81 results on '"Scott R. Florell"'
Search Results
2. Dermatologic care of incarcerated patients: A single-center descriptive study of teledermatology and face-to-face encounters
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Shreya A. Sreekantaswamy, Ashley M Snyder, Joshua J. Clark, Scott R. Florell, Marta J. Petersen, Bethany K.H. Lewis, and Aaron M. Secrest
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Teledermatology ,medicine.medical_specialty ,business.industry ,Prisoners ,Dermatology ,Single Center ,Skin Diseases ,Telemedicine ,Face-to-face ,Family medicine ,Humans ,Medicine ,Descriptive research ,business - Published
- 2021
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3. Pretibial Pruritic Papular Dermatitis: A Comprehensive Clinical and Pathologic Review of Cases at a Single Institution
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David A. Wada, Shadai Flores, Anneli R. Bowen, and Scott R. Florell
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Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Dermatitis ,Dermatology ,Pathology and Forensic Medicine ,Diagnosis, Differential ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Lymphomatoid Papulosis ,Papular dermatitis ,medicine ,Atypia ,Humans ,Single institution ,Lymphomatoid papulosis ,Aged ,Retrospective Studies ,integumentary system ,business.industry ,Pruritus ,General Medicine ,Middle Aged ,medicine.disease ,Female ,business - Abstract
Studies characterizing clinical and pathologic details of pretibial pruritic papular dermatitis (PPPD) are scarce. Several cases of PPPD at our institution have displayed lymphocyte atypia and CD30 positivity, resembling lymphomatoid papulosis (LyP). We explore the clinical and histological spectrum of PPPD, with emphasis on lymphocyte atypia.Retrospective observational study of 40 archived pathological specimens (hematoxylin/eosin, CD3, CD20, and CD30 immunohistochemistry) from 38 PPPD patients in an academic center. Clinical photographs were available in 22 cases.Microscopic epidermal changes were focal, but common (spongiosis 75%, parakeratosis 90%, interface changes 43%, Langerhans cell microgranulomas 25%, multinucleated keratinocytes 55%, Civatte bodies 55%, erosion 20%, and more than focal irregular psoriasiform hyperplasia 37%) and certain dermal changes were universal (papillary dermal fibrosis 100%, stellate fibroblasts 100%, and multinucleated fibroblasts 93%). At least focal lymphocyte atypia was present in all cases. Lymphocytes were almost exclusively CD3 T cells with rare CD20 B cells. Up to 30% of lymphocytes exhibited weak CD30 staining. Clinically, all cases exhibited discrete papules, but plaques and erosions were not uncommon.As a retrospective series, clinical images were not available for all cases.This study suggests a broader histological and clinical spectrum of PPPD than previously described. Epidermal changes are common in PPPD, as are atypical lymphocytes and focal CD30 positivity. Although the papular clinical appearance, lymphocyte atypia, and focal CD30 positivity may resemble LyP, the relatively low number of atypical lymphocytes, low intensity of CD30 staining, and absence of spontaneous resolution help to distinguish PPPD from LyP.
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- 2020
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4. Encountering Ethylene Vinyl Alcohol in Dimethyl Sulfoxide Embolization Material During Electrodesiccation and Curettage
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Jessica M. Donigan, Scott R. Florell, and Amber Jimenez
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Male ,Skin Neoplasms ,Biopsy ,Dermatology ,Curettage ,chemistry.chemical_compound ,Electrodesiccation and curettage ,Electrocoagulation ,Animals ,Humans ,Organic chemistry ,Dimethyl Sulfoxide ,Intraoperative Complications ,Aged, 80 and over ,Scalp ,Squamous Cell Carcinoma of Head and Neck ,Dimethyl sulfoxide ,General Medicine ,Embolization, Therapeutic ,Keratosis, Actinic ,chemistry ,Head and Neck Neoplasms ,Arteriovenous Fistula ,Embolization material ,Polyvinyls ,Surgery ,Carcinoma in Situ - Published
- 2021
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5. Favourable outcomes in folliculotropic mycosis fungoides after multimodality treatment in a single institution
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Caroline W. Laggis, Ahmad Halwani, Aaron M. Secrest, Scott R. Florell, David A. Wada, Nicole Ufkes, Rodney R. Miles, Randa Tao, Andrew Lamb, and David K. Gaffney
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Mycosis fungoides ,medicine.medical_specialty ,Skin Neoplasms ,business.industry ,Multimodality Treatment ,Dermatology ,Folliculotropic Mycosis Fungoides ,medicine.disease ,Combined Modality Therapy ,Cutaneous lymphoma ,Acitretin ,Mycosis Fungoides ,Infectious Diseases ,medicine ,Overall survival ,Humans ,Single institution ,business ,medicine.drug - Published
- 2020
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6. A Phase II Randomized Placebo-Controlled Trial of Oral N-acetylcysteine for Protection of Melanocytic Nevi against UV-Induced Oxidative Stress In Vivo
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Douglas Grossman, Scott R. Florell, Kenneth M. Boucher, Matthew Honeggar, Tong Liu, Pamela B. Cassidy, and Sancy A. Leachman
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0301 basic medicine ,Thioredoxin Reductase 1 ,Cancer Research ,Pathology ,medicine.medical_specialty ,Guanine ,Skin Neoplasms ,Ultraviolet Rays ,Glutamate-Cysteine Ligase ,Placebo-controlled study ,Administration, Oral ,Pilot Projects ,Pharmacology ,medicine.disease_cause ,Placebo ,Antioxidants ,Article ,Acetylcysteine ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,In vivo ,Oral administration ,medicine ,Humans ,Nevus ,skin and connective tissue diseases ,Melanoma ,Nevus, Pigmented ,business.industry ,medicine.disease ,Oxidative Stress ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Mutation ,Sunlight ,business ,Receptor, Melanocortin, Type 1 ,Biomarkers ,Oxidative stress ,medicine.drug - Abstract
Oxidative stress plays a role in UV-induced melanoma, which may arise from melanocytic nevi. We investigated whether oral administration of the antioxidant N-acetylcysteine (NAC) could protect nevi from oxidative stress in vivo in the setting of acute UV exposure. The minimal erythemal dose (MED) was determined for 100 patients at increased risk for melanoma. Patients were randomized to receive a single dose (1,200 mg) of NAC or placebo, in double-blind fashion, and then one nevus was irradiated (1–2 MED) using a solar simulator. One day later, the MED was redetermined and the irradiated nevus and a control unirradiated nevus were removed for histologic analysis and examination of biomarkers of NAC metabolism and UV-induced oxidative stress. Increased expression of 8-oxoguanine, thioredoxin reductase-1, and γ-glutamylcysteine synthase modifier subunit were consistently seen in UV-treated compared with unirradiated nevi. However, no significant differences were observed in these UV-induced changes or in the pre- and postintervention MED between those patients receiving NAC versus placebo. Similarly, no significant differences were observed in UV-induced changes between subjects with germline wild-type versus loss-of-function mutations in the melanocortin-1 receptor. Nevi showed similar changes of UV-induced oxidative stress in an open-label post-trial study in 10 patients who received NAC 3 hours before nevus irradiation. Thus, a single oral dose of NAC did not effectively protect nevi from UV-induced oxidative stress under the conditions examined. Cancer Prev Res; 10(1); 36–44. ©2016 AACR.
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- 2017
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7. Histopathologic vasculitis from the periulcer edge: A retrospective cohort study
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Marta J. Petersen, Angela P. Presson, Scott R. Florell, Anneli R. Bowen, and Cristian D. Gonzalez
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Adult ,Male ,Vasculitis ,medicine.medical_specialty ,Dermatology ,Skin Diseases, Vascular ,Sensitivity and Specificity ,Cohort Studies ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Predictive Value of Tests ,Medicine ,Humans ,Clinical significance ,Cutaneous Vasculitis ,Direct fluorescent antibody ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Leg Ulcer ,Histology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Confidence interval ,030220 oncology & carcinogenesis ,Etiology ,Female ,business - Abstract
Background Histopathologic vasculitis is often reported in periulcer specimens, but the frequency and clinical significance of this finding have not been evaluated. Objective We evaluated the sensitivity, specificity, negative predictive value, and positive predictive value of histopathologic vasculitis from the periulcer edge for detecting ulcers due to cutaneous vasculitis. Methods We performed a retrospective chart review of patients with leg ulcers at a tertiary hospital between 2009 and 2016. Histopathologic slides were evaluated by 2 dermatopathologists who were blinded to the etiology of ulcer. Focal vasculitis was defined as involvement of fewer than 3 vessels. Results Vasculitis at the periulcer edge was seen in 51.6% of the specimens (32 of 62). Of the specimens with histopathologic vasculitis, focal vasculitis was seen in the majority of specimens (71.9% [23 of 32]), whereas diffuse vasculitis was observed in 28.1% (9 of 32). Periulcer vasculitis yielded a high sensitivity (100% [95% confidence interval, 29%-100%]). Furthermore, the specificity was low (50.9% [95% confidence interval, 38.1%-63.6%]) for detecting vasculitis-induced ulcers. Limitations Small number of vasculitis-induced ulcers. Conclusion Focal vasculitis from the periulcer edge is a nonspecific finding and provides little diagnostic value in determining the etiology of lower leg ulcers. Emphasis should be placed on the combination of clinical history and examination, histology, and laboratory findings when diagnosing ulcers.
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- 2018
8. Capillary hemangioma associated with dermal atrophy masquerading as a deep fungal infection
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Jennifer L, Strunck, Scott R, Florell, and Douglas, Grossman
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Diagnosis, Differential ,Skin Neoplasms ,Mycoses ,Biopsy ,Humans ,Female ,Dermis ,Hemangioma, Capillary ,Atrophy ,Thoracic Wall ,Aged - Abstract
Hemangiomas are benign vascular neoplasms which arise in early adulthood. Herein we present a 79-year-old woman with a hemangioma of the lower flank masquerading as a cutaneous manifestation of a systemic fungal infection upon initial histological analysis. Decreased elastin and collagen within the lesion likely accounted for the clumping and splaying of the capillaries into "hyphae-like" structures. Loss of dermal elastic tissue and collagen apparently concentrated the capillary proliferation into an unusual morphology mimicking the hyphal structures. Through additional staining methods the lesion was confirmed to be an unusual presentation of a capillary hemangioma.
