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2. Use of Antipseudomonal Antibiotics is Not Associated With Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children With Complicated Appendicitis: Results From a Multicenter Regional Research Consortium

Author

Cramm, Shannon L., Graham, Dionne A., Feng, Christina, Allukian, Myron, Blakely, Martin L., Chandler, Nicole M., Cowles, Robert A., Kunisaki, Shaun M., Lipskar, Aaron M., Russell, Robert T., Santore, Matthew T., Campbell, Brendan T., Commander, Sarah J., DeFazio, Jennifer R., Dukleska, Katerina, Echols, Justice C., Esparaz, Joseph R., Gerall, Claire, Griggs, Cornelia L., Hanna, David N., He, Katherine, Keane, Olivia A., McLean, Sean E., Pace, Elizabeth, Scholz, Stefan, Sferra, Shelby R., Tracy, Elisabeth T., Zhang, Lucy, and Rangel, Shawn J.

Published
2024
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4. Use of Antipseudomonal Antibiotics is not Associated with Lower Rates of Postoperative Drainage Procedures or More Favorable Culture Profiles in Children with Complicated Appendicitis: Results from a Multicenter Regional Research Consortium

Author

Cramm, Shannon L., Graham, Dionne A., Feng, Christina, Allukian, Myron, Blakely, Martin L., Chandler, Nicole M., Cowles, Robert A., Kunisaki, Shaun M., Lipskar, Aaron M., Russell, Robert T., Santore, Matthew T., Campbell, Brendan T., Commander, Sarah J., DeFazio, Jennifer R., Dukleska, Katerina, Echols, Justice C., Esparaz, Joseph R., Gerall, Claire, Griggs, Cornelia L., Hanna, David N., He, Katherine, Keane, Olivia A., McLean, Sean E., Pace, Elizabeth, Scholz, Stefan, Sferra, Shelby R., Tracy, Elisabeth T., Zhang, Lucy, and Rangel, Shawn J.

Published
2023
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5. Fecal microbiota transplant rescues mice from human pathogen mediated sepsis by restoring systemic immunity

Author

Kim, Sangman M, DeFazio, Jennifer R, Hyoju, Sanjiv K, Sangani, Kishan, Keskey, Robert, Krezalek, Monika A, Khodarev, Nikolai N, Sangwan, Naseer, Christley, Scott, Harris, Katharine G, Malik, Ankit, Zaborin, Alexander, Bouziat, Romain, Ranoa, Diana R, Wiegerinck, Mara, Ernest, Jordan D, Shakhsheer, Baddr A, Fleming, Irma D, Weichselbaum, Ralph R, Antonopoulos, Dionysios A, Gilbert, Jack A, Barreiro, Luis B, Zaborina, Olga, Jabri, Bana, and Alverdy, John C

Subjects
Sepsis, Transplantation, Hematology, Infectious Diseases, Emerging Infectious Diseases, 5.1 Pharmaceuticals, Development of treatments and therapeutic interventions, Infection, Inflammatory and immune system, Good Health and Well Being, Animals, Butyric Acid, Fecal Microbiota Transplantation, Feces, Gastrointestinal Microbiome, Gastrointestinal Tract, Histone Deacetylase Inhibitors, Humans, Immunity, Interferon Regulatory Factor-3, Male, Mice, Inbred C57BL, Signal Transduction, Transcription, Genetic
Abstract

Death due to sepsis remains a persistent threat to critically ill patients confined to the intensive care unit and is characterized by colonization with multi-drug-resistant healthcare-associated pathogens. Here we report that sepsis in mice caused by a defined four-member pathogen community isolated from a patient with lethal sepsis is associated with the systemic suppression of key elements of the host transcriptome required for pathogen clearance and decreased butyrate expression. More specifically, these pathogens directly suppress interferon regulatory factor 3. Fecal microbiota transplant (FMT) reverses the course of otherwise lethal sepsis by enhancing pathogen clearance via the restoration of host immunity in an interferon regulatory factor 3-dependent manner. This protective effect is linked to the expansion of butyrate-producing Bacteroidetes. Taken together these results suggest that fecal microbiota transplantation may be a treatment option in sepsis associated with immunosuppression.

