16 results on '"Lowe, Lori"'
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2. The Impact of Next-generation Sequencing on Interobserver Agreement and Diagnostic Accuracy of Desmoplastic Melanocytic Neoplasms
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Pathologie Pathologen staf, Cancer, Chen, Alice, Sharma, Natasha, Patel, Pragi, Olivares, Shantel, Bahrami, Armita, Barnhill, Raymond L., Blokx, Willeke A.M., Bosenberg, Marcus, Busam, Klaus J., De La Fouchardière, Arnaud, Duncan, Lyn M., Elder, David E., Ko, Jennifer S., Landman, Gilles, Lazar, Alexander J., Lezcano, Cecilia, Lowe, Lori, Maher, Nigel, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas C., Redpath, Margaret, Scolyer, Richard A., Shea, Christopher R., Spatz, Alan, Tron, Victor, Xu, Xiaowei, Yeh, Iwei, Jung Yun, Sook, Zembowicz, Artur, Gerami, Pedram, Pathologie Pathologen staf, Cancer, Chen, Alice, Sharma, Natasha, Patel, Pragi, Olivares, Shantel, Bahrami, Armita, Barnhill, Raymond L., Blokx, Willeke A.M., Bosenberg, Marcus, Busam, Klaus J., De La Fouchardière, Arnaud, Duncan, Lyn M., Elder, David E., Ko, Jennifer S., Landman, Gilles, Lazar, Alexander J., Lezcano, Cecilia, Lowe, Lori, Maher, Nigel, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas C., Redpath, Margaret, Scolyer, Richard A., Shea, Christopher R., Spatz, Alan, Tron, Victor, Xu, Xiaowei, Yeh, Iwei, Jung Yun, Sook, Zembowicz, Artur, and Gerami, Pedram
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- 2024
3. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement
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Pathologie Pathologen staf, Cancer, Barnhill, Raymond L., Elder, David E., Piepkorn, Michael W., Knezevich, Stevan R., Reisch, Lisa M., Eguchi, Megan M., Bastian, Boris C., Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus J., Carr, Richard, Cochran, Alistair, Cook, Martin G., Duncan, Lyn M., Elenitsas, Rosalie, De La Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander J., Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas C., Schmidt, Birgitta, Shea, Christopher R., Scolyer, Richard A., Tetzlaff, Michael, Xu, Xiaowei, Yeh, Iwei, Zembowicz, Artur, Elmore, Joann G., Pathologie Pathologen staf, Cancer, Barnhill, Raymond L., Elder, David E., Piepkorn, Michael W., Knezevich, Stevan R., Reisch, Lisa M., Eguchi, Megan M., Bastian, Boris C., Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus J., Carr, Richard, Cochran, Alistair, Cook, Martin G., Duncan, Lyn M., Elenitsas, Rosalie, De La Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander J., Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas C., Schmidt, Birgitta, Shea, Christopher R., Scolyer, Richard A., Tetzlaff, Michael, Xu, Xiaowei, Yeh, Iwei, Zembowicz, Artur, and Elmore, Joann G.
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- 2023
4. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement.