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- 2018
9. Clinical validation of a gene expression signature that differentiates benign nevi from malignant melanoma
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Richard J. Wenstrup, Steven R. Tahan, Kristen Rushton, Kirstin M. Roundy, Sancy A. Leachman, Darl D. Flake, Loren E. Clarke, Colleen Rock, Benjamin B. Roa, Jane L. Messina, Alexander Gutin, Kathryn A. Kolquist, Scott R. Florell, Pedram Gerami, Steven D. Billings, Anne Renee Hartman, M. Bryan Warf, and Christopher R. Shea
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medicine.medical_specialty ,Pathology ,Skin Neoplasms ,Tissue Fixation ,Histology ,Expression Signature ,Dermatology ,Biology ,Sensitivity and Specificity ,Pathology and Forensic Medicine ,law.invention ,Cohort Studies ,Diagnosis, Differential ,law ,Gene expression ,melanoma ,medicine ,Humans ,Gene ,Polymerase chain reaction ,validation studies ,Retrospective Studies ,Nevus, Pigmented ,Paraffin Embedding ,Reverse Transcriptase Polymerase Chain Reaction ,Melanoma ,Original Articles ,medicine.disease ,Training cohort ,real time PCR ,Real-time polymerase chain reaction ,molecular diagnositcs ,Melanocytes ,Original Article ,pathology ,Histopathology ,Transcriptome - Abstract
Background Histopathologic examination is sometimes inadequate for accurate and reproducible diagnosis of certain melanocytic neoplasms. As a result, more sophisticated and objective methods have been sought. The goal of this study was to identify a gene expression signature that reliably differentiated benign and malignant melanocytic lesions and evaluate its potential clinical applicability. Herein, we describe the development of a gene expression signature and its clinical validation using multiple independent cohorts of melanocytic lesions representing a broad spectrum of histopathologic subtypes. Methods Using quantitative reverse-transcription polymerase chain reaction (PCR) on a selected set of 23 differentially expressed genes, and by applying a threshold value and weighting algorithm, we developed a gene expression signature that produced a score that differentiated benign nevi from malignant melanomas. Results The gene expression signature classified melanocytic lesions as benign or malignant with a sensitivity of 89% and a specificity of 93% in a training cohort of 464 samples. The signature was validated in an independent clinical cohort of 437 samples, with a sensitivity of 90% and specificity of 91%. Conclusions The performance, objectivity, reliability and minimal tissue requirements of this test suggest that it could have clinical application as an adjunct to histopathology in the diagnosis of melanocytic neoplasms.
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- 2015
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10. Midline Anterior Neck Inclusion Cyst
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Scott R. Florell, Luke Johnson, and Alice Frigerio
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Anterior neck ,business.industry ,Epidermal Cyst ,Pediatrics, Perinatology and Child Health ,Inclusion cyst ,Humans ,Infant ,Medicine ,Female ,Anatomy ,business ,Neck - Published
- 2019
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11. Selenium for the Prevention of Cutaneous Melanoma
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Philip J. Moos, James P. Cassidy, Kenneth M. Boucher, Sancy A. Leachman, Pamela B. Cassidy, Russell Gerads, Heidi D. Fain, Scott R. Florell, Sally Tran, and Douglas Grossman
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Male ,Skin Neoplasms ,methylseleninic acid ,medicine.disease_cause ,Mice ,0302 clinical medicine ,Oral administration ,Organoselenium Compounds ,selenium ,0303 health sciences ,Nutrition and Dietetics ,Human Growth Hormone ,Melanoma ,Cell Cycle ,Cell cycle ,3. Good health ,030220 oncology & carcinogenesis ,Female ,melanoma ,selenomethionine ,HGF mouse ,lcsh:Nutrition. Foods and food supply ,Genetically modified mouse ,medicine.medical_specialty ,Cell Survival ,Ultraviolet Rays ,Mice, Transgenic ,lcsh:TX341-641 ,Biology ,Article ,03 medical and health sciences ,Sodium Selenite ,In vivo ,Cell Line, Tumor ,Internal medicine ,medicine ,Animals ,Humans ,Proportional Hazards Models ,030304 developmental biology ,medicine.disease ,Selenocysteine ,Endocrinology ,Apoptosis ,Cutaneous melanoma ,Cancer research ,RNA ,Oxidative stress ,Food Science - Abstract
The role of selenium (Se) supplementation in cancer prevention is controversial; effects often depend on the nutritional status of the subject and on the chemical form in which Se is provided. We used a combination of in vitro and in vivo models to study two unique therapeutic windows for intervention in the process of cutaneous melanomagenisis, and to examine the utility of two different chemical forms of Se for prevention and treatment of melanoma. We studied the effects of Se in vitro on UV-induced oxidative stress in melanocytes, and on apoptosis and cell cycle progression in melanoma cells. In vivo, we used the HGF transgenic mouse model of UV-induced melanoma to demonstrate that topical treatment with l-selenomethionine results in a significant delay in the time required for UV-induced melanoma development, but also increases the rate of growth of those tumors once they appear. In a second mouse model, we found that oral administration of high dose methylseleninic acid significantly decreases the size of human melanoma xenografts. Our findings suggest that modestly elevation of selenium levels in the skin might risk acceleration of growth of incipient tumors. Additionally, certain Se compounds administered at very high doses could have utility for the treatment of fully-malignant tumors or prevention of recurrence.
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- 2013
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12. Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas)
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Howard G. Rosenthal, Lester J. Layfield, Ting Liu, Allie H. Grossmann, Russell A. Ward, Sheryl R. Tripp, R. Lor Randall, Scott R. Florell, Brian J. Hall, Clay J. Cockerell, and Nicholas P. Webber
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Adult ,Leiomyosarcoma ,Male ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Histology ,CD34 ,Stain ,Pathology and Forensic Medicine ,Lesion ,Recurrence ,Biomarkers, Tumor ,Tumor Microenvironment ,medicine ,Humans ,Tensin ,PTEN ,Cutaneous leiomyosarcoma ,Smooth Muscle Tumor ,Aged ,Aged, 80 and over ,Muscle Neoplasms ,biology ,business.industry ,PTEN Phosphohydrolase ,Middle Aged ,Prognosis ,Immunohistochemistry ,Actins ,Staining ,Medical Laboratory Technology ,biology.protein ,Female ,medicine.symptom ,business - Abstract
Atypical intradermal smooth muscle neoplasms (AISMN, formerly known as cutaneous leiomyosarcomas) are uncommon neoplasms, which seem to be remarkable for their excellent prognosis in contrast to their deeper counterparts. The rarity of AISMN has posed a challenge for characterizing the morphologic spectrum, immunohistochemical staining pattern, and behavior. In this study we evaluated the histologic and immunohistochemical features of 20 cases of AISMN. Clinical follow-up was available on 19 out of 20 patients and ranged from 1 to 124 months with an average of 35 months and a median of 20 months with a male predominance (male to female ratio was 2.3:1). Our data show a wide variation in differentiation and atypical features. Among these, the presence of mitotic figures is diagnostically valuable in rendering the final diagnosis. A broad panel of immunohistochemical stains revealed that smooth muscle actin and muscle specific actin, when used in combination, identified smooth muscle differentiation in 100% of the cases. With some caveats, CD34, S100, and CK 5/6 were helpful in ruling out other important cutaneous spindle cell neoplasms. Significantly, loss of phosphatase and tensin homolog (PTEN) staining was seen in the majority of our cases (80%), supporting a role for PTEN loss in the etiology of these lesions. Logistic regression analysis revealed that positive margin status was helpful for predicting recurrence (100% sensitivity and 94% specificity). We conclude that AISMN can have significant morphologic variation and overlap with other spindle cell neoplasms of the skin and that a limited panel of key immunohistochemical stains should be used to distinguish this lesion. The different surgical measures such as wide excision versus Mohs procedure showed a similar clinical outcome. Although the significance of frequent PTEN loss supports a molecular mechanism of tumor genesis, the diagnostic utility of the stain remains to be determined.
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- 2013
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13. Cutaneous carcinosarcoma: a series of six cases and a review of the literature
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Joshua J, Clark, Anneli R, Bowen, Glen M, Bowen, John R, Hyngstrom, Michael L, Hadley, Keith, Duffy, Scott R, Florell, and David A, Wada
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Aged, 80 and over ,Male ,Skin Neoplasms ,Carcinosarcoma ,Biomarkers, Tumor ,Humans ,Female ,Immunohistochemistry ,Aged - Abstract
Cutaneous carcinosarcoma is a rare tumor with distinct malignant epithelial and mesenchymal cell populations. The histologic subtypes of epithelial and mesenchymal components in cutaneous carcinosarcoma are variable, as an assortment of carcinomatous and sarcomatous patterns have been described in the literature.Clinical information was obtained from patient charts and archival slides were retrieved and reviewed.We present a novel series of six distinct cases of cutaneous carcinosarcoma and review the literature. Our cases consisted of basal cell, pilomatrical, squamous cell, and trichoblastic variants. These cases occurred in elderly men on sun exposed skin with treatment and follow up was available for 4 of 6 cases. The four cases were treated with Mohs micrographic surgery with mean follow up of nine months.We report six cases of cutaneous carcinosarcoma with distinctive clinical and histologic characterization not previously described in a single series.
