suggest that skin self-examination (SSE) ha... more Background Results from a single caseâ€"control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. T he purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. Design setting/participants Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) a a Purchase Export Recommended articles Citing articles (0)
Sir, We read with interest the publication by Belloni Fortina et al. (1). In this observational s... more Sir, We read with interest the publication by Belloni Fortina et al. (1). In this observational study, 717 melanocytic naevi in 160 consecutive paediatric patients were followed for changes in dermoscopic pattern. Patients were 3-16 years of age at baseline and their naevi were followed for up to 7 years. Of the 717 naevi included in the study, 140 (19.5%) exhibited a change in dermoscopic pattern during follow-up. These changes were common in all paediatric age groups, but most frequent (25.3%) in the naevi of younger patients (age 3-6 years at baseline). Notably, of the 140 naevi with dermoscopic change, the most common type was from globular to globular-reticular pattern (35 of 119 naevi with globular pattern at baseline, 29.4%), from globular to reticular (14/119, 11.8%) and from globularreticular to reticular (24 of 64 naevi with globular-reticular pattern at baseline, 37.5%). These observations are important and consistent with previous cross-sectional studies, which reported that, while a greater prevalence of globular naevi, including those with cobblestone pattern, was seen in children < 10 years, a predominance of reticular naevi was observed in adults (2-5).
BACKGROUND: Early detection of melanoma may provide an opportunity to positively impact melanoma ... more BACKGROUND: Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. OBJECTIVE: We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. DESIGN: Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. APPROACH: Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. KEY RESULTS: All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. CONCLUSIONS: Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.
Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the ... more Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the constitutional and behavioral factors associated with a mole-prone phenotype in adolescents. To identify host, behavioral, and dermoscopic factors in early adolescence (age, 14 years) that are associated with a mole-prone phenotype in late adolescence (age, 17 years). A prospective observational cohort study from the Study of Nevi in Children was conducted from January 1, 2009, to December 31, 2014, with a 2- to 3-year follow-up. A total of 569 students from the school system in Framingham, Massachusetts, were enrolled in the 8th or 9th grade (baseline; mean [SD] age, 14.4 [0.7] years). The overall retention rate was 73.3%, and 417 students were reassessed in the 11th grade. Mole-prone phenotype in the 11th grade, defined as total nevus count of the back and 1 randomly selected leg in the top decile of the cohort or having any nevi greater than 5 mm in diameter. Of the 417 students asses...
Dermoscopic triage algorithms have been shown to improve beginners' abilities for identifying... more Dermoscopic triage algorithms have been shown to improve beginners' abilities for identifying pigmented skin lesions requiring biopsy. To estimate the diagnostic accuracy of the Triage Amalgamated Dermoscopic Algorithm (TADA) for pigmented and nonpigmented skin cancers. Secondarily, to compare TADAs performance to those of existing triage algorithms for the identification of pigmented skin cancers. Cross-sectional, observational, reader study that took place at a beginner and intermediate level dermoscopy course. Two hundred medical professionals of various specialties attended the course and 120 voluntarily joined the study (60% participation rate). After receiving basic dermoscopy training, participants evaluated 50 polarized, dermoscopic images of pigmented (22 benign, 18 malignant) and nonpigmented (1 benign, 9 malignant) skin lesions using TADA. Pigmented lesions were also evaluated using the Three-Point Checklist and AC Rule. With TADA, participants first determined if a l...
The comparative diagnostic performance of dermoscopic algorithms and their individual criteria ar... more The comparative diagnostic performance of dermoscopic algorithms and their individual criteria are not well studied. To analyze the discriminatory power and reliability of dermoscopic criteria used in melanoma detection and compare the diagnostic accuracy of existing algorithms. This was a retrospective, observational study of 477 lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12 image sets that consisted of 39 or 40 images per set. A link on the International Dermoscopy Society website from January 1, 2011, through December 31, 2011, directed participants to the study website. Data analysis was performed from June 1, 2013, through May 31, 2015. Participants included physicians, residents, and medical students, and there were no specialty-type or experience-level restrictions. Participants were randomly assigned to evaluate 1 of the 12 image sets. Associations with melanoma and intraclass correlation coefficients (ICCs) were evaluated for the presence ...