Published
2020

6. Outcomes and Resource Utilization Associated with Use of Routine Pre-Discharge White Blood Cell Count for Clinical Decision-Making in Children with Complicated Appendicitis: A Multicenter Hospital-Level Analysis

Author

Cramm, Shannon L., Graham, Dionne A., Blakely, Martin L., Chandler, Nicole M., Cowles, Robert A., Kunisaki, Shaun M., Russell, Robert T., Allukian, Myron, DeFazio, Jennifer R., Griggs, Cornelia L., Santore, Matthew T., Scholz, Stefan, Aronowitz, Danielle I., Campbell, Brendan T., Collins, Devon T., Commander, Sarah J., Engwall-Gill, Abigail, Esparaz, Joseph R., Feng, Christina, Gerall, Claire, Hanna, David N., Keane, Olivia A., Lamoshi, Abdulraouf, Lipskar, Aaron M., Orlas Bolanos, Claudia P., Pace, Elizabeth, Regan, Maia D., Tracy, Elisabeth T., Williams, Sacha, Zhang, Lucy, and Rangel, Shawn J.

Published
2023
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7. Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network

Author

Hamilton-Hall, Malcolm N., III, Jungbauer, Dana, Finck, Christine, Middlesworth, William, Zendejas, Benjamin, Alaish, Samuel M., Griggs, Cornelia L., Russell, Robert T., Shieh, Hester F., Scholz, Stefan, Kunisaki, Shaun M., Feng, Christina, Danko, Melissa E., DeFazio, Jennifer R., Smithers, Charles J., Zamora, Irving J., and Knod, J. Leslie

Published
2023
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8. Association Between Antibiotic Redosing Before Incision and Risk of Incisional Site Infection in Children With Appendicitis

Author

Cramm, Shannon L., Chandler, Nicole M., Graham, Dionne A., Kunisaki, Shaun M., Russell, Robert T., Blakely, Martin L., Lipskar, Aaron M., Allukian, Myron, Aronowitz, Danielle I., Campbell, Brendan T., Collins, Devon T., Commander, Sarah J., Cowles, Robert A., DeFazio, Jennifer R., Esparaz, Joseph R., Feng, Christina, Griggs, Cornelia L., Guyer, Richard A., Hanna, David N., Kahan, Anastasia M., Keane, Olivia A., Lamoshi, Abdulraouf, Lopez, Carla M., Pace, Elizabeth, Regan, Maia D., Santore, Matthew T., Scholz, Stefan, Tracy, Elisabeth T., Williams, Sacha A., Zhang, Lucy, and Rangel, Shawn J.

Published
2023
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11. Bacterial colonization and succession in a newly opened hospital

Author

Lax, Simon, Sangwan, Naseer, Smith, Daniel, Larsen, Peter, Handley, Kim M, Richardson, Miles, Guyton, Kristina, Krezalek, Monika, Shogan, Benjamin D, Defazio, Jennifer, Flemming, Irma, Shakhsheer, Baddr, Weber, Stephen, Landon, Emily, Garcia-Houchins, Sylvia, Siegel, Jeffrey, Alverdy, John, Knight, Rob, Stephens, Brent, and Gilbert, Jack A

Subjects
Clinical Research, Aetiology, 2.2 Factors relating to the physical environment, Infection, Bacteria, Bayes Theorem, Hospitals, Humans, Microbiota, Propionibacterium, Staphylococcus, Biological Sciences, Medical and Health Sciences
Abstract

