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Melanoma: HELP
Articles by Brian R. Gastman
Based on 16 articles published since 2008
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Between 2008 and 2019, B. Gastman wrote the following 16 articles about Melanoma.
 
+ Citations + Abstracts
1 Guideline NCCN Guidelines Insights: Melanoma, Version 3.2016. 2016

Coit, Daniel G / Thompson, John A / Algazi, Alain / Andtbacka, Robert / Bichakjian, Christopher K / Carson, William E / Daniels, Gregory A / DiMaio, Dominick / Fields, Ryan C / Fleming, Martin D / Gastman, Brian / Gonzalez, Rene / Guild, Valerie / Johnson, Douglas / Joseph, Richard W / Lange, Julie R / Martini, Mary C / Materin, Miguel A / Olszanski, Anthony J / Ott, Patrick / Gupta, Aparna Priyanath / Ross, Merrick I / Salama, April K / Skitzki, Joseph / Swetter, Susan M / Tanabe, Kenneth K / Torres-Roca, Javier F / Trisal, Vijay / Urist, Marshall M / McMillian, Nicole / Engh, Anita. ·From Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; Huntsman Cancer Institute at the University of Utah; University of Michigan Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; UC San Diego Moores Cancer Center; Fred & Pamela Buffett Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; The University of Tennessee Health Science Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Aim at Melanoma; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Yale Cancer Center/Smilow Cancer Hospital; Fox Chase Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The University of Texas MD Anderson Cancer Center; Duke Cancer Institute; Roswell Park Cancer Institute; Stanford Cancer Institute; Massachusetts General Hospital Cancer Center; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; and National Comprehensive Cancer Network. ·J Natl Compr Canc Netw · Pubmed #27496110.

ABSTRACT: The NCCN Guidelines for Melanoma have been significantly revised over the past few years in response to emerging data on a number of novel agents and treatment regimens. These NCCN Guidelines Insights summarize the data and rationale supporting extensive changes to the recommendations for systemic therapy in patients with metastatic or unresectable melanoma.

2 Review Malignant Melanoma: Diagnostic and Management Update. 2018

Knackstedt, Thomas / Knackstedt, Rebecca W / Couto, Rafael / Gastman, Brian. ·Cleveland, Ohio From the Departments of Plastic Surgery and Dermatology, Cleveland Clinic Foundation. ·Plast Reconstr Surg · Pubmed #30045186.

ABSTRACT: LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Summarize the changes to the American Joint Committee on Cancer Eighth Edition Melanoma Staging System. 2. List advances in genetic, molecular, and histopathologic melanoma diagnosis and prognostication. 3. Recommend sentinel lymph node biopsy and appropriate surgical margins based on individualized patient needs. 4. Recognize the currently available treatments for in-transit metastasis and advanced melanoma. 5. Describe current and future therapies for melanoma with distant visceral or brain metastases. SUMMARY: Strides in melanoma surveillance, detection, and treatment continue to be made. The American Joint Committee on Cancer Eighth Edition Cancer Staging System has improved risk stratification of patients, introduced new staging categories, and resulted in stage migration of patients with improved outcomes. This review summarizes melanoma advances of the recent years with an emphasis on the surgical advances, including techniques and utility of sentinel node biopsy, controversies in melanoma margin selection, and the survival impact of time-to-treatment metrics. Once a disease manageable only with surgery, a therapeutic paradigm shift has given a more promising outlook to melanoma patients at any stage. Indeed, a myriad of novel, survival-improving immunotherapies have been introduced for metastatic melanoma and more recently in the high-risk adjuvant setting.

3 Clinical Trial Determining the False-Negative Rate Using Fluorescence Image-Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma. 2018

Couto, Rafael A / Lamaris, Gregory A / Knackstedt, Rebecca / Alleyne, Brendan / Durand, Paul / Rueda, Steven / Gastman, Brian. ·From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH. ·Ann Plast Surg · Pubmed #28930782.