Journal of the American Academy of Dermatology, Jan 25, 2016
Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, m... more Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS. We sought to determine if patients experience pain during their MMS visit. In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0-10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day. Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1-8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose. Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesth...
Purpose-To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural l... more Purpose-To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity. Methods-We describe an analysis of cross-sectional data from 443 children enrolled in the prospective study of nevi in children. To evaluate the joint effect, we partitioned the sum of squares due to interaction between sunburn and sun exposure into orthogonal components representing: (i) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends upon sunburn), and (ii) non-monotonic pattern. Results-In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (p-value = 0.08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (p < 0.001), but not among those with sunburn (p = 0.14). Sunburn was independently associated with log nevi (p = 0.02), even though sun sensitivity
Journal of the American Academy of Dermatology, 2015
Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), part... more Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), particularly in the United States. We sought to characterize clinical and histopathologic features of ATLL in patients with skin involvement. We retrospectively identified patients with ATLL from a single institution given a diagnosis during a 15-year period (1998-2013). Patients were categorized by the Shimoyama classification and stratified into skin-first, skin-second, and skin-uninvolved courses. The study population included 17 skin-first, 8 skin-second, and 29 skin-uninvolved cases. Skin-first patients (6 acute, 1 lymphoma, 4 chronic, 6 smoldering) were overwhelmingly of Caribbean origin (94%). They had longer median symptom duration (11.9 vs 1.9 months, P < .001) and overall survival (26.7 vs 10.0 months, P < .001) compared with skin-second/skin-uninvolved patients. Cutaneous lesion morphology at diagnosis included nodulotumoral (35%), multipapular (24%), plaques (24%), patches ...
OBJECTIVES: Early childhood UV light radiation (UVR) exposures have been shown to be associated w... more OBJECTIVES: Early childhood UV light radiation (UVR) exposures have been shown to be associated with melanoma development later in life. The objective of this study was to assess sunburn and changes in sunburn and sun behaviors during periadolescence. METHODS: A prospective, population-based study was conducted in fifth-grade children (∼10 years of age) from Framingham, Massachusetts. Surveys were administered at baseline (September–October 2004) and again 3 years later (September–October 2007). Surveys were analyzed to assess prevalence of reported sunburn and sun behaviors and to examine changes in response over the follow-up period. RESULTS: Data were analyzed from 360 participants who had complete information regarding sunburn at both time points. In 2004, ∼53% of the students reported having at least 1 sunburn during the previous summer, and this proportion did not significantly change by 2007 (55%, P = .79), whereas liking a tan and spending time outside to get a tan significa...
Journal of the American Academy of Dermatology, 2011
Background: Given the expanding role of multiple surgical procedures in dermatology, resident tra... more Background: Given the expanding role of multiple surgical procedures in dermatology, resident training in procedural dermatology must be continually assessed to keep pace with changes in the specialty. Objective: We sought to assess the third-year resident experience in procedural dermatology during residency training. Methods: This survey study was mailed to third-year dermatology residents at 107 Accreditation Council for Graduate Medical Education (ACGME)-approved dermatology residency programs in 2009. Results: A total of 240 residents responded (66%), representing 89% of programs surveyed. Residents assume the role of primary surgeon most commonly in excisional surgery (95%) and flap and graft reconstruction (49%) and least often in Mohs micrographic surgery (18%). In laser and cosmetic procedures, the resident role varies greatly. Residents believed they were most prepared in excisional surgery, botulinum toxin, and laser surgery. Residents believed it was sufficient to have only knowledge of less commonly performed procedures such as hair transplantation, tumescent liposuction, and ambulatory phlebectomy. Of responding residents, 55% were very satisfied with their procedural dermatology training during residency. Limitations: Individual responses from residents may be biased. Neither residency program nor dermatologic surgery directors were surveyed. Conclusion: This survey confirms dermatology residents received broad training in procedural dermatology in 2009, in keeping with ACGME/Residency Review Committee program guidelines. The results provide feedback to dermatology residency programs and are an invaluable tool for assessing, modifying, and strengthening the current procedural dermatology curriculum.