The microorganisms that inhabit hospitals may influence patient recovery and outcome, although the complexity and diversity of these bacterial communities can confound our ability to focus on potential pathogens in isolation. To develop a community-level understanding of how microorganisms colonize and move through the hospital environment, we characterized the bacterial dynamics among hospital surfaces, patients, and staff over the course of 1 year as a new hospital became operational. The bacteria in patient rooms, particularly on bedrails, consistently resembled the skin microbiota of the patient occupying the room. Bacterial communities on patients and room surfaces became increasingly similar over the course of a patient's stay. Temporal correlations in community structure demonstrated that patients initially acquired room-associated taxa that predated their stay but that their own microbial signatures began to influence the room community structure over time. The α- and β-diversity of patient skin samples were only weakly or nonsignificantly associated with clinical factors such as chemotherapy, antibiotic usage, and surgical recovery, and no factor except for ambulatory status affected microbial similarity between the microbiotas of a patient and their room. Metagenomic analyses revealed that genes conferring antimicrobial resistance were consistently more abundant on room surfaces than on the skin of the patients inhabiting those rooms. In addition, persistent unique genotypes of Staphylococcus and Propionibacterium were identified. Dynamic Bayesian network analysis suggested that hospital staff were more likely to be a source of bacteria on the skin of patients than the reverse but that there were no universal patterns of transmission across patient rooms.

Published
2017

15. A 10-year review of outpatient skin biopsy results and skin cancer subtypes

Author

DeMarco, Sebastian S, Vos, Paul, Green, Harris, Defazio, Jennifer, Davis, Natalie, Fiz, Lindsey, and Phillips, Charles

Subjects
Skin, Cancer, Cutaneous, Biopsy, Results, Review
Abstract

The results of skin biopsies over a 10 year period were reviewed from the outpatient dermatology clinic at the Brody School of Medicine in Greenville, North Carolina. This research was conducted because there are very few studies that characterize this information over a long-term horizon. The biopsy rate per patient encounter, the clinical reason for the biopsy, the biopsy outcomes, the distribution of cutaneous malignancies per encounter, and the distribution of the subtypes of basal cell carcinoma, squamous cell carcinoma, and melanoma were analyzed. Biopsy logs from January 1, 2001 to December 31, 2010 were reviewed. Our investigation found that 20% of patient encounters resulted in a biopsy. Of these biopsies, 87.9% were performed to rule out malignancy and 12.1% were completed on patients suspected of having inflammatory skin conditions. The basal cell carcinomas diagnosed in Greenville, NC have more aggressive histologic subtypes compared to other studies, whereas the squamous cell carcinomas and melanomas were less aggressive.

Published
2016

16. Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis.

Author

Cramm, Shannon L., Graham, Dionne A., Blakely, Martin L., Kunisaki, Shaun M., Chandler, Nicole M., Cowles, Robert A., Feng, Christina, He, Katherine, Russell, Robert T., Allukian, Myron, Campbell, Brendan T., Commander, Sarah J., DeFazio, Jennifer R., Dukleska, Katerina, Echols, Justice C., Esparaz, Joseph R., Gerall, Claire, Griggs, Cornelia L., Hanna, David N., and Keane, Olivia A.

Published
2024
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19. Outcomes and resource utilization associated with use of routine pre-discharge white blood cell count for clinical decision-making in children with complicated appendicitis: A multi-center hospital-level analysis

Author

Cramm, Shannon L., primary, Graham, Dionne A., additional, Blakely, Martin L., additional, Chandler, Nicole M., additional, Cowles, Robert A., additional, Kunisaki, Shaun M., additional, Russell, Robert T., additional, Allukian, Myron, additional, DeFazio, Jennifer R., additional, Griggs, Cornelia L., additional, Santore, Matthew T., additional, Scholz, Stefan, additional, Aronowitz, Danielle I., additional, Campbell, Brendan T., additional, Collins, Devon T., additional, Commander, Sarah J., additional, Engwall-Gill, Abigail, additional, Esparaz, Joseph R., additional, Feng, Christina, additional, Gerall, Claire, additional, Hanna, David N., additional, Keane, Olivia A., additional, Lamoshi, Abdulraouf, additional, Lipskar, Aaron M., additional, Orlas Bolanos, Claudia P., additional, Pace, Elizabeth, additional, Regan, Maia D., additional, Tracy, Elisabeth T., additional, Williams, Sacha, additional, Zhang, Lucy, additional, and Rangel, Shawn J., additional

Published
2023
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20. A communal catalogue reveals Earths multiscale microbial diversity