ABSTRACT: INTRODUCTION: Despite the advances in cutaneous melanoma management, the false-negative rates (FNRs) of sentinel lymph node biopsy (SLNB) are still high. These rates are dependent not only on the technique but also on definitional terms and percentage of head/neck melanoma (highest false-negative SLNB). Fluorescence imaging technology is well acquainted in plastic surgery and other specialties. Having demonstrated that fluorescence-assisted SLNB is effective in melanoma, we are interested in determining its FNR. METHODS: We obtained institutional review board approval to follow up prospectively all patients with cutaneous melanoma who underwent radioisotope/fluorescence-assisted SLNB with the intent to capture 100 negative SLNB patients. Inclusion criteria were as follows: (1) National Comprehensive Cancer Network criteria; (2) an SLNB report; (3) at least 24 months of follow-up in the negative SLNB group. The outcome variables were FNR and adjusted FNR of SLNB, considering the criterion standard of assessing the accuracy of SNLB. The FNR was defined as the proportion of patients with false-negative SLNB to patients with true-positive and false-negative SLNB [false negative/(false negative + true positive)]. Adjusted FNR refers to the previously described false-negative SLNB, but in the absence of local/in-transit recurrence or distant metastases. Furthermore, false-negative incidence (false-negative/negative SLNB patients) was also calculated. Length of follow-up was date of surgery to the date of last follow-up/death. RESULTS: A total of 125 participants, with 52.0% being male and 48.0% being female, were included. One hundred patients had an SLNB negative for metastases, whereas the rest had positive SLNB results. Median follow-up time of the cohort and that of the negative SLNB group were 36.7 (2.6-58.5) and 37.9 (24.0-58.5) months, respectively. A relatively high number (24.8%) of head/neck melanoma were included. We identified 2 cases of false-negative SLNB, with one having in-transit metastases. Thus, the FNR and adjusted FNR were 7.4% and 3.7%, respectively. The false-negative incidence and adjusted false-negative incidence were 2.0% and 1.0%, respectively. CONCLUSIONS: This is the first prospective study examining the FNR of fluorescence-assisted SLNB for patients with cutaneous melanoma. Our study reveals that this technique has one of the lowest FNRs published, especially considering the large percentage of participants with head/neck melanoma involved.

4 Article Predictors of sentinel lymph node positivity in thin melanoma using the National Cancer Database. 2019

Conic, Rosalynn R Z / Ko, Jennifer / Damiani, Giovanni / Funchain, Pauline / Knackstedt, Thomas / Vij, Alok / Vidimos, Allison / Gastman, Brian R. ·Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. · Department of Pathology, Cleveland Clinic, Cleveland, Ohio. · Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio. · Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: gastmab@ccf.org. ·J Am Acad Dermatol · Pubmed #30240775.

ABSTRACT: BACKGROUND: Sentinel lymph node biopsy (SLNB) specimens are often obtained from patients for further staging after these patients have undergone melanoma excision. Limited data regarding predictors of SLNB positivity in thin melanoma are available. OBJECTIVE: We sought to evaluate predictors of SLNB positivity in thin melanoma. METHODS: Patients with cutaneous melanoma with a Breslow thickness ≤1.00 mm who received a SLNB were identified from the National Cancer Database between 2004 and 2014 (n = 9186). Predictors of SLNB positivity were analyzed using logistic regression. RESULTS: In a multivariate analysis, patients <60 years of age (P < .001) and Breslow thickness >0.8 mm (P = .03) were at increased risk for positive sentinel lymph node (SLN). Moreover, on multivariate analysis, the presence of dermal mitoses increased the odds of SLN positivity by 95% (odds ratio [OR] 1.95 [95% confidence interval {CI} 1.53-2.5], P < .001), ulceration by 63% (OR 1.63 [95% CI 1.21-2.18], P < .001), and Clark level IV to V by 48% (OR 1.48 [95% CI 1.19-1.85]). Patients without ulceration but with dermal mitoses had 92% (OR 1.92 [95% CI 1.5-2.48], P < .001) increased SLN positivity. LIMITATIONS: Limited survival data are available. CONCLUSIONS: Younger age, a Breslow thickness >0.8 mm, the presence of dermal mitoses, ulceration, and Clark level IV to V are positive predictors of positive SLN. While the new American Joint Committee on Cancer system has removed dermal mitotic rate from staging, continued evaluation of dermal mitotic rate could be valuable for guiding surgical decision making about SLNB.