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Blokx, Willeke, Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus, Carr, Richard, Cochran, Alistair, Cook, Martin, Duncan, Lyn, Elenitsas, Rosalie, de la Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander, Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas, Schmidt, Birgitta, Shea, Christopher, Scolyer, Richard, Tetzlaff, Michael, Xu, Xiaowei, Zembowicz, Artur, Elmore, Joann, Barnhill, Raymond, Elder, David, Piepkorn, Michael, Knezevich, Stevan, Reisch, Lisa, Eguchi, Megan, Bastian, Boris, Yeh, Iwei, Blokx, Willeke, Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus, Carr, Richard, Cochran, Alistair, Cook, Martin, Duncan, Lyn, Elenitsas, Rosalie, de la Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander, Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela, Parker, Douglas, Schmidt, Birgitta, Shea, Christopher, Scolyer, Richard, Tetzlaff, Michael, Xu, Xiaowei, Zembowicz, Artur, Elmore, Joann, Barnhill, Raymond, Elder, David, Piepkorn, Michael, Knezevich, Stevan, Reisch, Lisa, Eguchi, Megan, Bastian, Boris, and Yeh, Iwei
- Abstract
IMPORTANCE: A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE: To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW: Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS: The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE: The implementation of the newly revised MPATH-Dx version 2.0 schem
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- 2023
5. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement
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Barnhill, Raymond L; https://orcid.org/0000-0001-8086-8544, Elder, David E, Piepkorn, Michael W, Knezevich, Stevan R, Reisch, Lisa M, Eguchi, Megan M, Bastian, Boris C, Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus J, Carr, Richard, Cochran, Alistair, Cook, Martin G, Duncan, Lyn M, Elenitsas, Rosalie, de la Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander J, Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela; https://orcid.org/0000-0002-2215-9958, Parker, Douglas C, Schmidt, Birgitta, Shea, Christopher R, Scolyer, Richard A, Tetzlaff, Michael, et al, Barnhill, Raymond L; https://orcid.org/0000-0001-8086-8544, Elder, David E, Piepkorn, Michael W, Knezevich, Stevan R, Reisch, Lisa M, Eguchi, Megan M, Bastian, Boris C, Blokx, Willeke, Bosenberg, Marcus, Busam, Klaus J, Carr, Richard, Cochran, Alistair, Cook, Martin G, Duncan, Lyn M, Elenitsas, Rosalie, de la Fouchardière, Arnaud, Gerami, Pedram, Johansson, Iva, Ko, Jennifer, Landman, Gilles, Lazar, Alexander J, Lowe, Lori, Massi, Daniela, Messina, Jane, Mihic-Probst, Daniela; https://orcid.org/0000-0002-2215-9958, Parker, Douglas C, Schmidt, Birgitta, Shea, Christopher R, Scolyer, Richard A, Tetzlaff, Michael, and et al
- Abstract
IMPORTANCE A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE The implementation of the newly revised MPATH-Dx version 2.0 schema int
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- 2023
6. Appropriate use criteria for ancillary diagnostic testing in dermatopathology: New recommendations for 11 tests and 220 clinical scenarios from the American Society of Dermatopathology Appropriate Use Criteria Committee.
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AUC Committee Members, AUC Committee Members, Fung, Maxwell A, Vidal, Claudia I, Armbrecht, Eric A, Andea, Aleodor A, Cassarino, David S, Comfere, Nneka I, Emanuel, Patrick O, Ferringer, Tammie, Hristov, Alexandra C, Kim, Jinah, Lauer, Scott R, Linos, Konstantinos, Missall, Tricia A, Motaparthi, Kiran, Novoa, Roberto A, Patel, Rajiv, Shalin, Sara C, Sundram, Uma, Rating Panel, Calame, Antoanella, Bennett, Daniel D, Duncan, Lyn M, Elston, Dirk M, Hosler, Gregory A, Hurley, Yadira M, Lazar, Alexander J, Lowe, Lori, Messina, Jane, Myles, Jonathan, Plaza, Jose A, Prieto, Victor G, Reddy, Vijaya, Schaffer, András, Subtil, Antonio, AUC Committee Members, AUC Committee Members, Fung, Maxwell A, Vidal, Claudia I, Armbrecht, Eric A, Andea, Aleodor A, Cassarino, David S, Comfere, Nneka I, Emanuel, Patrick O, Ferringer, Tammie, Hristov, Alexandra C, Kim, Jinah, Lauer, Scott R, Linos, Konstantinos, Missall, Tricia A, Motaparthi, Kiran, Novoa, Roberto A, Patel, Rajiv, Shalin, Sara C, Sundram, Uma, Rating Panel, Calame, Antoanella, Bennett, Daniel D, Duncan, Lyn M, Elston, Dirk M, Hosler, Gregory A, Hurley, Yadira M, Lazar, Alexander J, Lowe, Lori, Messina, Jane, Myles, Jonathan, Plaza, Jose A, Prieto, Victor G, Reddy, Vijaya, Schaffer, András, and Subtil, Antonio