Author

Thompson, Luke R., Sanders, Jon G., McDonald, Daniel, Amir, Amnon, Ladau, Joshua, Locey, Kenneth J., Prill, Robert J., Tripathi, Anupriya, Gibbons, Sean M., Ackermann, Gail, Navas-Molina, Jose A., Janssen, Stefan, Kopylova, Evguenia, Vzquez-Baeza, Yoshiki, Gonzlez, Antonio, Morton, James T., Mirarab, Siavash, Zech Xu, Zhenjiang, Jiang, Lingjing, Haroon, Mohamed F., Kanbar, Jad, Zhu, Qiyun, Jin Song, Se, Kosciolek, Tomasz, Bokulich, Nicholas A., Lefler, Joshua, Brislawn, Colin J., Humphrey, Gregory, Owens, Sarah M., Hampton-Marcell, Jarrad, Berg-Lyons, Donna, McKenzie, Valerie, Fierer, Noah, Fuhrman, Jed A., Clauset, Aaron, Stevens, Rick L., Shade, Ashley, Pollard, Katherine S., Goodwin, Kelly D., Jansson, Janet K., Gilbert, Jack A., Knight, Rob, Rivera, Jose L. Agosto, Al-Moosawi, Lisa, Alverdy, John, Amato, Katherine R., Andras, Jason, Angenent, Largus T., Antonopoulos, Dionysios A., Apprill, Amy, Armitage, David, Ballantine, Kate, Barta, Jiri, Baum, Julia K., Berry, Allison, Bhatnagar, Ashish, Bhatnagar, Monica, Biddle, Jennifer F., Bittner, Lucie, Boldgiv, Bazartseren, Bottos, Eric, Boyer, Donal M., Braun, Josephine, Brazelton, William, Brearley, Francis Q., Campbell, Alexandra H., Caporaso, J. Gregory, Cardona, Cesar, Carroll, JoLynn, Cary, S. Craig, Casper, Brenda B., Charles, Trevor C., Chu, Haiyan, Claar, Danielle C., Clark, Robert G., Clayton, Jonathan B., Clemente, Jose C., Cochran, Alyssa, Coleman, Maureen L., Collins, Gavin, Colwell, Rita R., Contreras, Monica, Crary, Benjamin B., Creer, Simon, Cristol, Daniel A., Crump, Byron C., Cui, Duoying, Daly, Sarah E., Davalos, Liliana, Dawson, Russell D., Defazio, Jennifer, Delsuc, Frederic, Dionisi, Hebe M., Dominguez-Bello, Maria Gloria, Dowell, Robin, Dubinsky, Eric A., Dunn, Peter O., Ercolini, Danilo, Espinoza, Robert E., Ezenwa, Vanessa, Fenner, Nathalie, Findlay, Helen S., Fleming, Irma D., Fogliano, Vincenzo, Forsman, Anna, Freeman, Chris, Friedman, Elliot S., Galindo, Giancarlo, Garcia, Liza, Garcia-Amado, Maria Alexandra, Garshelis, David, Gasser, Robin B., Gerdts, Gunnar, Gibson, Molly K., Gifford, Isaac, Gill, Ryan T., Giray, Tugrul, Gittel, Antje, Golyshin, Peter, Gong, Donglai, Grossart, Hans-Peter, Guyton, Kristina, Haig, Sarah-Jane, Hale, Vanessa, Hall, Ross Stephen, Hallam, Steven J., Handley, Kim M., Hasan, Nur A., Haydon, Shane R., Hickman, Jonathan E., Hidalgo, Glida, Hofmockel, Kirsten S., Hooker, Jeff, Hulth, Stefan, Hultman, Jenni, Hyde, Embriette, Ibanez-Alamo, Juan Diego, Jastrow, Julie D., Jex, Aaron R., Johnson, L. Scott, Johnston, Eric R., Joseph, Stephen, Jurburg, Stephanie D., Jurelevicius, Diogo, Karlsson, Anders, Karlsson, Roger, Kauppinen, Seth, Kellogg, Colleen T. E., Kennedy, Suzanne J., Kerkhof, Lee J., King, Gary