Purpose Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless,... more Purpose Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless, follow-up guidelines have largely been empirical rather than evidence-based. Patients and Methods Clinical records of stage III patients with no evidence of disease seen at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1992 and 2004, who ultimately relapsed, were reviewed retrospectively to evaluate date of first relapse, time to first relapse, method of first relapse detection, and survival. We also determined overall 5-year relapse-free survival (RFS) of all stage III patients seen at MSKCC during this period. Results The overall 5-year RFS for stage IIIA, IIIB, and IIIIC patients was 63%, 32%, and 11%, respectively. Among relapsing patients, 340 had adequate follow-up to be evaluable for all parameters. Site of first relapse was local/in-transit (28%), regional nodal (21%), or systemic (51%). First relapses were detected by the patient or family, physician, or by screening r...
Purpose To evaluate the ability of either oral minocycline, topical tazarotene or both, to reduce... more Purpose To evaluate the ability of either oral minocycline, topical tazarotene or both, to reduce or prevent cetuximab-related acneiform rash when administered starting on day 1 of cetuximab therapy. Patients and Methods Metastatic colorectal cancer patients preparing to initiate cetuximab were randomly assigned to receive daily oral minocycline or placebo, and to receive topical tazarotene application to either left or right side of the face. Both therapies were administered for 8 weeks. Results Forty-eight eligible patients were randomly assigned to minocycline (n = 24) or placebo (n = 24). Total facial lesion counts were significantly lower in patients receiving minocycline at weeks 1 through 4. At week 4, a lower proportion of patients in the minocycline arm reported moderate to severe itch than in the placebo arm (20% v 50%, P = .05). Facial photographs, obtained at week 4, were reviewed for rash global severity. Patients in the minocycline arm trended toward lower frequency of...
Cancer Epidemiology, Biomarkers & Prevention, 2006
This prospective study examines psychosocial mediators of an efficacious skin self-examination (S... more This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months. (Cancer Epidemiol Biomarkers Prev 2006;15(6):1212–6)
Key Points Lenalidomide is effective in refractory advanced cutaneous T-cell lymphoma, with an ov... more Key Points Lenalidomide is effective in refractory advanced cutaneous T-cell lymphoma, with an overall response rate of 28%. Patients demonstrate a transient flare reaction in skin, blood, and/or lymph nodes that may be associated with improvement in disease burden.
To describe the dermoscopic features of congenital melanocytic nevi (CMN) and assess whether pred... more To describe the dermoscopic features of congenital melanocytic nevi (CMN) and assess whether predominant dermoscopic patterns present in CMN are related to an individual's age (Ͻ12 years vs Ն12 years), sex, or lesional site (head, neck, and trunk vs extremities).
To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized... more To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized light dermoscopy (PD).
To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized... more To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy. Design: Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions. Setting: Dermatology clinic specializing in pigmented lesions. Patients: Fifty patients with dermatofibromas. Results: The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images. Conclusions: Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.