- Abstract
BackgroundAppropriate use criteria (AUC) provide patient-centered physician guidance in test selection. An initial set of AUC was reported by the American Society of Dermatopathology (ASDP) in 2018. AUC reflect evidence collected at single timepoints and may be affected by evolving evidence and experience. The objective of this study was to update and expand AUC for selected tests.MethodsRAND/UCLA (RAND Corporation [Santa Monica, CA]/University of California Los Angeles) methodology used includes the following: (a) literature review; (b) review of previously rated tests and previously employed clinical scenarios; (c) selection of previously rated tests for new ratings; (d) development of new clinical scenarios; (e) selection of additional tests; (f) three rating rounds with feedback and group discussion after rounds 1 and 2.ResultsFor 220 clinical scenarios comprising lymphoproliferative (light chain clonality), melanocytic (comparative genomic hybridization, fluorescence in situ hybridization, reverse transcription polymerase chain reaction, telomerase reverse transcriptase promoter), vascular disorders (MYC), and inflammatory dermatoses (periodic acid-Schiff, Gömöri methenamine silver), consensus by panel raters was reached in 172 of 220 (78%) scenarios, with 103 of 148 (70%) rated "usually appropriate" or "rarely appropriate" and 45 of 148 (30%), "appropriateness uncertain."LimitationsThe study design only measures appropriateness. Cost, availability, test comparison, and additional clinical considerations are not measured. The possibility that the findings of this study may be influenced by the inherent biases of the dermatopathologists involved in the study cannot be excluded.ConclusionsAUC are reported for selected diagnostic tests in clinical scenarios that occur in dermatopathology practice. Adhering to AUC may reduce inappropriate test utilization and improve healthcare delivery.
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- 2022
7. Update on Thin Melanoma: Outcome of an International Workshop
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Mihic-Probst, Daniela, Shea, Chris, Duncan, Lyn, de la Fouchardiere, Arnaud, Landman, Gilles, Landsberg, Jennifer, Ven den Oord, Joost, Lowe, Lori, Cook, Martin G, Jung Yun, Sook, Clarke, Loren, Messina, Jane, Elder, David E, Barnhill, Raymond L, Mihic-Probst, Daniela, Shea, Chris, Duncan, Lyn, de la Fouchardiere, Arnaud, Landman, Gilles, Landsberg, Jennifer, Ven den Oord, Joost, Lowe, Lori, Cook, Martin G, Jung Yun, Sook, Clarke, Loren, Messina, Jane, Elder, David E, and Barnhill, Raymond L
- Abstract
The following communication summarizes the proceedings of a 1-day Workshop of the International Melanoma Pathology Study Group, which was devoted to thin melanoma. The definitions and histologic criteria for thin melanoma were reviewed. The principal differential diagnostic problems mentioned included the distinction of thin melanoma from nevi, especially from nevi of special site, irritated nevi, inflamed and regressing nevi, and dysplastic nevi. Histologic criteria for this analysis were discussed and the importance of clinico-pathologic correlation, especially in acral sites, was emphasized. Criteria for the minimal definition of invasion were also discussed. In addition, a new technique of m-RNA expression profiling with 14 genes was presented and facilitated the distinction of thin melanomas from nevus in histologically obvious cases. However, for particular nevi, it was not obvious why the results indicated a malignant lesion. Despite many molecular and other ancillary investigations, Breslow thickness remains the most important prognostic factor in thin melanoma. The prognostic significance of radial (horizontal) and vertical growth phases, Clark level, regression, and mitotic rate were also discussed. Because of the increasing frequency of thin melanomas, there is a great need to develop more refined predictors of thin melanomas with worse clinical outcome.