M., Kling, George W., Koehler, Anson V., Krezalek, Monika, Kueneman, Jordan, Lamendella, Regina, Landon, Emily M., Lane-deGraaf, Kelly, LaRoche, Julie, Larsen, Peter, Laverock, Bonnie, Lax, Simon, Lentino, Miguel, Levin, Iris I., Liancourt, Pierre, Liang, Wenju, Linz, Alexandra M., Lipson, David A., Liu, Yongqin, Lladser, Manuel E., Lozada, Mariana, Spirito, Catherine M., MacCormack, Walter P., MacRae-Crerar, Aurora, Magris, Magda, Martin-Platero, Antonio M., Martin-Vivaldi, Manuel, Martinez, L. Margarita, Martinez-Bueno, Manuel, Marzinelli, Ezequiel M., Mason, Olivia U., Mayer, Gregory D., McDevitt-Irwin, Jamie M., McDonald, James E., McGuire, Krista L., McMahon, Katherine D., McMinds, Ryan, Medina, Monica, Mendelson, Joseph R., Metcalf, Jessica L., Meyer, Folker, Michelangeli, Fabian, Miller, Kim, Mills, David A., Minich, Jeremiah, Mocali, Stefano, Moitinho-Silva, Lucas, Moore, Anni, Morgan-Kiss, Rachael M., Munroe, Paul, Myrold, David, Neufeld, Josh D., Ni, Yingying, Nicol, Graeme W., Nielsen, Shaun, Nissimov, Jozef I., Niu, Kefeng, Nolan, Matthew J., Noyce, Karen, OBrien, Sarah L., Okamoto, Noriko, Orlando, Ludovic, Castellano, Yadira Ortiz, Osuolale, Olayinka, Oswald, Wyatt, Parnell, Jacob, Peralta-Sanchez, Juan M., Petraitis, Peter, Pfister, Catherine, Pilon-Smits, Elizabeth, Piombino, Paola, Pointing, Stephen B., Pollock, F. Joseph, Potter, Caitlin, Prithiviraj, Bharath, Quince, Christopher, Rani, Asha, Ranjan, Ravi, Rao, Subramanya, Rees, Andrew P., Richardson, Miles, Riebesell, Ulf, Robinson, Carol, Rockne, Karl J., Rodriguezl, Selena Marie, Rohwer, Forest, Roundstone, Wayne, Safran, Rebecca J., Sangwan, Naseer, Sanz, Virginia, Schrenk, Matthew, Schrenzel, Mark D., Scott, Nicole M., Seger, Rita L., Seguin-Orlando, Andaine, Seldin, Lucy, Seyler, Lauren M., Shakhsheer, Baddr, Sheets, Gabriela M., Shen, Congcong, Shi, Yu, Shin, Hakdong, Shogan, Benjamin D., Shutler, Dave, Siegel, Jeffrey, Simmons, Steve, Sjoling, Sara, Smith, Daniel P., Soler, Juan J., Sperling, Martin, Steinberg, Peter D., Stephens, Brent, Stevens, Melita A., Taghavi, Safiyh, Tai, Vera, Tait, Karen, Tan, Chia L., Tas, Neslihan, Taylor, D. Lee, Thomas, Torsten, Timling, Ina, Turner, Benjamin L., Urich, Tim, Ursell, Luke K., van der Lelie, Daniel, Van Treuren, William, van Zwieten, Lukas, Vargas-Robles, Daniela, Thurber, Rebecca Vega, Vitaglione, Paola, Walker, Donald A., Walters, William A., Wang, Shi, Wang, Tao, Weaver, Tom, Webster, Nicole S., Wehrle, Beck, Weisenhorn, Pamela, Weiss, Sophie, Werner, Jeffrey J., West, Kristin, Whitehead, Andrew, Whitehead, Susan R., Whittingham, Linda A., Willerslev, Eske, Williams, Allison E., Wood, Stephen A., Woodhams, Douglas C., Yang, Yeqin, Zaneveld, Jesse, Zarraonaindia, Iratxe, Zhang, Qikun, and Zhao, Hongxia