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- 2016
14. Differentiation of Malignant Melanoma From Benign Nevus Using a Novel Genomic Microarray With Low Specimen Requirements
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Mona S. Jahromi, Sarah T. South, Joshua D. Schiffman, Wells M. Chandler, Leslie R. Rowe, and Scott R. Florell
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,Microarray ,Malignancy ,Sensitivity and Specificity ,Pathology and Forensic Medicine ,Cohort Studies ,Humans ,Medicine ,Child ,Melanoma ,Nevus ,Aged ,Oligonucleotide Array Sequence Analysis ,Skin ,Aged, 80 and over ,business.industry ,Clinical course ,Infant ,Histology ,DNA, Neoplasm ,General Medicine ,medicine.disease ,Medical Laboratory Technology ,Molecular Diagnostic Techniques ,Female ,Benign nevus ,business ,Follow-Up Studies ,Genome-Wide Association Study - Abstract
Context.—Histologic examination of clinically suspicious melanocytic lesions is very sensitive and specific for the detection of malignant melanoma. Yet, the malignant potential of a small percentage of melanocytic lesions remains histologically uncertain. Molecular testing offers the potential to detect the genetic alterations that lead to malignant behavior without overt histologic evidence of malignancy. Objective.—To differentiate benign melanocytic nevi from malignant melanoma and to predict the clinical course of melanocytic lesions with ambiguous histology using a novel genomic microarray. Design.—We applied a newly developed single-nucleotide polymorphism genomic microarray to formalin-fixed, paraffin-embedded melanocytic lesions to differentiate benign nevi (n = 23) from malignant melanoma (n = 30) and to predict the clinical course of a set of histologically ambiguous melanocytic lesions (n = 11). Results.—For cases with unambiguous histology, there was excellent sensitivity and specificity for identifying malignant melanoma with this genomic microarray (89% sensitivity, 100% specificity). For cases with ambiguous histology, the performance of this genomic microarray was less impressive. Conclusions.—Without microdissection and with quantities of DNA one-tenth what is required for more commonly used microarrays, this microarray can differentiate between malignant melanoma and benign melanocytic nevi. For histologically ambiguous lesions, longer clinical follow-up is needed to confidently determine the sensitivity and specificity of this microarray. Some of the previous technical hurdles to the clinical application of genomic microarray technology are being overcome, and the advantages over targeted fluorescence in situ hybridization assays currently in clinical use are becoming apparent.
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- 2012
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15. A Decade of Melanomas: Identification of Factors Associated with Delayed Detection in an Academic Group Practice
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Douglas Grossman, Agnessa Gadeliya Goodson, Scott R. Florell, and Kenneth M. Boucher
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medicine.medical_specialty ,Delayed Diagnosis ,Skin Neoplasms ,Dermatology ,Lentigo maligna ,Hutchinson's Melanotic Freckle ,Utah ,Biopsy ,Humans ,Medicine ,Nevus ,Stage (cooking) ,Melanoma ,neoplasms ,Retrospective Studies ,medicine.diagnostic_test ,Sentinel Lymph Node Biopsy ,business.industry ,Incidence ,Cancer ,Retrospective cohort study ,General Medicine ,medicine.disease ,Head and Neck Neoplasms ,Group Practice ,Surgery ,Skin cancer ,business - Abstract
BACKGROUND Melanoma incidence is increasing, but the effect of various clinical factors on tumor stage is unclear. OBJECTIVE To review histologic and clinical features of melanomas diagnosed in our group over a 10-year period to determine trends in diagnosis and lesion derivation, predictive value of clinical lesion size, and effect of physician and patient concerns before biopsy. METHOD Relevant pathology reports and physician clinic notes were reviewed for 572 melanomas. RESULT From 1999 to 2008, melanoma biopsies increased significantly more than nevus biopsies and patient visits. Melanomas predominantly (81%) arose de novo, with remaining lesions as likely to arise from common as dysplastic nevi. Melanomas were detected at twice the rate, and at earlier stage, in established as in new patients. Clinical size of invasive melanomas was related to lesion depth. For 64% of melanomas, patient and physician concern drove the decision to biopsy, whereas 1.4% of melanomas were biopsied only for patient concern. CONCLUSION The increase in melanoma diagnoses was largely due to increases in cases of lentigo maligna on the head and neck. Delayed detection was associated with location on trunk and extremities, new patient status, patient concern before biopsy, and physician suspicion of nonmelanoma skin cancer. Doug Grossman is supported by the Department of Dermatology, the Huntsman Cancer Foundation, and the National Institutes of Health.
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- 2011
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16. Use of Oral N-Acetylcysteine for Protection of Melanocytic Nevi against UV-Induced Oxidative Stress: Towards a Novel Paradigm for Melanoma Chemoprevention
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Douglas Grossman, Pamela B. Cassidy, Mark Wade, Tong Liu, Murray A. Cotter, Agnessa Gadeliya Goodson, Kenneth M. Boucher, and Scott R. Florell
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Adult ,Male ,Risk ,Cancer Research ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Time Factors ,Antioxidant ,Ultraviolet Rays ,medicine.medical_treatment ,Administration, Oral ,Pharmacology ,medicine.disease_cause ,Antioxidants ,Article ,Acetylcysteine ,chemistry.chemical_compound ,medicine ,Anticarcinogenic Agents ,Humans ,Nevus ,Cysteine ,skin and connective tissue diseases ,Melanoma ,neoplasms ,Aged ,Nevus, Pigmented ,integumentary system ,business.industry ,Glutathione ,Middle Aged ,Melanocytic nevus ,medicine.disease ,Oxidative Stress ,Oncology ,chemistry ,Female ,business ,Oxidative stress ,Ex vivo ,medicine.drug - Abstract
Purpose: Induction of oxidative stress has been implicated in UV-induced melanoma. We sought to determine whether the antioxidant N-acetylcysteine (NAC) could be safely administered to protect melanocytic nevi from the oxidative stress resulting from acute UV exposure. Experimental Design: Patients at increased risk for melanoma were recruited from a screening clinic. Induction and detection of oxidative stress (reactive oxygen species and glutathione depletion) was optimized in nevi following ex vivo UV irradiation. Nevi were removed from patients before, and following, oral ingestion of a single (1,200 mg) dose of NAC, and then these nevi were UV irradiated (4,000 J/m2). Results: Oxidative stress was induced in nevi 24 to 48 hours following ex vivo UV irradiation. A single oral dose of NAC was well tolerated in all patients (n = 72). Basal levels of reduced glutathione and the NAC metabolite cysteine were well correlated between similar-appearing nevi from the same patient and were significantly increased in nevi removed 3 hours after NAC ingestion compared with nevi removed before drug ingestion. In approximately half (9 of 19) of patients tested, UV-induced glutathione depletion was attenuated in the postdrug (compared with predrug) nevus. Conclusions: NAC can be safely administered to patients for the purpose of modulating UV-induced oxidative stress in nevi. This study suggests the feasibility of patients taking NAC prophylactically before acute UV exposure, to prevent pro-oncogenic oxidative stress in nevi and ultimately reduce long-term melanoma risk. (Clin Cancer Res 2009;15(23):7434–40)
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- 2009
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17. C4d immunohistochemical stain is a sensitive method to confirm immunoreactant deposition in formalin-fixed paraffin-embedded tissue in bullous pemphigoid
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John J. Zone, Scott R. Florell, and Wells M. Chandler
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Epidermolysis bullosa acquisita ,medicine.medical_specialty ,Pathology ,Tissue Fixation ,Histology ,H&E stain ,Dermatology ,Sensitivity and Specificity ,Basement Membrane ,Pathology and Forensic Medicine ,Formaldehyde ,Pemphigoid, Bullous ,Complement C4b ,medicine ,Humans ,Direct fluorescent antibody ,Basement membrane ,Paraffin Embedding ,Staining and Labeling ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Immunohistochemistry ,Peptide Fragments ,medicine.anatomical_structure ,Skin biopsy ,Bullous pemphigoid ,business - Abstract
Background: Bullous pemphigoid (BP) is characterized clinically by the onset of pruritic urticarial plaques, vesicles and bullae in a predominantly elderly population. While the diagnosis may be suspected on routine hematoxylin and eosin histology of formalin-fixed paraffin-embedded tissue, fresh-frozen tissue must be used to show the immunologic nature of the bullous process by direct immunofluorescence (DIF). The diagnosis is further confirmed and separated from epidermolysis bullosa acquisita (EBA) by subsequent serologic studies to detect antibodies directed against BP180 and BP230 antigens and characteristic antibody deposition on salt-split skin. Methods: Using a polyclonal complement fragment 4d (C4d) antibody, we stained formalin-fixed paraffin-embedded skin biopsy specimens from cases of BP and controls. Results: We showed characteristic linear basement membrane deposition of C4d in formalin-fixed paraffin-embedded tissue in seven of nine cases diagnosed as BP vs. EBA by DIF on fresh-frozen tissue. None of the four controls for which we had adequate tissue were positive. Conclusion: These results indicate that formalin-fixed paraffin-embedded tissue can be stained for the immunoreactant C4d to show characteristic immunoreactant deposition, potentially obviating the need for repeat biopsy for DIF and allowing clinicians to proceed to serologic confirmation of BP.
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- 2009
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18. Eccrine Syringofibroadenoma-Like Change Adjacent to a Squamous Cell Carcinoma: Potential Histologic Pitfall in Mohs Micrographic Surgery
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Anneli R. Bowen, Scott R. Florell, Keith L. Duffy, Michael L. Hadley, and Payam Tristani-Firouzi
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medicine.medical_specialty ,Pathology ,Skin Neoplasms ,Syringofibroadenoma ,medicine.medical_treatment ,Dermatology ,Micrographic surgery ,medicine ,Humans ,Basal cell ,Basal cell carcinoma ,Aged, 80 and over ,Eccrine syringofibroadenoma ,business.industry ,Cancer ,Dermis ,Skin Transplantation ,General Medicine ,Microsurgery ,Mohs Surgery ,medicine.disease ,Combined Modality Therapy ,Sweat Gland Neoplasms ,Epidermoid carcinoma ,Fibroadenoma ,Carcinoma, Squamous Cell ,Female ,Surgery ,business - Published
- 2009
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19. Androgen receptor expression patterns in Becker's nevi: An immunohistochemical study
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Ronald M. Harris, C. David Hansen, Scott R. Florell, Hege Grande Sarpa, Michael L. Hadley, and Kristina Callis Duffin
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Adult ,Male ,medicine.medical_specialty ,Pathology ,Skin Neoplasms ,Adolescent ,Gene Expression ,Dermatology ,Biopsy ,Humans ,Medicine ,Nevus ,Receptor ,Skin ,Becker's nevus ,Nevus, Pigmented ,integumentary system ,biology ,medicine.diagnostic_test ,business.industry ,Anatomical pathology ,Fibroblasts ,medicine.disease ,Immunohistochemistry ,Androgen receptor ,Receptors, Androgen ,biology.protein ,Female ,Antibody ,business - Abstract
Background Becker's nevus (BN) is a hyperpigmented patch that traditionally presents on the upper torso in adolescent males. Previous studies have reported an association with increased androgen receptors (ARs) in lesional skin in men and women who have associated physical abnormalities. Objective This study was conducted to assess the presence of ARs immunohistochemically in female patients with BN but no other physical abnormalities and compare this finding with BN in males and in normal skin. Methods Biopsy specimens from Becker's nevi in 3 women and 3 men as well as normal skin in the 3 female subjects were stained with AR antibody, and the level of expression in various cutaneous structures was measured. Results ARs were increased in dermal fibroblasts in Becker's nevi compared to that found in normal skin. Limitations The major limitation of the study was the small sample size. Conclusion In BN there is increased AR expression in dermal fibroblasts; immunohistochemical staining may aid in making the biopsy diagnosis.