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- 2016
8. Fine-needle aspiration cytology of metastatic eccrine porocarcinoma
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Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48108, Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48108 ; Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48108, Yu, Limin, Olsen, Stephen, Lowe, Lori, Michael, Claire, Jing, Xin, Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48108, Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48108 ; Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48108, Yu, Limin, Olsen, Stephen, Lowe, Lori, Michael, Claire, and Jing, Xin
- Abstract
Eccrine porocarcinoma (EP), although rare, is widely recognized as the most common malignant sweat gland tumor. EP typically grows slowly and usually is cured by surgical excision with clear margins. An elevated mortality rate, however, is observed when regional lymph nodes are involved. We herein describe cytohistologic findings in a case of metastatic EP. An 86-year-old man with a history of EP of the left lateral ankle and squamous cell carcinoma in situ (Bowen's disease) of the penis presented with enlarged left inguinal lymph nodes. A superficial fine-needle aspiration (FNA) was performed and demonstrated a hypercellular sample with discohesive clusters and/or individual tumor cells. The tumor cells were round or oval with most of the cells showing dense, refractile cytoplasm. Intracytoplasmic vacuoles were readily appreciated in some of the cells. Nuclear enlargement, high N/C ratio, nuclear hyperchromasia, bi- and multinucleation, and prominent nucleoli were seen. A diagnosis of metastatic eccrine porocarcinoma was rendered. Enlarged retroperitoneal lymph nodes were detected and CT-guided left retroperitoneal core biopsy was performed 1 week later. The biopsy revealed features consistent with metastatic eccrine porocarcinoma. Diagn. Cytopathol. 2009. ?? 2009 Wiley-Liss, Inc.
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- 2009
9. The atypical Spitz tumor of uncertain biologic potential
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Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: (734) 936-6395 ; Department of Dermatology, University of Michigan Medical School, 1618 A. Alfred Taubman Healthcare Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Statistics, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Ludgate, Mathew W., Fullen, Douglas R., Lee, Julia, Lowe, Lori, Bradford, Carol, Geiger, James, Schwartz, Jennifer, Johnson, Timothy M., Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: (734) 936-6395 ; Department of Dermatology, University of Michigan Medical School, 1618 A. Alfred Taubman Healthcare Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Statistics, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, Ludgate, Mathew W., Fullen, Douglas R., Lee, Julia, Lowe, Lori, Bradford, Carol, Geiger, James, Schwartz, Jennifer, and Johnson, Timothy M.
- Abstract
BACKGROUND: Atypical Spitz tumors (AST) are rare spitzoid melanocytic proliferations with an uncertain malignant potential. ASTs have overlapping features of both Spitz nevi and spitzoid melanoma, and consequently generate controversy with diagnosis and management. Sentinel lymph node biopsy (SLNB) has been proposed as a possible means to gain additional insight into the true biologic potential of these tumors; however, previous reports on the use of SLNB in ASTs have been limited by small numbers of patients and short durations of follow-up. METHODS: The authors extracted data from their institution's prospective melanoma database, collected between 1994 and 2007, for all patients with ASTs of uncertain biologic potential. They reviewed the clinical features of these patients, including the sentinel lymph node status, and the histological features of the tumors. RESULTS: A total of 67 patients with ASTs were identified, with a median age of 23.7 years. The mean depth was 2.4 mm. Of these, 57 had a SLNB performed, with 27 (47%) having a positive sentinel lymph node. SLNB-positive cases had a significantly lower mean age than SLNB-negative cases (17.9 vs 28.7 years; P = .013); however, no other significant differences were observed. All 27 patients with a positive SLNB were alive and disease free with median follow-up of 43.8 months. One patient who did not receive a SLNB developed recurrent disease with regional and distant metastases. CONCLUSIONS: ASTs do not appear to behave like conventional melanoma. There is a high incidence of microscopic lymph node deposits in SLNBs, but despite this finding, patients have a favorable prognosis. Our findings raise several questions regarding the malignant potential of ASTs, and the role of SLNB in their management. Cancer 2009. ?? 2009 American Cancer Society.