Subjects
Biological diversity -- Observations -- Environmental aspects, Microbial colonies -- Environmental aspects, Environmental issues, Science and technology, Zoology and wildlife conservation
Abstract

Our growing awareness of the microbial worlds importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earths microbial diversity., Author(s): Luke R. Thompson [1, 2, 3]; Jon G. Sanders [1]; Daniel McDonald [1]; Amnon Amir [1]; Joshua Ladau [4]; Kenneth J. Locey [5]; Robert J. Prill [6]; Anupriya Tripathi [...]

Published
2017
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22. Association Between Antibiotic Redosing Before Incision and Risk of Incisional Site Infection in Children With Appendicitis

Author

Cramm, Shannon L., primary, Chandler, Nicole M., additional, Graham, Dionne A., additional, Kunisaki, Shaun M., additional, Russell, Robert T., additional, Blakely, Martin L., additional, Lipskar, Aaron M., additional, Allukian, Myron, additional, Aronowitz, Danielle I., additional, Campbell, Brendan T., additional, Collins, Devon T., additional, Commander, Sarah J., additional, Cowles, Robert A., additional, DeFazio, Jennifer R., additional, Esparaz, Joseph R., additional, Feng, Christina, additional, Griggs, Cornelia L., additional, Guyer, Richard A., additional, Hanna, David N., additional, Kahan, Anastasia M., additional, Keane, Olivia A., additional, Lamoshi, Abdulraouf, additional, Lopez, Carla M., additional, Pace, Elizabeth, additional, Regan, Maia D., additional, Santore, Matthew T., additional, Scholz, Stefan, additional, Tracy, Elisabeth T., additional, Williams, Sacha A., additional, Zhang, Lucy, additional, and Rangel, Shawn J., additional

Published
2022
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26. Results of the 2016 International Skin Imaging Collaboration International Symposium on Biomedical Imaging challenge: Comparison of the accuracy of computer algorithms to dermatologists for the diagnosis of melanoma from dermoscopic images

Author

Marchetti, Michael A., Codella, Noel C.F., Dusza, Stephen W., Gutman, David A., Helba, Brian, Kalloo, Aadi, Mishra, Nabin, Carrera, Cristina, Celebi, Emre M., DeFazio, Jennifer L., Jaimes, Natalia, Marghoob, Ashfaq A., Quigley, Elizabeth, Scope, Alon, Yélamos, Oriol, and Halpern, Allan C.

Published
2018
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31. Association of Gangrenous, Suppurative, and Exudative Findings With Outcomes and Resource Utilization in Children With Nonperforated Appendicitis.

Author

Cramm, Shannon L., Lipskar, Aaron M., Graham, Dionne A., Kunisaki, Shaun M., Griggs, Cornelia L., Allukian, Myron, Russell, Robert T., Chandler, Nicole M., Santore, Matthew T., Aronowitz, Danielle I., Blakely, Martin L., Campbell, Brendan, Collins, Devon T., Commander, Sarah J., Cowles, Robert A., DeFazio, Jennifer R., Echols, Justice C., Esparaz, Joseph R., Feng, Christina, and Guyer, Richard A.

Published
2022
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37. Neonates With Complex Cardiac Malformation and Congenital Diaphragmatic Hernia Born to SARS-CoV-2 Positive Women—A Single Center Experience

Author

Goldshtrom, Nimrod, primary, Vargas, Diana, additional, Vasquez, Angelica, additional, Kim, Faith, additional, Desai, Kinjal, additional, Turner, Mariel E., additional, Barry, Oliver, additional, Torres, Alejandro, additional, Levasseur, Stéphanie, additional, Strletsova, Svetlana, additional, Gupta, Palka R., additional, Defazio, Jennifer R., additional, Duron, Vincent, additional, Middlesworth, William, additional, Saiman, Lisa, additional, Miller, Russell, additional, Goffman, Dena, additional, Bacha, Emile A., additional, Kalfa, David, additional, LaPar, Damien J., additional, and Krishnamurthy, Ganga, additional

Published
2020
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42. Acral dermatofibroma: P1501