5 Article Identification of patients at risk of metastasis using a prognostic 31-gene expression profile in subpopulations of melanoma patients with favorable outcomes by standard criteria. 2019

Gastman, Brian R / Gerami, Pedram / Kurley, Sarah J / Cook, Robert W / Leachman, Sancy / Vetto, John T. ·Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio. · Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Skin Cancer Institute, Northwestern University Lurie Comprehensive Cancer Center, Chicago, Illinois. · Castle Biosciences, Inc, Friendswood, Texas. · Castle Biosciences, Inc, Friendswood, Texas. Electronic address: rcook@castlebiosciences.com. · Department of Dermatology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon. · Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon. ·J Am Acad Dermatol · Pubmed #30081113.

ABSTRACT: BACKGROUND: A substantial number of patients who relapse and die from cutaneous melanoma (CM) are categorized as being at low risk by traditional staging factors. The 31-gene expression profile (31-GEP) test independently stratifies metastatic risk of patients with CM as low (Class 1, with 1A indicating lowest risk) or high (Class 2,with 2B indicating highest risk). OBJECTIVE: To assess risk prediction by the 31-GEP test within 3 low-risk (according to the American Joint Committee on Cancer) populations of patients with CM: those who are sentinel lymph node (SLN) negative, those with stage I to IIA tumors, and those with thin (≤1 mm [T1]) tumors. METHODS: A total of 3 previous validation studies provided a nonoverlapping cohort of 690 patients with 31-GEP results, staging information, and survival outcomes. Kaplan-Meier and Cox regression analysis were performed. RESULTS: The results included the identification of 70% of SLN-negative patients who experienced metastasis as Class 2, the discovery of reduced recurrence-free survival for patients with thin tumors and Class 2B biology compared with that of those with Class 1A biology (P < .0001); and determination of the 31-GEP test as an independent predictor of risk compared with traditional staging factors in patients with stage I to IIA tumors. LIMITATIONS: Diagnoses spanned multiple versions of pathologic staging criteria. CONCLUSIONS: The 31-GEP test identifies high-risk patients who are likely to experience recurrence or die of melanoma within low-risk groups of subpopulations of patients with CM who have SLN-negative disease, stage I to IIA tumors, and thin tumors.

6 Article Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma. 2018

Stiegel, Evan / Xiong, David / Ya, Jason / Funchain, Pauline / Isakov, Raymond / Gastman, Brian / Vij, Alok. ·Department of Dermatology, Cleveland Clinic, Cleveland, Ohio. Electronic address: estiegel1@gmail.com. · Department of Dermatology, Cleveland Clinic, Cleveland, Ohio. · Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio. · Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. ·J Am Acad Dermatol · Pubmed #29408526.

ABSTRACT: BACKGROUND: Sentinel lymph node (SLN) biopsy is widely performed for melanoma with certain histologic parameters and offers important prognostic and staging information. Breslow thickness (BT) by itself also provides meaningful prognostic information. OBJECTIVE: To evaluate whether SLN status provides prognostic information independent from that which is already provided by BT. METHODS: We conducted a retrospective cohort study of 896 patients who underwent SLN biopsy for primary cutaneous melanoma. Stratified analysis of the impact of SLN status within BT groups (0.01-1 mm, 1.01-2.00 mm, 2.01-4.00 mm, and >4.00 mm) was performed. In addition, a Cox proportional hazard model was fit to evaluate the interaction between BT unadjusted and then adjusted for SLN status to determine whether predictive ability is improved. RESULTS: Having a negative SLN did not confer a statistically significant survival advantage for any BT subgroup (P = .54, .075, .17, and .95 for subgroups 0.01-1 mm, 1.01-2.00 mm, 2.01-4.00 mm, and >4.00 mm, respectively). In multivariate analysis, SLN status did not demonstrate independent prognostic ability over that of BT alone (P = .067). LIMITATIONS: Retrospective study, single institution. CONCLUSION: Our data suggest that SLN status does not offer better prognostic information for patients than BT alone.