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- 2009
10. What is a sentinel node? Re-evaluating the 10% rule for sentinel lymph node biopsy in melanoma
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Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48105. Fax: (734) 647-9647., Kroon, Hidde M., Lowe, Lori, Wong, Sandra, Fullen, Doug, Su, Lyndon, Cimmino, Vincent, Chang, Alfred E., Johnson, Timothy, Sabel, Michael S., Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48105. Fax: (734) 647-9647., Kroon, Hidde M., Lowe, Lori, Wong, Sandra, Fullen, Doug, Su, Lyndon, Cimmino, Vincent, Chang, Alfred E., Johnson, Timothy, and Sabel, Michael S.
- Abstract
Introduction Many surgeons use the “10% rule” to define whether a lymph node is a sentinel node (SLN) when staging malignant melanoma. However, this increases the number of SLN removed and the time and cost of the procedure. We examined the impact of raising this threshold on the accuracy of the procedure. Methods We reviewed the records of 561 patients with melanoma (624 basins) who underwent SLN with technetium Tc99 labeled sulfur colloid using a definition of a SLN as 10% of that of the node with the highest counts per minute (CPM). Results Of the 624 basins, 154 (25%) were positive for metastases. An average of 1.9 nodes per basin were removed (range 1–6). Metastases were found in the hottest node in 137 cases (89% of positive basins, 97% of basins overall). Increasing the threshold above 10% decreased the number of nodes excised and the costs involved, but incrementally raised the number of false negative cases above baseline (a 4% increase for a “20% rule,” 5% for a “30% rule,” 6% for a “40% rule,” and 7% for a “50% rule”). Taking only the hottest node would raise the false negative rate by 11%. Conclusions Although using thresholds higher than 10% for the definition of a SLN will minimize the extent of surgery and decrease the costs associated with the procedure, it will compromise the accuracy of the procedure and is not recommended. J. Surg. Oncol. 2007;95:623–628. © 2007 Wiley-Liss, Inc.
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- 2007
11. Wide excision without radiation for desmoplastic melanoma
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Department of Surgery, University of Michigan, Ann Arbor, Michigan, Department of Pathology, University of Michigan, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan, Ann Arbor, Michigan, Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, Department of Surgery, University of Michigan, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, Department of Surgery, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 657-9647 ; 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48105, Arora, Alisha, Lowe, Lori, Su, Lyndon D., Rees, Riley S., Bradford, Carol R., Cimmino, Vincent M., Chang, Alfred E., Johnson, Timothy M., Sabel, Michael S., Department of Surgery, University of Michigan, Ann Arbor, Michigan, Department of Pathology, University of Michigan, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan, Ann Arbor, Michigan, Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, Department of Surgery, University of Michigan, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, Department of Surgery, University of Michigan, Ann Arbor, Michigan ; Fax: (734) 657-9647 ; 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48105, Arora, Alisha, Lowe, Lori, Su, Lyndon D., Rees, Riley S., Bradford, Carol R., Cimmino, Vincent M., Chang, Alfred E., Johnson, Timothy M., and Sabel, Michael S.
- Abstract
BACKGROUND Adjuvant radiation has been proposed for the treatment of patients with desmoplastic melanoma, who reportedly have local recurrence rates as high as 40–60%. The authors investigated local recurrence rates at a tertiary referral center to determine the success of wide excision alone for patients with desmoplastic melanoma. METHODS A review of a prospectively maintained melanoma clinical data base identified 65 patients between March 1997 and March 2004 with pure cutaneous desmoplastic melanoma. Complete surgical, histopathologic, and staging information was collected along with data on outcome, including local, regional, and distant recurrence and survival. RESULTS Similar to previous reports, patients with desmoplastic melanoma had a male-to-female ratio of 2 to 1, a mean age of 65.0 years (range, 31–92 yrs), and the majority of their tumors (55%) were located on the head and neck. The mean Breslow depth at diagnosis was 4.21 mm, with 38% of tumors thicker than 4.0 mm. All patients in this series underwent wide excision without radiation therapy. Surgical margins ≤ 2 cm were obtained for all trunk and extremity lesions and for 63% of head and neck lesions that measured > 1 mm in depth (63%). Margins of 1–2 cm were obtained for the remaining patients. Among 49 patients who had a minimum of 2 years of follow-up (mean, 3.7 yrs), the local recurrence rate was 4% (2 of 49 patients). Seventy-eight percent of the patients studied remained alive with no evidence of disease. CONCLUSIONS Local recurrence rates in the current series were considerably lower than the historically reported rates. This finding suggests that, for patients with desmoplastic melanoma, wide local excision with careful attention to appropriate margins produces excellent local control rates without the need for adjuvant radiation. Cancer 2005. © 2005 American Cancer Society.