Author

Amin, Bijal, DeFazio, Jennifer, Busam, Klaus, Myskowski, Patricia, and Spencer, Philip

Published
2010

46. Total Body Skin Examination Practices: A Survey Study Amongst Dermatologists at High-Risk Skin Cancer Clinics

Author

Bajaj, Shirin, Wolner, Zachary J, Dusza, Stephen W, Braun, Ralph P, Marghoob, Ashfaq A, DeFazio, Jennifer, Bajaj, Shirin, Wolner, Zachary J, Dusza, Stephen W, Braun, Ralph P, Marghoob, Ashfaq A, and DeFazio, Jennifer

Abstract

Background/Objectives Although total body skin examination (TBSE) is the primary screening mechanism for melanoma, there is no consensus on which anatomic sites a screening TBSE should include. We sought to establish which anatomic sites are examined during routine (>90%) TBSEs of patients at high risk for skin cancer. Methods A Google survey was emailed to 173 international dermatologist skin cancer specialists. Results More than 75% of participants reported routinely examining the scalp, ears, face and neck, trunk, breasts, inframammary areas, axillae, extremities, palms and soles, nails, interdigital spaces, and buttocks. The least frequently inspected anatomic sites included genitalia, with male genitalia more frequently examined than female (penis n = 39; 52%; labia majora n = 21; 28%; P = 0.003), the perianal region (n = 26; 34.7%), and the ocular conjunctiva and oral mucosa (n = 35; 46.7%). Participants cited not screening these areas because of perceived patient discomfort, low prevalence of malignancy, and the expectation that other specialists examine the area. Conclusions The role of routine surveillance of neglected anatomic sites is unclear and warrants further discussion weighing potential mortality benefit against the incidence of melanoma in obscure sites, morbidity of intervention in sensitive sites, cost-effectiveness, and potential for patient discomfort.

Published
2019

50. Results of the 2016 International Skin Imaging Collaboration ISBI Challenge: Comparison of the accuracy of computer algorithms to dermatologists for the diagnosis of melanoma from dermoscopic images

Author

Marchetti, Michael A., Codella, Noel C.F., Dusza, Stephen W., Gutman, David A., Helba, Brian, Kalloo, Aadi, Mishra, Nabin, Carrera, Cristina, Celebi, M. Emre, DeFazio, Jennifer L., Jaimes, Natalia, Marghoob, Ashfaq A., Quigley, Elizabeth, Scope, Alon, Yélamos, Oriol, and Halpern, Allan C.

Subjects
Lentigo, Skin Neoplasms, Dermoscopy, Congresses as Topic, Article, Machine Learning, Cross-Sectional Studies, ROC Curve, Humans, Diagnosis, Computer-Assisted, Melanoma, Nevus, Algorithms, Dermatologists
Abstract

Computer vision may aid in melanoma detection.We sought to compare melanoma diagnostic accuracy of computer algorithms to dermatologists using dermoscopic images.We conducted a cross-sectional study using 100 randomly selected dermoscopic images (50 melanomas, 44 nevi, and 6 lentigines) from an international computer vision melanoma challenge dataset (n = 379), along with individual algorithm results from 25 teams. We used 5 methods (nonlearned and machine learning) to combine individual automated predictions into "fusion" algorithms. In a companion study, 8 dermatologists classified the lesions in the 100 images as either benign or malignant.The average sensitivity and specificity of dermatologists in classification was 82% and 59%. At 82% sensitivity, dermatologist specificity was similar to the top challenge algorithm (59% vs. 62%, P = .68) but lower than the best-performing fusion algorithm (59% vs. 76%, P = .02). Receiver operating characteristic area of the top fusion algorithm was greater than the mean receiver operating characteristic area of dermatologists (0.86 vs. 0.71, P = .001).The dataset lacked the full spectrum of skin lesions encountered in clinical practice, particularly banal lesions. Readers and algorithms were not provided clinical data (eg, age or lesion history/symptoms). Results obtained using our study design cannot be extrapolated to clinical practice.Deep learning computer vision systems classified melanoma dermoscopy images with accuracy that exceeded some but not all dermatologists.

Published
2017

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