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- 2008
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20. Increased Melanocytic Nevi and Nevus Density in a G-34T CDKN2A/p16 Melanoma-Prone Pedigree
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Kenneth M. Boucher, John J. Zone, Douglas Grossman, Wolfram E. Samlowski, Lisa A. Cannon-Albright, Scott R. Florell, Ronald M. Harris, Laurence Meyer, and Sancy A. Leachman
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Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,CDKN2A-p16+ ,Dermatology ,Polymorphism, Single Nucleotide ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Polymorphism (computer science) ,medicine ,Humans ,Nevus ,Genetic Predisposition to Disease ,Longitudinal Studies ,Melanoma ,Molecular Biology ,Cyclin-Dependent Kinase Inhibitor p16 ,030304 developmental biology ,Nevus, Pigmented ,0303 health sciences ,Extramural ,business.industry ,Follow up studies ,Case-control study ,Cell Biology ,Middle Aged ,medicine.disease ,Pedigree ,Phenotype ,Case-Control Studies ,030220 oncology & carcinogenesis ,Mutation ,Female ,business ,Follow-Up Studies - Published
- 2008
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21. Onychodystrophy and tumor-stage mycosis fungoides confined to a single digit: Report of a case and review of nail findings in cutaneous T-cell lymphoma
- Author
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Hege Grande-Sarpa, Kristina Callis Duffin, and Scott R. Florell
- Subjects
Male ,medicine.medical_specialty ,Pathology ,Skin Neoplasms ,Dermatology ,Diagnosis, Differential ,Fingers ,Lymphocytic Infiltrate ,Nail Diseases ,Mycosis Fungoides ,Onychodystrophy ,medicine ,Humans ,Aged ,Mycosis fungoides ,integumentary system ,business.industry ,Cutaneous T-cell lymphoma ,medicine.disease ,Peripheral T-cell lymphoma ,medicine.anatomical_structure ,Nail disease ,Nail (anatomy) ,Epidermis ,business ,CD8 - Abstract
Mycosis fungoides is often considered one of the great disease imitators presenting with a wide variety of clinical manifestations. We present a case of tumor-stage mycosis fungoides involving a single digit clinically presenting with diffuse swelling of the digit and onychodystrophy. Histologic findings included a reticular dermal lymphocytic infiltrate with increased ratio of CD4:CD8 cells. The patient was treated with radiation resulting in complete resolution. Nail involvement with mycosis fungoides has been scarcely reported, but when present ranges from 20-nail dystrophy to yellow discoloration. The disease often involves most of the nails when present.
- Published
- 2008
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22. Acute Presentation of Tender Papules and Plaques in a Patient With Leukemia
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Aaron M. Secrest, Sandeep S. Saluja, and Scott R. Florell
- Subjects
Vasculitis ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Skin Diseases, Papulosquamous ,Dermatology ,Skin Diseases, Vascular ,Scalp Dermatosis ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Leukemic Infiltration ,Medicine ,Humans ,Bone Marrow Transplantation ,Scalp ,business.industry ,Biopsy, Needle ,Papule ,Middle Aged ,medicine.disease ,Tumor lysis syndrome ,Leukemia ,Leukemia, Myeloid, Acute ,Scalp Dermatoses ,030220 oncology & carcinogenesis ,Female ,Differential diagnosis ,medicine.symptom ,Presentation (obstetrics) ,business ,Blast Crisis ,Tumor Lysis Syndrome - Published
- 2016
23. Human Herpesvirus 8 and Iron Staining Are Useful in Differentiating Kaposi Sarcoma From Interstitial Granuloma Annulare
- Author
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Scott R. Florell, Sheryl R. Tripp, Sherrie L. Perkins, David A. Wada, and Cheryl M. Coffin
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Male ,CD31 ,Pathology ,medicine.medical_specialty ,Staining and Labeling ,biology ,Iron ,CD34 ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,Immunohistochemistry ,Staining ,Granuloma Annulare ,Hemosiderin ,Herpesvirus 8, Human ,medicine ,Humans ,Gammaherpesvirinae ,Sarcoma ,Sarcoma, Kaposi ,Granuloma annulare - Abstract
We studied 20 granuloma annulare (GA) cases (10 interstitial and 10 palisaded) and 19 Kaposi sarcoma (KS) cases (9 "early" and 10 typical). Tissue sections were stained for iron, Hale colloidal iron, human herpesvirus 8 (HHV-8), CD31, CD34, CD68, collagen IV, factor XIIIa, and MIB-1. Iron staining of dermal tissue associated with the lesion was confirmed in all KS cases and no GA cases. Immunohistochemical stains for HHV-8 were positive in all 9 cases of early KS and most cases (9/10) of typical KS. All 20 cases of GA were HHV-8-. CD31, CD34, CD68, factor XIIIa, and MIB-1 were also stained but were difficult to interpret and did not seem specific for GA or KS. Iron staining and immunohistochemical HHV-8 staining in combination were reliable markers for KS compared with interstitial GA. MIB-1 fractions of less than 5% favored a diagnosis of GA, whereas fractions greater than 10% favored a diagnosis of KS. This study provides novel data characterizing iron staining in KS and details the use of iron staining, HHV-8, and MIB-1 to distinguish KS from GA.
- Published
- 2007
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24. Cost-Effective Dynamic Telepathology in the Mohs Surgery Laboratory Utilizing iChat AV Videoconferencing Software
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Scott R. Florell and Jeffrey K. McKENNA
- Subjects
medicine.medical_specialty ,Telemedicine ,Cost-Benefit Analysis ,medicine.medical_treatment ,Telepathology ,Dermatology ,computer.software_genre ,Skin Diseases ,User-Computer Interface ,Videoconferencing ,Software ,Mohs surgery ,medicine ,Apple computer ,Frozen Sections ,Humans ,Medical physics ,business.industry ,Remote Consultation ,Digital video ,Reproducibility of Results ,General Medicine ,Mohs Surgery ,Video image ,Surgery ,business ,computer - Abstract
BACKGROUND Dynamic telepathology is the real-time transmission of histologic images from one pathologist to another by means of telecommunications technology. OBJECTIVE The objective was to determine whether dynamic telepathology can be accomplished accurately and inexpensively by use of readily available off-the-shelf consumer products and software. METHODS We attached a standard, consumer-grade, digital video camera to a microscope in the Mohs surgery laboratory and then transmitted via the Internet real-time histologic video images and audio to a consultant dermatopathologist by means of iChat AV videoconferencing software (Apple Computer Inc., Cupertino, CA). In the first part of the study, 20 unknown formalin-fixed, paraffin-embedded slides from tumors typically seen in a Mohs practice were evaluated by the consultant dermatopathologist. In the second part of the study, the Mohs surgeon consulted the dermatopathologist on 20 Mohs frozen section slides in which the surgeon had a particular question (e.g., "Is this part of a pilosebaceous unit or is this basal cell carcinoma?"). RESULTS The video images were adequate for pathologic interpretation. There was agreement between conventional light microscopy and dynamic telepathology diagnosis in 19 of 20 tumors. There was complete agreement for all 20 Mohs frozen section consultations. CONCLUSION Dynamic telepathology can be accomplished accurately and inexpensively by use of readily available consumer products and software.
- Published
- 2007
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25. microRNAs in Psoriasis
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Gerald G. Krueger, Ryan M. O'Connell, Kristina Callis Duffin, Scott R. Florell, Jason E. Hawkes, Giang Nguyen, and Mayumi Fujita
- Subjects
0301 basic medicine ,Male ,Dermatology ,Biology ,Bioinformatics ,Biochemistry ,Sensitivity and Specificity ,Pathogenesis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Psoriasis ,microRNA ,medicine ,Humans ,Genetic Predisposition to Disease ,Molecular Biology ,Regulation of gene expression ,Gene Expression Profiling ,IRAK1 ,Cell Biology ,Non-coding RNA ,medicine.disease ,Gene expression profiling ,MicroRNAs ,030104 developmental biology ,Gene Expression Regulation ,Immunology ,Female - Abstract
Psoriasis is a chronic inflammatory skin condition resulting from a complex interplay among the immune system, keratinocytes, susceptibility genes, and environmental factors. However, the pathogenesis of psoriasis is not completely elucidated. microRNAs represent a promising class of small, noncoding RNA molecules that function to regulate gene expression. Although microRNA research in psoriasis and dermatology is still relatively new, evidence is rapidly accumulating for the role of microRNAs in the pathogenesis of psoriasis and other chronic inflammatory conditions. In this article, we present a comprehensive review of what is known about microRNAs and their role in the pathogenesis of psoriasis.
- Published
- 2015
26. Lentigo Maligna/Lentigo Maligna Melanoma
- Author
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Jeffrey K. McKENNA, Glenn D. Goldman, Glen M. Bowen, and Scott R. Florell
- Subjects
Pathology ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Melanoma in situ ,Cryotherapy ,Lentigo maligna ,Dermatology ,Delayed diagnosis ,Hutchinson's Melanotic Freckle ,medicine ,Mohs surgery ,Humans ,Lentigo maligna melanoma ,Pigmentation disorder ,integumentary system ,business.industry ,Lasers ,General Medicine ,Mohs Surgery ,medicine.disease ,Surgery ,Facial Neoplasms ,Neoplasm Recurrence, Local ,Premalignant lesion ,business - Abstract
Lentigo maligna (LM) is a subtype of melanoma in situ that typically develops on sun-damaged skin. Presentation may be quite subtle and delayed diagnosis is common. Clinical margins are often ill defined. Histologic evaluation can be difficult due to the widespread atypical melanocytes that are present in the background of long-standing sun damage. Recurrence following standard therapies is common.To review the clinical features, histopathology, and treatment options for LM. Emphasis is placed on recent advances in the treatment of LM.Literature review.The estimated lifetime risk of LM progressing to LM melanoma is 5%. Standard excision of LM with 5 mm margins is insufficient in 50% of cases. The recurrence rate with standard excision ranges from 8 to 20%. Mohs surgery and staged excision may offer better margin control and lower recurrence rates (4-5%). Estimates of recurrence rates following nonsurgical therapies such as cryosurgery, radiotherapy, electrodessication and curettage, laser surgery, and topical medications range from 20 to 100% at 5 years.Adequate treatment of LM requires a comprehensive knowledge of the diagnostic features, histopathology, and treatment options. Surgical modalities with meticulous evaluation of tissue margins appears to offer the lowest rates of disease recurrence.