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- 2006
12. Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model
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Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan, Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan, Biostatistics, University of Michigan Health System, Ann Arbor, Michigan, Pathology, University of Michigan Health System, Ann Arbor, Michigan; Dermatology, University of Michigan Health System, Ann Arbor, Michigan, Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Room 3306, Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0932, Ann Arbor, Moon, James, Chang, Alfred E., Sabel, Michael S., Wang, Yue, Johnson, Timothy M., Lowe, Lori, Yahanda, Alan M., Grover, Amelia C., Taylor, Jeremy M.G., Sondak, Vernon K., Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan, Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan, Biostatistics, University of Michigan Health System, Ann Arbor, Michigan, Pathology, University of Michigan Health System, Ann Arbor, Michigan; Dermatology, University of Michigan Health System, Ann Arbor, Michigan, Departments of Surgery, University of Michigan Health System, Ann Arbor, Michigan; Room 3306, Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-0932, Ann Arbor, Moon, James, Chang, Alfred E., Sabel, Michael S., Wang, Yue, Johnson, Timothy M., Lowe, Lori, Yahanda, Alan M., Grover, Amelia C., Taylor, Jeremy M.G., and Sondak, Vernon K.
- Abstract
Background: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy.
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- 2006
13. Desmoplastic and neurotropic melanoma
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Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Fax: (734) 936-2756 ; Department of Pathology, Division of Dermatopathology, University of Michigan Medical Center, Medical Sciences I, M5224, 1301 Catherine Street, Ann Arbor, MI 48109-0602, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Otorhinolaryngology, University of Michigan Medical Center, Ann Arbor, Michigan, Su, Lyndon D., Fullen, Douglas R., Lowe, Lori, Wang, Timothy S., Schwartz, Jennifer L., Cimmino, Vincent M., Sondak, Vernon K., Johnson, Timothy M., Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Fax: (734) 936-2756 ; Department of Pathology, Division of Dermatopathology, University of Michigan Medical Center, Medical Sciences I, M5224, 1301 Catherine Street, Ann Arbor, MI 48109-0602, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan ; Department of Otorhinolaryngology, University of Michigan Medical Center, Ann Arbor, Michigan, Su, Lyndon D., Fullen, Douglas R., Lowe, Lori, Wang, Timothy S., Schwartz, Jennifer L., Cimmino, Vincent M., Sondak, Vernon K., and Johnson, Timothy M.
- Abstract
BACKGROUND Desmoplastic and neurotropic melanoma (DNMM) occasionally metastasizes to regional lymph nodes and extranodal sites. The value of sentinel lymph node biopsy (SLNB) has not been demonstrated clearly for patients with DNMM. The authors report on the utility of SLNB in the management of patients with DNMM. METHODS The authors identified 33 patients with DNMM who were seen during a 5-year period in their institution who underwent lymphatic mapping and SLNB. Clinical and histopathologic data were reviewed. RESULTS Thirty-three patients with DNMM underwent SLNB (mean Breslow depth, 4.0 mm; median, 2.8 mm). There were 25 male patients and 8 female patients with a median age of 61 years (range, 31-86 years). Fifty-two percent of tumors presented in the head and neck region, and 24% were associated with lentigo maligna. Four of 33 patients (12%) without clinical evidence of metastatic disease who underwent SLNB had at least 1 positive sentinel lymph node. No additional positive lymph nodes were found in subsequent therapeutic regional lymphadenectomy in any of these four patients. CONCLUSIONS SLNB detected subclinical metastases of DNMM to regional lymph nodes. SLNB at the time of resection can provide useful information to guide early treatment and, coupled with lymphadenectomy in positive patients, may limit tumor spread and prevent recurrence at the draining lymph node basin. Cancer 2004. © 2003 American Cancer Society.