7 Article Performance of a prognostic 31-gene expression profile in an independent cohort of 523 cutaneous melanoma patients. 2018

Zager, Jonathan S / Gastman, Brian R / Leachman, Sancy / Gonzalez, Rene C / Fleming, Martin D / Ferris, Laura K / Ho, Jonhan / Miller, Alexander R / Cook, Robert W / Covington, Kyle R / Meldi-Plasseraud, Kristen / Middlebrook, Brooke / Kaminester, Lewis H / Greisinger, Anthony / Estrada, Sarah I / Pariser, David M / Cranmer, Lee D / Messina, Jane L / Vetto, John T / Wayne, Jeffrey D / Delman, Keith A / Lawson, David H / Gerami, Pedram. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 N. McKinley Drive room 4123, Tampa, FL, 33612, USA. · Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. · Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR, 97239, USA. · Department of Medical Oncology, University of Colorado School of Medicine, 12801 E. 17th Avenue, Aurora, CO, 80045, USA. · Department of Surgical Oncology, The University of Tennessee Health Science Center, 910 Madison, Suite 303, Memphis, TN, 38163, USA. · Department of Dermatology, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA. · Department of Pathology, University of Pittsburgh Medical Center, 3708 Fifth Avenue, Suite 500.94, Pittsburgh, PA, 15213, USA. · START Center for Cancer Care, 4383 Medical Drive, San Antonio, TX, 78229, USA. · Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA. · Dermatology North Palm Beach, 840 U.S. Highway Number One, North Palm Beach, FL, 33408, USA. · Research & Development, Kelsey Research Foundation, 5615 Kirby Drive, Suite 660, Houston, TX, 77005, USA. · Affiliated Dermatology, 20401 North 73rd Street, Suite 230, Scottsdale, AZ, 85255, USA. · Pariser Dermatology Specialists, Virginia Clinical Research, Inc., 6160 Kempsville Circle, Suite 200A, Norfolk, VA, 23502, USA. · Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501-1980, USA. · Department of Sarcoma Medical Oncology, Seattle Cancer Care Alliance, 825 Eastlake Avenue E, Seattle, WA, 98109, USA. · Department of Anatomic Pathology, Moffitt Cancer Center, 10920 N. McKinley Drive, Tampa, FL, 33612, USA. · Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR, 97239, USA. · Department of Surgical Oncology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Chicago, IL, 60611, USA. · Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1600, Chicago, IL, 60611, USA. · Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, 420 East Superior Street, Chicago, IL, 60611, USA. · Department of Surgery, Emory University Winship Cancer Institute, 1364 Clifton Road NE, Atlanta, GA, 30322, USA. · Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, 550 Peachtree Street NE, Atlanta, GA, 30308, USA. · Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, 420 East Superior Street, Chicago, IL, 60611, USA. pgerami1@nm.org. · Departments of Dermatology and Pathology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 1600, Chicago, IL, 60611, USA. pgerami1@nm.org. ·BMC Cancer · Pubmed #29402264.

ABSTRACT: BACKGROUND: The heterogeneous behavior of patients with melanoma makes prognostication challenging. To address this, a gene expression profile (GEP) test to predict metastatic risk was previously developed. This study evaluates the GEP's prognostic accuracy in an independent cohort of cutaneous melanoma patients. METHODS: This multi-center study analyzed primary melanoma tumors from 523 patients, using the GEP to classify patients as Class 1 (low risk) and Class 2 (high risk). Molecular classification was correlated to clinical outcome and assessed along with AJCC v7 staging criteria. Primary endpoints were recurrence-free (RFS) and distant metastasis-free (DMFS) survival. RESULTS: The 5-year RFS rates for Class 1 and Class 2 were 88% and 52%, respectively, and DMFS rates were 93% versus 60%, respectively (P < 0.001). The GEP was a significant predictor of RFS and DMFS in univariate analysis (hazard ratio [HR] = 5.4 and 6.6, respectively, P < 0.001 for each), along with Breslow thickness, ulceration, mitotic rate, and sentinel lymph node (SLN) status (P < 0.001 for each). GEP, tumor thickness and SLN status were significant predictors of RFS and DMFS in a multivariate model that also included ulceration and mitotic rate (RFS HR = 2.1, 1.2, and 2.5, respectively, P < 0.001 for each; and DMFS HR = 2.7, 1.3 and 3.0, respectively, P < 0.01 for each). CONCLUSIONS: The GEP test is an objective predictor of metastatic risk and provides additional independent prognostic information to traditional staging to help estimate an individual's risk for recurrence. The assay identified 70% of stage I and II patients who ultimately developed distant metastasis. Its role in consideration of patients for adjuvant therapy should be examined prospectively.