- Published
- 2006
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27. Population-Based Analysis of Prognostic Factors and Survival in Familial Melanoma
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Charles L. Wiggins, R. Dirk Noyes, Gilda Garibotti, John Astle, Richard A. Kerber, Geraldine P. Mineau, Wolfram E. Samlowski, Sancy A. Leachman, Lisa A. Cannon-Albright, John J. Zone, Scott R. Florell, Alexander Tsodikov, and Kenneth M. Boucher
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,medicine.medical_specialty ,Multivariate statistics ,Percentile ,Skin Neoplasms ,Multivariate analysis ,Databases, Factual ,Population ,Sex Factors ,Utah ,Internal medicine ,medicine ,Population Database ,Humans ,Genetic Predisposition to Disease ,Neoplasm Invasiveness ,Registries ,education ,Melanoma ,Survival analysis ,Aged ,education.field_of_study ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Cancer registry ,Surgery ,Multivariate Analysis ,Female ,business - Abstract
Purpose Familial melanoma patients are reported to present with thinner melanomas, to be younger at the time of diagnosis, and to have a greater likelihood of developing multiple primary tumors. We sought to determine whether melanomas that occur in a familial setting demonstrate different prognostic and survival statistics relative to sporadic melanoma. Patients and Methods This population-based study used the Utah Cancer Registry and Utah Population Database to objectively evaluate prognostic and survival statistics of the familial melanoma population. From 1973 to 1999, there were 7,785 cases of invasive melanoma identified through the Utah Cancer Registry. These were linked to the Utah Population Database, resulting in 2,659 subjects with family-history information from which a familiality score could be calculated. Cases scored in the top ninth percentile were assigned as high familial risk, and the remaining 91% were considered low familial risk. Results Multivariate logistic-regression analysis found no association between sex, Breslow depth, Clark level, or survival and the familial status. Age at first diagnosis of invasive melanoma was slightly lower in the high-familial-risk group (57 v 60 years; P = .03). High-familial-risk subjects had more melanomas diagnosed at age 30 or younger (12% v 6%; P < .001). A significant difference in the overall number of individuals with two or more primary malignant melanomas was not detected among the groups (P = .2). Conclusion These data suggest that melanomas occurring in the context of an underlying inherited susceptibility do not have a significantly different biologic behavior.
- Published
- 2005
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28. Neutrophilic sebaceous adenitis with intralobular Demodex mites: a case report and review of the literature
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Maryam Liaqat, David A. Wada, Lindsay H. Wilson, Anneli R. Bowen, and Scott R. Florell
- Subjects
Male ,medicine.medical_specialty ,Mite Infestations ,Nasal bridge ,Neutrophils ,Biopsy ,ANNULAR PLAQUE ,Dermatology ,Pathology and Forensic Medicine ,Sebaceous Glands ,Demodex brevis ,Anti-Infective Agents ,Sebaceous adenitis ,parasitic diseases ,Medicine ,Animals ,Humans ,Nose ,Histological examination ,Mites ,biology ,business.industry ,General Medicine ,Middle Aged ,biology.organism_classification ,Sebaceous Gland Diseases ,medicine.anatomical_structure ,Treatment Outcome ,Demodex mites ,business ,Facial Dermatoses - Abstract
A 61-year-old white man presented with a 1-week history of an asymptomatic erythematous, annular plaque with minimal scale limited to the nasal bridge. Histological examination showed a mixed infiltrate of lymphocytes and neutrophils within sebaceous glands. The clinical and histopathological presentation was consistent with a diagnosis of neutrophilic sebaceous adenitis. Several Demodex brevis mites were present deep within the affected sebaceous lobules. Demodex brevis mites are uncommon inhabitants of sebaceous glands of the nose, presenting more commonly on other body sites. The cause of neutrophilic sebaceous adenitis is unknown, but the presence of D. brevis in affected sebaceous glands in this case suggests a possible association.
- Published
- 2014
29. Benign melanocytic lymph node deposits in the setting of giant congenital melanocytic nevi: the large congenital nodal nevus
- Author
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Anneli R, Bowen, Keith L, Duffy, Frederic C, Clayton, Robert H I, Andtbacka, and Scott R, Florell
- Subjects
Male ,Nevus, Pigmented ,Skin Neoplasms ,Adolescent ,Sentinel Lymph Node Biopsy ,S100 Proteins ,Middle Aged ,MART-1 Antigen ,Biomarkers, Tumor ,Humans ,Melanocytes ,Lymph Nodes ,Melanoma ,Melanoma-Specific Antigens ,Aged ,Follow-Up Studies ,gp100 Melanoma Antigen - Abstract
Benign melanocytic rests are a frequent finding in superficial lymph nodes removed during sentinel lymph node biopsies for melanoma. Whereas the histopathology of these deposits is well understood, very little is known regarding melanocytic lymph node deposits in the setting of giant congenital melanocytic nevi.We analyzed lymph nodes removed from the drainage basin of giant congenital melanocytic nevi in three patients who had developed melanoma within their giant congenital nevi.Two of three patients showed widespread, capsular and parenchymal melanocytic deposits in multiple nodes (9 of 11 nodes in one patient and 6 of 8 in the other). Melanocytes were small, non-mitotically active and resembled those in the associated giant congenital melanocytic nevus. Melanocytes were arranged singly and in small nests ∼0.05 mm in diameter, with some larger sheets up to 1 mm. Nodal melanocytes stained for Melan A and S100 on immunohistochemical evaluation, but showed negative or minimal HMB-45 reactivity.Evaluation of lymph nodes in the setting of giant congenital melanocytic nevi is complicated by the presence of often numerous, parenchymal melanocytic nevic deposits. Bland cytology and minimal or absent HMB-45 staining may be helpful in differentiating these nodal melanocytic nevi from metastatic melanoma. We term this phenomena large congenital nodal nevus.
- Published
- 2014
30. Preservation of RNA for Functional Genomic Studies: A Multidisciplinary Tumor Bank Protocol
- Author
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Bradley K. Summers, Sancy A. Leachman, Joseph A. Holden, David A. Jones, John W. Gerwels, Cheryl M. Coffin, James W. Zimmermann, and Scott R. Florell
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Pathology, Surgical ,RNA Stability ,Guidelines as Topic ,Tissue Banks ,Biology ,Exocytosis ,Pathology and Forensic Medicine ,Immunoenzyme Techniques ,Cytokeratin ,Fresh Tissue ,Human Genome Project ,medicine ,Humans ,Melanoma ,Aged ,Oligonucleotide Array Sequence Analysis ,Skin ,Aged, 80 and over ,Carcinoma ,Histology ,Genomics ,Staining ,Tumor Bank ,Trizol ,Tissue bank ,RNA ,Immunohistochemistry ,Female ,Tissue Preservation - Abstract
Few human tumors are collected such that RNA is preserved for molecular analysis. Completion of the Human Genome Project will soon result in the identification of more than 100,000 new genes. Consequently, increasing attention is being diverted to identifying the function of these newly described genes. Here we describe a multidisciplinary tumor bank procurement protocol that preserves both the integrity of tissue for pathologic diagnosis, and the RNA for molecular analyses. Freshly excised normal skin was obtained from five patients undergoing wound reconstruction following Mohs micrographic surgery for cutaneous neoplasia. Tissues treated for 24 hours with RNAlater were compared histologically and immunohistochemically to tissues not treated with RNAlater. Immunohistochemical stains studied included: CD45, CEA, cytokeratin AE1/3, vimentin, S-100, and CD34 on formalin-fixed, paraffin embedded tissue and CD45 staining of frozen tissue. Slides were blinded and evaluated independently by three pathologists. The histologic and immunohistochemical parameters of tissue stored in RNAlater were indistinguishable from tissue processed in standard fashion with the exception of S-100 stain which failed to identify melanocytes or Langerhan's cells within the epidermis in any of the RNAlater-treated tissues. Interestingly, nerve trunks within the dermis stained appropriately for S-100. Multiple non-cutaneous autopsy tissues were treated with RNAlater, formalin, liquid nitrogen (LN2), and TRIzol Reagent. The pathologists were unable to distinguish between tissues treated with RNAlater, formalin, or frozen in LN2, but could easily distinguish tissues treated with TRIzol Reagent because of extensive cytolysis. RNA was isolated from a portion of the tissue treated with RNAlater and used for molecular studies including Northern blotting and microarray analysis. RNA was adequate for Northern blot analysis and mRNA purified from RNAlater-treated tissues consistently provided excellent templates for reverse transcription and subsequent microarray analysis. We conclude that tissues treated with RNAlater before routine processing are indistinguishable histologically and immunohistochemically from tissues processed in routine fashion and that the RNA isolated from these tissues is of high quality and can be used for molecular studies. Based on this study, we developed a multidisciplinary tumor bank procurement protocol in which fresh tissue from resection specimens are routinely stored in RNAlater at the time of preliminary dissection. Thus, precious human tissue can be utilized for functional genomic studies without compromising the tissue's diagnostic and prognostic qualities.