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- 2006
14. Low recurrence rate after surgery for dermatofibrosarcoma protuberans
- Author
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Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Pathology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: (734) 647-9647 ; Department of Surgery, University of Michigan Health System, 3306 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0932, DuBay, Derek, Cimmino, Vincent M., Lowe, Lori, Johnson, Timothy M., Sondak, Vernon K., Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Pathology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Dermatology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otolaryngology, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Health System, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: (734) 647-9647 ; Department of Surgery, University of Michigan Health System, 3306 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0932, DuBay, Derek, Cimmino, Vincent M., Lowe, Lori, Johnson, Timothy M., and Sondak, Vernon K.
- Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma with a propensity for local recurrence. Treatments with wide excision, Mohs surgery, and other approaches have been reported with widely variable local control rates. The objective of this study was to review the experience with a multidisciplinary approach employing wide excision and Mohs surgery selectively in the treatment of patients with DFSP at a single academic institution over the past 10 years. METHODS The records of 62 patients with 63 DFSP tumors who underwent wide excision, Mohs surgery, or a multidisciplinary combination approach from January 1991 to December 2000 were reviewed retrospectively. Primary endpoints included the ability to extirpate the DFSP lesion completely, the tumor recurrence rate, and the need for skin grafts or local tissue flaps. Additional objectives included defining surgical practice patterns at the authors' institution. RESULTS Sixty-three DFSP lesions were removed from 62 patients. At a median follow-up of 4.4 years, no local or distant recurrences were detected in any patient. Forty-three lesions were treated with wide local excision, 11 lesions were treated with Mohs surgery, and 9 lesions were treated with a combination approach. Ninety-five percent of lesions that were approached initially with wide local excision were cleared histologically. Two patients (5%) received postoperative radiation for positive margins after undergoing maximal excision. Eighty-five percent of lesions that were approached initially with Mohs surgery were cleared histologically. The remaining 15% of lesions subsequently were cleared surgically with a wide excision. DFSP lesions that were approached initially with Mohs surgery tended to be smaller. Patients with head and neck lesions most often underwent Mohs surgery or were treated with a multidisciplinary combination approach (87%). CONCLUSIONS Wide local excision with careful pathologic analysis of margins was found to have a ver
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- 2006
15. Thin primary cutaneous melanomas
- Author
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Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: 734-936-6395 ; Department of Dermatology, University of Michigan, 1910 Taubman Center, Ann Arbor, MI 48109-0314, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otorhinolaryngology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Surgery, Division of Plastic Surgery, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Schwartz, Jennifer L., Wang, Timothy S., Hamilton, Ted A., Lowe, Lori, Sondak, Vernon K., Johnson, Timothy M., Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Fax: 734-936-6395 ; Department of Dermatology, University of Michigan, 1910 Taubman Center, Ann Arbor, MI 48109-0314, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Pathology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Otorhinolaryngology, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan ; Department of Surgery, Division of Plastic Surgery, University of Michigan Medical Center and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, Schwartz, Jennifer L., Wang, Timothy S., Hamilton, Ted A., Lowe, Lori, Sondak, Vernon K., and Johnson, Timothy M.