8 Article Determination of the impact of melanoma surgical timing on survival using the National Cancer Database. 2018

Conic, Ruzica Z / Cabrera, Claudia I / Khorana, Alok A / Gastman, Brian R. ·Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. · Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio. · Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: gastmab@ccf.org. ·J Am Acad Dermatol · Pubmed #29054718.

ABSTRACT: BACKGROUND: The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery. OBJECTIVE: To assess the impact of time to definitive melanoma surgery on overall survival. METHODS: Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi-square test were used to compare variables. Cox regression was used for multivariate analysis. RESULTS: In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01-1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02-1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01-1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07-1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12-1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21-1.65). Surgical timing did not affect survival in stages II and III. LIMITATIONS: Melanoma-specific survival was not available. CONCLUSION: Expeditious treatment of stage I melanoma is associated with improved outcomes.

9 Article Mixed Versus Pure Variants of Desmoplastic Melanoma: The Cleveland Clinic Experience. 2018

Conic, Ruzica Z / Ko, Jennifer / Allam, Sherihan H / Atanaskova-Mesinkovska, Natasha / Kovalyshyn, Ivanka / Bergfeld, Wilma / Gastman, Brian R. · ·Ann Plast Surg · Pubmed #28984655.

ABSTRACT: BACKGROUND: Desmoplastic melanoma (DM) is a subvariant of spindle cell melanoma, accounting for less than 4% of all cutaneous melanomas. It occurs later in life and is associated with chronic sun exposure. Desmoplastic melanoma prognosis is considered more favorable than other variants, with lower rates of metastasis and higher survival. Recently, DM has been further subclassified into pure and mixed, calling into question surgical management and patient outcomes as well as viability of current nationwide databases without this distinction. METHODS: We identified all patients with a histopathologic diagnosis of DM from the Cleveland Clinic electronic melanoma database (n = 58) from 1997 to 2013. Clinical and histopathologic data were collected. Comparison in clinical variables was performed between patients who had pure (n = 15) and mixed (n = 43) variants of DM. RESULTS: There were no differences in age, sex, location of lesion, Breslow depth, ulceration, or regression. Patients with mixed DM were more likely to have lymphovascular invasion (P = 0.03) compared with pure DM. There was no difference in performance of sentinel lymph node biopsy (P = 0.25) or sentinel lymph node positivity (P = 0.31) between the 2 groups. Recurrence was present in 13.3% of pure and 30.2% of mixed patients. Overall, Kaplan-Meier 3-year survival was 75% for pure and 80% for mixed DM (P = 0.53). CONCLUSIONS: Pure and mixed DMs seem to have similar clinical characteristics and outcomes. This indicates that analysis of national datasets without this subclassification remains viable.

10 Article Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A National Surgical Quality Improvement Program Review. 2017

Ascha, Mona / Ascha, Mustafa S / Gastman, Brian. ·From the *Case Western Reserve University School of Medicine; †Center for Clinical Investigation, Department of Epidemiology and Biostatistics, Case Western Reserve University; and ‡Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH. ·Ann Plast Surg · Pubmed #28650410.

ABSTRACT: INTRODUCTION: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are commonly performed in the staging and care of patients with malignant melanoma. These procedures are accompanied by complications that may result in hospital readmission, negatively affecting patient outcomes and potentially affecting surgical procedure reimbursement. The National Surgical Quality Improvement Program (NSQIP) database offers a large data set allowing physicians to evaluate 30-day readmission for surgical complications. We used this database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions. METHODS: Data from the years 2005 to 2014 of the American College of Surgeons NSQIP database were used. Cohorts were constructed according to International Classification of Diseases, Ninth Revision, classification and current procedural terminology codes. The outcome of 30-day return to hospital was defined as patients who were readmitted to the hospital or the operating room within 30 days. Multiple logistic regression results are presented for a prespecified set of predictors and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated using maximum likelihood estimates, along with Wald test P values. RESULTS: A total of 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and for cervical SLNB on multivariate analysis. Age was a significant predictor for cervical and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, preoperative hematocrit, and male sex were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD procedures. CONCLUSIONS: This is the first and largest study using American College of Surgeons NSQIP to examine 30-day readmission after SLNB and LAD for melanoma in 3 commonly operated anatomical regions. We have found several significant risk factors associated with hospital readmission, which are now being used as a quality measure for hospital performance and reimbursement, that may help surgeons optimize patient selection for SLNB and LAD.