- Published
- 2001
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31. Chondroid Syringoma: Case Report of a Highly Unusual Foot Tumor
- Author
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Scott R. Florell, Carolin Teman, Timothy C. Beals, Florian Nickisch, and Lester J. Layfield
- Subjects
Adult ,medicine.medical_specialty ,business.industry ,Radiography ,Forefoot ,Adenoma, Pleomorphic ,Forefoot, Human ,Chondroid Syringoma ,medicine.disease ,Dermatology ,Sweat Gland Neoplasms ,Syringoma ,medicine ,Humans ,Female ,Orthopedics and Sports Medicine ,Surgery ,business ,Foot (unit) - Abstract
Level of Evidence: V, Expert Opinion
- Published
- 2010
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32. Nevus Distribution in a Utah Melanoma Kindred with a Temperature-Sensitive CDKN2A Mutation
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Kenneth M. Boucher, Lisa A. Cannon-Albright, Wolfram E. Samlowski, Ronald M. Harris, Scott R. Florell, Marybeth Hart, Jason P. Brinton, Sancy A. Leachman, Douglas Grossman, Laurence Meyer, and John J. Zone
- Subjects
Male ,CDKN2A Mutation ,Skin Neoplasms ,Dermatology ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Utah ,Medicine ,Distribution (pharmacology) ,Nevus ,Humans ,skin and connective tissue diseases ,Melanoma ,Molecular Biology ,Cyclin-Dependent Kinase Inhibitor p16 ,030304 developmental biology ,0303 health sciences ,business.industry ,Genetic Carrier Screening ,Temperature ,Cell Biology ,medicine.disease ,Molecular biology ,030220 oncology & carcinogenesis ,Mutation ,Temperature sensitive ,Female ,business - Published
- 2005
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33. Rare skin malignancies of the head and neck: a review
- Author
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Scott R. Florell, Luke O. Buchmann, and Jason P. Hunt
- Subjects
medicine.medical_specialty ,Skin Neoplasms ,integumentary system ,business.industry ,Melanoma ,Incidence (epidemiology) ,Carcinoma ,Sarcoma ,medicine.disease ,Dermatology ,Rare Diseases ,Head and Neck Neoplasms ,Epidemiology ,Medicine ,Humans ,Surgery ,Histopathology ,Skin cancer ,business ,Head and neck - Abstract
The skin of the head and neck is a common location for skin cancers to develop. The majority of skin cancers of the head and neck are basal cell and squamous cell carcinomas, with melanoma also occurring at a significant incidence. However, there are many other histologies that occur and raise diagnostic and treatment challenges. In this article, we review some of the more common histologies that are classified as rare skin malignancies of the head and neck. Specifically, epidemiology, pathogenesis, histopathology, and treatment options for each of these histologies will be discussed. There is a growing emphasis on Mohs micrographic surgery in the treatment of these lesions, although, some are not amenable to this technique. A multidisciplinary approach is frequently useful in their treatment.
- Published
- 2013
34. Polarizable elements in scabies infestation: a clue to diagnosis
- Author
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Chong Wee, Foo, Scott R, Florell, and Anneli R, Bowen
- Subjects
Male ,Feces ,Mites ,Scabies ,Birefringence ,Pruritus ,Animals ,Humans ,Dermoscopy ,Female ,Microscopy, Polarization ,Hair Follicle ,Retrospective Studies - Abstract
The diagnosis of scabies infestation is straightforward in cases where mite parts are largely visible; however, mites are often not captured in a specimen's planes of section. Polariscopic examination is a fast and simple adjunctive diagnostic tool to light microscopy. We describe the unique polariscopic findings in scabies infestation. Two cases of crusted scabies and eight cases of typical scabies were subjected to polariscopic examination. Diagnostic mite parts were visualized in at least one section in all cases. Attached and detached spines as well as scybala (fecal material) are polarizable. Specifically, spines show a polarizable outer sheath with dark central core while scybala show peripherally concentrated, stippled birefringence. Similar stippled birefringence is visible within the gut of some mites whereas significant birefringence is not appreciated in other mite parts. These results suggest that polariscopic examination is a helpful clue in the diagnosis of scabies infestation, especially in cases where the body of the mite is not visualized.
- Published
- 2012
35. Sentinel lymph node biopsy for melanoma in pregnant women
- Author
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Douglas Grossman, Glen M. Bowen, Matthew R. Donaldson, Kenneth F. Grossmann, Tawnya L. Bowles, Scott R. Florell, Robert H.I. Andtbacka, Christopher J. Anker, Hung Thieu Khong, Anneli R Bowen, Keith L. Duffy, Sancy A. Leachman, and R. Dirk Noyes
- Subjects
Adult ,medicine.medical_specialty ,Skin Neoplasms ,medicine.medical_treatment ,Sentinel lymph node ,Gestational Age ,Young Adult ,Fetus ,Postoperative Complications ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Melanoma ,Neoplasm Staging ,Retrospective Studies ,Obstetrics ,business.industry ,Sentinel Lymph Node Biopsy ,General surgery ,Wide local excision ,Pregnancy Outcome ,Gestational age ,Retrospective cohort study ,medicine.disease ,Oncology ,Surgery ,Lymphadenectomy ,Female ,business ,Pregnancy Complications, Neoplastic ,Follow-Up Studies - Abstract
The incidence of melanoma is rising in young women of childbearing age. Melanoma diagnosed during pregnancy presents unique challenges. This study was conducted to determine the effect of sentinel lymph node biopsy (SLNB) for melanoma on maternal and fetal outcomes in pregnant women. A prospective melanoma database was retrospectively queried for women diagnosed with melanoma during or immediately before pregnancy as well as SLNB in pregnant women. The outcomes of SLNB for the mothers and fetuses were evaluated. Fifteen pregnant women underwent wide local excision (WLE) and SLNB for melanoma from 1997 to 2012. The median gestational age was 20 weeks. More than half of the women noticed changes in the primary melanoma lesion during the pregnancy. The median Breslow thickness was 1.00 mm. Lymphatic mapping and SLNB were performed with some combination of radiocolloid or vital blue dye without adverse effects. Three patients had micrometastatic disease and underwent a completion lymphadenectomy. Sixteen children were born at a median gestational age of 39 weeks. The median 1- and 5-minute Apgar scores were 8 and 9, respectively. At a median follow-up of 54.4, months none of the patients had experienced recurrence, and all children were healthy and free of melanoma. In this series of pregnant women with melanoma, SLNB was performed safely during pregnancy without adverse effects to the mothers and fetuses. We recommend that clinicians explain the risks and benefits of the SLNB procedure to pregnant women so an informed decision can be made about the procedure.
- Published
- 2012
36. Results of an investigator-initiated single-blind split-face comparison of photodynamic therapy and 5% imiquimod cream for the treatment of actinic keratoses
- Author
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Murray A. Cotter, Michael L. Hadley, Christopher M. Hull, Jason C. Hadley, Scott R. Florell, and Payam Tristani-Firouzi
- Subjects
Male ,medicine.medical_specialty ,Interferon Inducers ,Keratosis ,medicine.medical_treatment ,Treatment outcome ,Photodynamic therapy ,Imiquimod ,Dermatology ,medicine ,Humans ,Single-Blind Method ,Aged ,Aged, 80 and over ,business.industry ,Treatment options ,General Medicine ,Actinic keratoses ,Aminolevulinic Acid ,Middle Aged ,medicine.disease ,Keratosis, Actinic ,Treatment Outcome ,Photochemotherapy ,Aminoquinolines ,Quality of Life ,Surgery ,Single blind ,business ,Facial Dermatoses ,medicine.drug - Abstract
Topical photodynamic therapy (PDT) with aminolevulinic acid (ALA) and 5% imiquimod cream are effective therapies for the treatment of actinic keratoses (AKs), but no split-face studies directly comparing these treatment options are available in the literature.To compare the efficacy and tolerability of ALA-PDT and imiquimod 5% cream for the treatment of AKs.Sixty-one patients were enrolled from the Salt Lake City Veterans Affairs Hospital; 51 completed the study and were included in the analysis. All patients were randomized to receive half of a sachet of imiquimod 5% cream twice weekly on half of their face and two sessions of PDT with 20% solution of ALA applied for 1 hour to the other side of the face. The 75% AK clearance rate was 34.6% for ALA-PDT and 25% for imiquimod 5% cream (p = .30). The mean reduction in AK count was 59.2% for ALA-PDT and 41.4% for imiquimod 5% cream (p = .002). Dermatology Life Quality Index (DLQI) scores were assessed for each treatment modality at week 4 and were 1.95 and 1.38, respectively (p = .20).The sample size was small, and patients applied a small amount of imiquimod 5% cream (half a sachet) to a large surface area.There was no statistically significant difference in treatment response when the 100% or 75% clearance rate cutoff was used, but our secondary outcome suggests that two sessions of ALA-PDT is superior to imiquimod 5% cream for the treatment of AKs. There was no statistically significant difference in effect on quality of life as assessed using the DLQI.
- Published
- 2012
37. Anal apocrine carcinoma: a case report and literature review
- Author
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Scott R. Florell, Brian J. Hall, Bradford Sklow, and Ting Liu
- Subjects
Adenoma ,Male ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Biopsy ,Dermatology ,Malignancy ,Pathology and Forensic Medicine ,Lesion ,Eosinophilic ,medicine ,Biomarkers, Tumor ,Humans ,Aged ,medicine.diagnostic_test ,business.industry ,Wide local excision ,Carcinoma ,Anal Region ,Apocrine Carcinoma ,General Medicine ,medicine.disease ,Anus Neoplasms ,Immunohistochemistry ,Sweat Gland Neoplasms ,medicine.anatomical_structure ,Apocrine Glands ,medicine.symptom ,business ,Subcutaneous tissue - Abstract
Apocrine carcinoma (AC) is an extremely rare skin appendage tumor, which is located at lower dermal and subcutaneous tissue. We report a case of an anal AC arising from an apocrine adenoma in the anal region, which is only the second case reported in this region. A 71-year-old male presented to clinic with soreness in the anal region for 6 weeks. An excisional biopsy was performed. Histologically, the lesion was poorly circumscribed, infiltrative, and was composed of small to medium sized glands extending to the surgical margins. There were centrally dilated large glands with duct-like openings into the mucosal surface. The larger central glands contain periodic acid-Schiff-positive eosinophilic acellular secretions. At the periphery, there were smaller glands with significant cytologic atypia and numerous mitoses. A diagnosis of AC was made making it the second case report of this very rare malignancy in this region. Although ACs usually do not have a fatal outcome, there have been case reports of distant metastases and even death from this disease, making histologic distinction of this malignancy from a benign apocrine adenoma important. Wide local excision is typically the treatment of choice, although Mohs micrographic surgery has also been used with similar success.