- Abstract
BACKGROUND Public awareness and education may lead to the detection of thinner melanomas, which may result in a decrease in morbidity and mortality rates. Which detection patterns, lesion, and patient characteristics are associated with early detection? METHODS Using the University of Michigan prospective melanoma database, the detection patterns, lesion characteristics, and patient characteristics of 1515 consecutive patients with in situ or invasive cutaneous melanomas were reviewed. Tumor thickness (measured in millimeters) was evaluated in relationship to detection patterns (patient, physician, spouse), lesion characteristics (change in color, size, shape/elevation, ulceration, bleeding, tenderness, itching), and patient characteristics (gender, skin type, number of atypical and clinically benign nevi, history of sunburn, personal and family history of melanoma). RESULTS Patient characteristics associated with early detection included female gender, at least one atypical nevus, greater than 20 clinically benign nevi, and/or a personal history of melanoma. Skin types I, II, and III, a history of sunburn, and/or a family history of melanoma were also associated with thinner lesions, but these associations were not statistically significant. Lesion characteristics associated with earlier detection included a change in color, size, shape/elevation, and/or itching. Physician-detected melanomas were significantly thinner than patient or spouse-detected lesions. CONCLUSIONS Educational campaigns should include increasing melanoma awareness in males and educating the public on the early signs and symptoms. Education should be directed at both high and low-risk groups. Physicians should consider performing total skin examinations routinely on patients. Although they detect a relatively small percentage of all melanomas, physicians detect significantly thinner lesions. Cancer 2002;95:1562-8. © 2002 American Cancer Society. DOI 10.1002/cncr. 10880
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- 2006
16. Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma See related editorial on pages 2134???6 and accompanying article on pages 2279???84, this issue.
- Author
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Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Fax: (734) 936-2756 ; Division of Dermatopathology, Department of Pathology, University of Michigan Medical Center, Medical Sciences I, M5224, 1301 Catherine Street, Ann Arbor, MI 48109-0602, Bogner, Paul N., Fullen, Douglas R., Lowe, Lori, Paulino, Augusto F.G., Sybil Biermann, J., Sondak, Vernon K., Su, Lyndon D., Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, Department of Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan ; Fax: (734) 936-2756 ; Division of Dermatopathology, Department of Pathology, University of Michigan Medical Center, Medical Sciences I, M5224, 1301 Catherine Street, Ann Arbor, MI 48109-0602, Bogner, Paul N., Fullen, Douglas R., Lowe, Lori, Paulino, Augusto F.G., Sybil Biermann, J., Sondak, Vernon K., and Su, Lyndon D.
- Abstract
BACKGROUND Several subtypes of sweat gland carcinoma have been found to demonstrate a propensity to metastasize systemically and to regional lymph nodes. The predictive value and benefit of sentinel lymph node (SLN) biopsy have been established in numerous other malignancies, but to the authors' knowledge there is little literature published to date regarding the use of SLN biopsy in patients with sweat gland carcinoma. In the current study, the authors demonstrated the utility of SLN biopsy in detecting subclinical metastases of sweat gland carcinoma, which may result in early treatment. METHODS The authors identified five patients with malignant eccrine tumors in whom SLN biopsy was performed at the study institution. Clinical and histopathologic data were reviewed. RESULTS The five study cases included two cases of aggressive digital papillary adenocarcinoma (both occurring on upper extremity digits), two cases of hidradenocarcinoma (occurring on the knee and foot, respectively), and an eccrine carcinoma (occurring on the scalp). In each biopsy-established case, there was no clinical evidence of metastatic disease, and a wide local excision or amputation was performed with concurrent SLN biopsy. Four of 18 SLNs in 3 of the 5 patients (60%) were found to be positive for metastatic carcinoma, as identified in hematoxylin and eosin stains and/or cytokeratin immunohistochemical stains. All three lymph node-positive patients subsequently underwent regional lymphadenectomy and were found to have no evidence of additional metastases. CONCLUSIONS The results of the current study demonstrate that SLN biopsy detects subclinical metastases from sweat gland carcinomas to regional lymph nodes. SLN mapping and biopsy at the time of resection can provide useful information with which to guide early treatment. Further studies are necessary to determine whether this procedure results in a survival benefit in patients with sweat gland carcinomas. Cancer 2003;97:2285???9.?? 2003 A
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- 2006
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