Background Results from a single caseâ€"control study suggest that skin self-examination (SSE) ha... more Background Results from a single caseâ€"control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. T he purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. Design setting/participants Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) a a Purchase Export Recommended articles Citing articles (0)
Sir, We read with interest the publication by Belloni Fortina et al. (1). In this observational s... more Sir, We read with interest the publication by Belloni Fortina et al. (1). In this observational study, 717 melanocytic naevi in 160 consecutive paediatric patients were followed for changes in dermoscopic pattern. Patients were 3-16 years of age at baseline and their naevi were followed for up to 7 years. Of the 717 naevi included in the study, 140 (19.5%) exhibited a change in dermoscopic pattern during follow-up. These changes were common in all paediatric age groups, but most frequent (25.3%) in the naevi of younger patients (age 3-6 years at baseline). Notably, of the 140 naevi with dermoscopic change, the most common type was from globular to globular-reticular pattern (35 of 119 naevi with globular pattern at baseline, 29.4%), from globular to reticular (14/119, 11.8%) and from globularreticular to reticular (24 of 64 naevi with globular-reticular pattern at baseline, 37.5%). These observations are important and consistent with previous cross-sectional studies, which reported that, while a greater prevalence of globular naevi, including those with cobblestone pattern, was seen in children < 10 years, a predominance of reticular naevi was observed in adults (2-5).
BACKGROUND: Early detection of melanoma may provide an opportunity to positively impact melanoma ... more BACKGROUND: Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. OBJECTIVE: We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. DESIGN: Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. APPROACH: Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. KEY RESULTS: All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. CONCLUSIONS: Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.
Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the ... more Nevi are important phenotypic risk factors for melanoma in adults. Few studies have examined the constitutional and behavioral factors associated with a mole-prone phenotype in adolescents. To identify host, behavioral, and dermoscopic factors in early adolescence (age, 14 years) that are associated with a mole-prone phenotype in late adolescence (age, 17 years). A prospective observational cohort study from the Study of Nevi in Children was conducted from January 1, 2009, to December 31, 2014, with a 2- to 3-year follow-up. A total of 569 students from the school system in Framingham, Massachusetts, were enrolled in the 8th or 9th grade (baseline; mean [SD] age, 14.4 [0.7] years). The overall retention rate was 73.3%, and 417 students were reassessed in the 11th grade. Mole-prone phenotype in the 11th grade, defined as total nevus count of the back and 1 randomly selected leg in the top decile of the cohort or having any nevi greater than 5 mm in diameter. Of the 417 students asses...
Dermoscopic triage algorithms have been shown to improve beginners' abilities for identifying... more Dermoscopic triage algorithms have been shown to improve beginners' abilities for identifying pigmented skin lesions requiring biopsy. To estimate the diagnostic accuracy of the Triage Amalgamated Dermoscopic Algorithm (TADA) for pigmented and nonpigmented skin cancers. Secondarily, to compare TADAs performance to those of existing triage algorithms for the identification of pigmented skin cancers. Cross-sectional, observational, reader study that took place at a beginner and intermediate level dermoscopy course. Two hundred medical professionals of various specialties attended the course and 120 voluntarily joined the study (60% participation rate). After receiving basic dermoscopy training, participants evaluated 50 polarized, dermoscopic images of pigmented (22 benign, 18 malignant) and nonpigmented (1 benign, 9 malignant) skin lesions using TADA. Pigmented lesions were also evaluated using the Three-Point Checklist and AC Rule. With TADA, participants first determined if a l...
The comparative diagnostic performance of dermoscopic algorithms and their individual criteria ar... more The comparative diagnostic performance of dermoscopic algorithms and their individual criteria are not well studied. To analyze the discriminatory power and reliability of dermoscopic criteria used in melanoma detection and compare the diagnostic accuracy of existing algorithms. This was a retrospective, observational study of 477 lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12 image sets that consisted of 39 or 40 images per set. A link on the International Dermoscopy Society website from January 1, 2011, through December 31, 2011, directed participants to the study website. Data analysis was performed from June 1, 2013, through May 31, 2015. Participants included physicians, residents, and medical students, and there were no specialty-type or experience-level restrictions. Participants were randomly assigned to evaluate 1 of the 12 image sets. Associations with melanoma and intraclass correlation coefficients (ICCs) were evaluated for the presence ...
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Papers by Stephen Dusza