- Published
- 2012
38. Use of proliferation rate, p53 staining and perforating elastic fibers in distinguishing keratoacanthoma from hypertrophic lichen planus: a pilot study
- Author
-
Lindsay M. Burt, Kenneth M. Boucher, Anneli R. Bowen, Scott R. Florell, and Payam Tristani-Firouzi
- Subjects
Hypertrophic lichen planus ,Adult ,Male ,Keratoacanthoma ,Pathology ,medicine.medical_specialty ,Histology ,Proliferation index ,Pilot Projects ,Dermatology ,Pathology and Forensic Medicine ,Proliferation rate ,Medicine ,Humans ,Aged ,Cell Proliferation ,Retrospective Studies ,Skin ,Aged, 80 and over ,business.industry ,Lichen Planus ,Middle Aged ,medicine.disease ,Elastic Tissue ,Immunohistochemistry ,Staining ,Gene Expression Regulation, Neoplastic ,Female ,Tumor Suppressor Protein p53 ,business - Abstract
Background: Distinguishing keratoacanthoma (KA) and hypertrophic lichen planus (LP) histopathologically can be difficult, and the challenge is compounded by the tendency of KA to arise in association with hypertrophic LP. Methods: In this pilot study, we compared 18 cases each of KA and hypertrophic LP for proliferation index (MIB-1), p53 staining and the presence of perforating elastic fibers (elastic Verhoeff-van Gieson) to determine the utility of these staining modalities in distinguishing KA from hypertrophic LP. Results: Proliferation index in KA compared to hypertrophic LP is 88.2 (mean positive MIB-1 cells/×100 field), SD = 56.6 and 47.3, SD = 68.4, respectively. p53 staining in KA compared to hypertrophic LP is 251 (mean positive cells/×100 field), SD = 117 and 158, SD = 119, respectively. Fifteen of eighteen (83%) keratoacanthomata demonstrate perforating elastic fibers compared to 1/18 (6%) for hypertrophic LP. Conclusion: Proliferation index is not significantly different between KA and hypertrophic LP (p = 0.059). Expression of p53 is increased in KA over hypertrophic LP (p = 0.024). The presence of perforating elastic fibers in KA is significantly different from hypertrophic LP (p < 0.0001) and suggests that elastic Verhoeff-van Gieson staining may be of practical benefit in distinguishing KA from hypertrophic LP in difficult cases. Bowen AR, Burt L, Boucher K, Tristani-Firouzi P, Florell SR. Use of proliferation rate, p53 staining and perforating elastic fibers in the distinction of keratoacanthoma and hypertrophic lichen planus: a pilot study.
- Published
- 2012
39. Lentigo maligna: one size does not fit all
- Author
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Glen M. Bowen, Scott R. Florell, and Anneli R. Bowen
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,business.industry ,Dermatology ,General Medicine ,Lentigo maligna ,medicine.disease ,Hutchinson's Melanotic Freckle ,Medicine ,Humans ,Female ,business ,Melanoma - Published
- 2011
40. Report of a novel OCA2 gene mutation and an investigation of OCA2 variants on melanoma risk in a familial melanoma pedigree
- Author
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Sancy A. Leachman, Prashiela Manga, Jason E. Hawkes, David E. Goldgar, Raymond E. Boissy, Scott R. Florell, Lisa A. Cannon-Albright, and Pamela B. Cassidy
- Subjects
Male ,Heterozygote ,Skin Neoplasms ,genetic structures ,DNA Mutational Analysis ,Mutation, Missense ,Dermatology ,Gene mutation ,Biology ,Biochemistry ,Article ,03 medical and health sciences ,0302 clinical medicine ,CDKN2A ,medicine ,Humans ,Genetic Predisposition to Disease ,TYRP1 ,neoplasms ,Molecular Biology ,Melanoma ,030304 developmental biology ,OCA2 ,Genetics ,0303 health sciences ,Membrane Transport Proteins ,Iris melanoma ,Middle Aged ,medicine.disease ,Oculocutaneous albinism ,3. Good health ,Pedigree ,Albinism, Oculocutaneous ,030220 oncology & carcinogenesis ,Cutaneous melanoma ,Albinism ,Female - Abstract
Summary Background Oculocutaneous albinism type 2 (OCA2) is caused by mutations of the OCA2 gene. Individuals affected by OCA2 as well as other types of albinism are at a significantly increased risk for sun-induced skin-cancers, including malignant melanoma (MM). Objective To identify the molecular etiology of oculocutaneous albinism in a previously uncharacterized melanoma pedigree and to investigate the relationship between two OCA2 variants and melanoma predisposition in this pedigree. Methods DNA and RNA were isolated from the peripheral blood of seven patients in a familial melanoma pedigree. Electron microscopy was performed on the individual with clinical oculocutaneous albinism. OCA2 , TYRP1 , MC1R , CDKN2A / p16 , CDKN2A / p19ARF , and CDK4 genes were sequenced in affected individuals. The relationship between OCA2 variants and melanoma was assessed using a pedigree likelihood-based method. Results The proband was determined to be an OCA2 compound heterozygous mutation carrier with a previously reported conservative missense mutation (V443I) and a novel non-conservative missense mutation (L734R). The pedigree contained individuals diagnosed with both cutaneous and iris melanoma. Based on co-segregation analysis, the odds of these OCA2 variants being high penetrance loci for melanoma was: 1.3-to-1 if we include the iris melanoma as affected and 6.5-to-1 if we only consider cutaneous melanoma as affected. Conclusion The discovery of this novel OCA2 variant adds to the body of evidence on the detrimental effects of OCA2 gene mutations on pigmentation, supports existing GWAS data on the relevance of the OCA2 gene in melanoma predisposition, and may ultimately assist in the development of targeted molecular therapies in the treatment of OCA and melanoma.
- Published
- 2011
41. Basal cell carcinoma arising in a nevus sebaceus in a child with facial trichoepitheliomas
- Author
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Allison L, Jensen, Scott R, Florell, Sheryll L, Vanderhooft, and Allen E, Bale
- Subjects
Male ,Skin Neoplasms ,Carcinoma, Basal Cell ,Neoplastic Syndromes, Hereditary ,Hamartoma ,Humans ,Facial Neoplasms ,Child ,Sebaceous Gland Diseases - Abstract
Nevus sebaceus (NS) is a congenital skin hamartoma that presents in childhood. Tumors may arise within these lesions over time. Mutations in the PTCH gene have been associated with both NS and some of the developing tumors. Only nine documented cases of basal cell carcinoma arising in nevus sebaceus in childhood are available. We present a case of an 8-year-old male with nevus sebaceus who developed a basal cell carcinoma. Evaluation for constitutional PTCH gene mutation and loss of heterozygosity (LOH) from the BCC within the NS did not reveal an underlying mutation. We further discuss the literature regarding prophylactic excision of NS.
- Published
- 2010
42. Comparative analysis of total body and dermatoscopic photographic monitoring of nevi in similar patient populations at risk for cutaneous melanoma
- Author
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Douglas Grossman, Glen M. Bowen, Agnessa Gadeliya Goodson, Scott R. Florell, and Mark A. Hyde
- Subjects
medicine.medical_specialty ,Skin Neoplasms ,Biopsy ,Dermoscopy ,Dermatology ,Article ,Cohort Studies ,Predictive Value of Tests ,Risk Factors ,medicine ,Image Processing, Computer-Assisted ,Photography ,Nevus ,Humans ,Neoplasm Invasiveness ,skin and connective tissue diseases ,Melanoma ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Retrospective cohort study ,General Medicine ,medicine.disease ,Predictive value of tests ,Cutaneous melanoma ,Cohort ,Surgery ,business ,Cohort study - Abstract
BACKGROUND Our previous experience monitoring nevi in high-risk patients using serial digital epiluminescence microscopy (DELM) photography achieved low biopsy rates but was limited by melanomas presenting as new lesions or arising from nevi that had not been photographed. OBJECTIVE To determine whether biopsy rates, efficiency of melanoma detection, and melanoma origin (de novo vs nevus derived) differed in a similar patient population monitored using total body (TB) photography. METHODS One thousand seventy-six patients (including 187 from a prior cohort) underwent TB photography and were monitored using photographs obtained at the initial visit. Risk factors and median monitoring periods for these patients were comparable with those of patients previously monitored using DELM photography. RESULTS Two hundred seventy-five biopsies were performed in 467 patients on follow-up visits. Of 12 melanomas detected on follow-up, five were invasive, five presented as changing lesions and two as new lesions, nine arose de novo, and the remainder were nevus derived. CONCLUSIONS In our experience with both approaches, monitoring patients at risk for melanoma using TB photography was associated with lower biopsy rates and lower nevus-to-melanoma ratios than using DELM and facilitated detection of new and changing lesions. In both cohorts, the majority of melanomas detected on follow-up arose de novo.
- Published
- 2010
43. Anatomic variability in superficial blood vessel and lymphatic vessel density
- Author
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Scott R. Florell, David E. Goldgar, Glen M. Bowen, Keith L. Duffy, Mark A. Hyde, Anneli R. Bowen, and Brad Tanner
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Histology ,Dermatology ,Pathology and Forensic Medicine ,Antibodies, Monoclonal, Murine-Derived ,Young Adult ,Antibodies monoclonal ,Cadaver ,medicine ,Lymphatic vessel ,Humans ,Lymph node ,Aged ,Lymphatic Vessels ,Skin ,business.industry ,Antibodies, Monoclonal ,Anatomical pathology ,Anatomy ,Middle Aged ,Platelet Endothelial Cell Adhesion Molecule-1 ,medicine.anatomical_structure ,Lymphatic system ,Blood Vessels ,Female ,business ,Blood vessel - Published
- 2010
44. Foamy cell angiosarcoma: a rare and deceptively bland variant of cutaneous angiosarcoma
- Author
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Amy D. Tatsas, Jean F. Simpson, Vicki L. Keedy, Justin M M Cates, Cheryl M. Coffin, Mark C. Kelley, and Scott R. Florell
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Shoulder ,Histology ,Skin Neoplasms ,Cell ,Hemangiosarcoma ,Tumor cells ,Dermatology ,Pathology and Forensic Medicine ,Diagnosis, Differential ,Young Adult ,Xanthomatosis ,Medicine ,Humans ,Angiosarcoma ,Forehead ,neoplasms ,Aged ,Granuloma ,business.industry ,digestive system diseases ,medicine.anatomical_structure ,Head and Neck Neoplasms ,Differential diagnosis ,business ,Foam Cells - Abstract
Cutaneous angiosarcoma can sometimes mimic other benign and malignant lesions, thereby presenting a difficult differential diagnosis. In the two cases of cutaneous angiosarcoma presented herein, extensive foamy cell alteration of tumor cells resembled a reactive xanthogranulomatous process. Foamy cell angiosarcoma is an unusual and deceptively benign morphologic variant of cutaneous angiosarcoma. Critical features for diagnosis include the presence of a deep, permeative, sometimes 'scaffolding' growth pattern and subtle areas of vascular formation.
- Published
- 2010
45. Low rates of clinical recurrence after biopsy of benign to moderately dysplastic melanocytic nevi
- Author
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Scott R. Florell, Kenneth M. Boucher, Agnessa Gadeliya Goodson, and Douglas Grossman
- Subjects
medicine.medical_specialty ,Nevus, Pigmented ,Skin Neoplasms ,medicine.diagnostic_test ,business.industry ,Physical examination ,Dermatology ,Melanocytic nevus ,medicine.disease ,Severity of Illness Index ,Article ,Dysplasia ,Biopsy ,Severity of illness ,medicine ,Dysplastic nevus ,Nevus ,Humans ,Neoplasm Recurrence, Local ,skin and connective tissue diseases ,business ,Shave biopsy - Abstract
Background Little is known about the recurrence/persistence rates of dysplastic nevi (DN) after biopsy, and whether incompletely removed DN should be re-excised to prevent recurrence. Objective Our purpose was to determine the recurrence rates of previously biopsied DN, and to assess whether biopsy method, margin involvement, congenital features, epidermal location, and degree of dysplasia are associated with recurrence. Methods Patients having a history of a "nevus biopsy" at least 2 years earlier were assessed for clinical recurrence. Slides of original lesions were re-reviewed by a dermatopathologist. Results A total of 271 nevus biopsy sites were assessed in 115 patients. Of 195 DN with greater than 2 years of follow-up, 7 (3.6%) demonstrated recurrence on clinical examination. In all, 98 DN had a follow-up period of at least 4 years with no clinical recurrence. Of 61 benign nevus biopsy sites examined, clinical recurrence was observed in two (3.3%). For all nevi, recurrence was significantly associated with shave biopsy technique but not with nevus dysplasia or subtype, or the presence of positive margin or congenital features. Limitations Most biopsies were performed in a pigmented lesion clinic at a single tertiary referral center. Determinations of nevus recurrence were made on clinical rather than histologic grounds, and follow-up times were limited in some cases. Conclusion In this cohort, rates of clinical recurrence after biopsy of DN and benign nevi were extremely low. Re-excision of nevi, including mildly to moderately DN with a positive margin, may not be necessary.
- Published
- 2009
46. Tender papule of the nail fold--quiz case
- Author
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Michael L. Hadley, Scott R. Florell, Christopher M. Hull, Ronald M. Harris, Anneli R. Bowen, and Keith L. Duffy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,business.industry ,Papule ,Dermatology ,General Medicine ,Fibroma ,medicine.disease ,Nail fold ,Fingers ,Nails ,medicine ,Humans ,medicine.symptom ,business - Published
- 2009
47. Acquired port wine stain of the upper eyelid after cluster headache
- Author
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John D. McCann, Scott R. Florell, Chun Cheng Lin, Richard L. Anderson, and M. Reza Vagefi
- Subjects
Dermatochalasis ,Blepharoplasty ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Port-Wine Stain ,Cluster Headache ,Lesion ,Diagnosis, Differential ,medicine ,Humans ,Aged ,business.industry ,Papillary dermis ,Cluster headache ,Port-wine stain ,Eyelids ,General Medicine ,medicine.disease ,Dermatology ,Ophthalmology ,medicine.anatomical_structure ,Surgery ,Eyelid ,Headaches ,medicine.symptom ,business ,Follow-Up Studies - Abstract
A 69-year-old white man with a medical history of left-sided cluster headaches presented for evaluation of dermatochalasis. The left upper eyelid demonstrated red- pink, blanchable macules that coalesced in a patch. The lesion appeared after an episode of a cluster headache. Upper eyelid blepharoplasty permitted en bloc removal of most of the lesion. Histopathologic evaluation demonstrated aggregates of telangiectatic blood vessels in the papillary dermis consistent with the diagnosis of an acquired port wine stain. The authors report, to their knowledge, the first description of an acquired port wine stain associated with cluster headaches.
- Published
- 2008
48. Neonatal pemphigus in an infant born to a mother with serologic evidence of both pemphigus vulgaris and gestational pemphigoid
- Author
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Kristin M. Leiferman, Jason C. Hadley, Jacqueline Panko, Sheryll L. Vanderhooft, John J. Zone, and Scott R. Florell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pemphigoid ,Mucocutaneous zone ,Fluorescent Antibody Technique ,Dermatology ,Infant, Newborn, Diseases ,Gestational pemphigoid ,immune system diseases ,Pregnancy ,Pemphigoid, Bullous ,medicine ,Humans ,skin and connective tissue diseases ,education ,Maternal-Fetal Exchange ,Autoantibodies ,Autoimmune disease ,education.field_of_study ,integumentary system ,business.industry ,Pemphigus vulgaris ,Infant, Newborn ,Pemphigoid Gestationis ,medicine.disease ,Pregnancy Complications ,Pemphigus ,Immunoglobulin G ,Desmoglein 3 ,Immunology ,Female ,business - Abstract
Neonatal pemphigus is a rarely reported transitory autoimmune blistering disease caused by transfer of maternal IgG autoantibodies to desmoglein 3 to the neonate through the placenta when the mother is affected with pemphigus. It is clinically characterized by transient flaccid blisters and erosions on the skin and, rarely, the mucous membranes. Neonatal pemphigus vulgaris has never been reported to persist beyond the neonatal period and progress to adult disease. Gestational pemphigoid is an uncommon, pregnancy-associated, autoimmune blistering disease. This disease typically flares with delivery and then spontaneously resolves within months without treatment. In 5% to 10% of cases, the antibodies responsible for gestational pemphigoid are transferred to the neonate through the placenta, causing transitory blistering in the neonate. While both gestational pemphigoid and pemphigus vulgaris can occur during pregnancy, these clinically, histologically, and serologically distinct diseases are not known to occur simultaneously in the same patient. We describe a case of a 36-year-old woman with clinical evidence of mucocutaneous pemphigus, but not gestational pemphigoid, who had serum antibodies to the antigens responsible for pemphigus as well as those responsible for gestational pemphigoid. This patient gave birth to a neonate with neonatal pemphigus but no evidence of neonatal gestational pemphigoid.
- Published
- 2008
49. Sampling of melanocytic nevi for research purposes: a prospective, pilot study to determine effect on diagnosis
- Author
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Scott R. Florell, Bruce R. Smoller, Kenneth M. Boucher, Douglas Grossman, Ronald M. Harris, Sancy A. Leachman, and Glen M. Bowen
- Subjects
medicine.medical_specialty ,Biopsy ,Pilot Projects ,Dermatology ,Lesion ,Fixatives ,Formaldehyde ,medicine ,Nevus ,Humans ,Prospective Studies ,Medical diagnosis ,skin and connective tissue diseases ,Prospective cohort study ,Melanoma ,Skin ,Nevus, Pigmented ,medicine.diagnostic_test ,business.industry ,Melanocytic nevus ,medicine.disease ,Immunohistochemistry ,Homogeneous ,medicine.symptom ,business - Abstract
Background Research on melanocytic nevi predominantly utilizes formalin-fixed, paraffin-embedded tissue, largely limiting research to morphologic and immunohistochemical observations. Withholding portions of fresh nevus tissue for molecular studies could result in the loss of important diagnostic material. Objective This study prospectively evaluated melanocytic nevi for histologic homogeneity to determine if using a portion for research would have affected diagnosis. Methods Thirty-three subjects were enrolled in a prospective study in which pigmented lesions were chosen for biopsy on a clinical basis. Lesions were sectioned and each piece submitted in a separate block (mean, 2.7; range 2-5 blocks per lesion). Slides from nevi were examined in two phases. In phase I, sections of nevi were randomized and a diagnosis was rendered for each section of nevus. In phase II, the dermatopathologist reviewed all slides for each nevus as a case, similar to the original interpretation of the lesion provided to the clinician. Diagnoses from phases I and II were compared with the original diagnosis. Results Case material included 51 melanocytic lesions from 31 subjects. The phase I diagnosis matched the original diagnosis for 99 of 121 slides that showed a melanocytic lesion (82%). The phase II diagnosis matched the original diagnosis for 45 of 51 specimens (88%). Limitations The study was limited by: a small number of specimens; the clinician could have chosen clinically homogeneous nevi for biopsy; effect of interobserver and intraobserver variability on diagnosis. Conclusions For the majority of melanocytic nevi in this study, the diagnostic information present in one section of a melanocytic nevus could be extrapolated to the remainder of the specimen without adverse consequences from a diagnostic or therapeutic perspective.
- Published
- 2008
50. Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma
- Author
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Stanley R. Fuller, Glen M. Bowen, Ben Tanner, Douglas Grossman, and Scott R. Florell
- Subjects
medicine.medical_specialty ,Skin Neoplasms ,Population ,Physical examination ,Dermoscopy ,Dermatology ,Article ,Predictive Value of Tests ,medicine ,Nevus ,Humans ,Longitudinal Studies ,Risk factor ,skin and connective tissue diseases ,education ,neoplasms ,Melanoma ,Dermatoscopy ,education.field_of_study ,Nevus, Pigmented ,integumentary system ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Atypical nevus ,Predictive value of tests ,Surgery ,sense organs ,business - Abstract
BACKGROUND Atypical nevi are a common risk factor for melanoma. OBJECTIVES The objective was to determine the utility of monitoring dermoscopic photographs of atypical nevi in a high-risk population. METHODS Over a 4.5-year period, digital dermoscopic photographs were taken of clinically atypical nevi at initial and follow-up visits, such that side-by-side comparisons could be made. RESULTS A total of 5,945 lesions were monitored in 297 patients over 3 to 52 months (median, 22 months), and 324 lesions were biopsied. Photographic (dermoscopic) changes were noted in 96 of 5,945 (1.6%) lesions, which included 64 dysplastic nevi (67%), 25 common nevi (26%), and 1 melanoma (1.0%). Of 6 melanomas biopsied during the follow-up period, only 1 was detected by dermoscopic photographic change at follow-up. CONCLUSIONS Most clinically atypical melanocytic nevi are stable over time, and lesions exhibiting dermoscopic changes are most likely to be dysplastic nevi. Although dermoscopy is a useful tool for clinical examination, the sensitivity of dermoscopic monitoring is limited by melanomas that may arise in normal skin or in clinically benign nevi that were not initially photographed.
- Published
- 2007
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