11 Article The Response of microRNAs to Solar UVR in Skin-Resident Melanocytes Differs between Melanoma Patients and Healthy Persons. 2016

Sha, Jingfeng / Gastman, Brian R / Morris, Nathan / Mesinkovska, Natasha A / Baron, Elma D / Cooper, Kevin D / McCormick, Thomas / Arbesman, Joshua / Harter, Marian L. ·Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States of America. · Department of Immunology, Cleveland Clinic, Cleveland, OH, 44195, United States of America. · Statistical Science Core in the Center for Clinical Investigation, Case Western Reserve University, Cleveland, OH, 44106, United States of America. · Department of Dermatology, Cleveland Clinic, Cleveland, OH, 44195, United States of America. · Department of Dermatology, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, 44106, United States of America. · Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States of America. ·PLoS One · Pubmed #27149382.

ABSTRACT: The conversion of melanocytes into cutaneous melanoma is largely dictated by the effects of solar ultraviolet radiation (UVR). Yet to be described, however, is exactly how these cells are affected by intense solar UVR while residing in their natural microenvironment, and whether their response differs in persons with a history of melanoma when compared to that of healthy individuals. By using laser capture microdissection (LCM) to isolate a pure population of melanocytes from a small area of skin that had been intermittingly exposed or un-exposed to physiological doses of solar UVR, we can now report for the first time that the majority of UV-responsive microRNAs (miRNAs) in the melanocytes of a group of women with a history of melanoma are down-regulated when compared to those in the melanocytes of healthy controls. Among the miRNAs that were commonly and significantly down-regulated in each of these women were miR-193b (P<0.003), miR-342-3p (P<0.003), miR186 (P<0.007), miR-130a (P<0.007), and miR-146a (P<0.007). To identify genes potentially released from inhibition by these repressed UV-miRNAs, we analyzed databases (e.g., DIANA-TarBase) containing experimentally validated microRNA-gene interactions. In the end, this enabled us to construct UV-miRNA-gene regulatory networks consisting of individual genes with a probable gain-of-function being intersected not by one, but by several down-regulated UV-miRNAs. Most striking, however, was that these networks typified well-known regulatory modules involved in controlling the epithelial-to-mesenchymal transition and processes associated with the regulation of immune-evasion. We speculate that these pathways become activated by UVR resulting in miRNA down regulation only in melanocytes susceptible to melanoma, and that these changes could be partially responsible for empowering these cells toward tumor progression.

12 Article Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age. 2016

Tellez, Alejandra / Rueda, Steven / Conic, Ruzica Z / Powers, Kristin / Galdyn, Izabela / Mesinkovska, Natasha Atanaskova / Gastman, Brian. ·Department of Dermatology, Cleveland Clinic, Cleveland, Ohio. · Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. · Georgetown University School of Medicine, Washington, District of Columbia. · Department of Plastic Surgery, Loma Linda University, Loma Linda, California. · Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: gastmab@ccf.org. ·J Am Acad Dermatol · Pubmed #26803345.

ABSTRACT: BACKGROUND: Melanoma is the fifth most common cancer in the United States, with recent reports indicating increasing incidence among young women. OBJECTIVE: This study sought to investigate histopathology, staging, risk factors, and outcomes of cutaneous melanoma in women younger than 50 years. METHODS: All female patients aged up to 49 years with biopsy-proven diagnosis of melanoma between 1988 and 2012 were included. Patients with a follow-up of less than 2 years were excluded. RESULTS: A total of 462 patients were identified, with mean age of 34.7 years. Invasive melanoma was less common in women 19 years of age or younger (P < .0008). Positive sentinel node status (P < .008), recurrence rates, metastatic disease (P < .001), and death rates (P < .008) were higher for women ages 40 to 49 years. The 41 patients with a pregnancy-associated melanoma had a significantly worse prognosis in comparison with a control group of nonpregnant patients, with a 9-fold increase in recurrence (P < .001), 7-fold increase in metastasis (P = .03) and 5-fold increase in mortality (P = .06). LIMITATIONS: This was a retrospective study. CONCLUSION: The increasing incidence of melanoma for women younger than 50 years suggests that regular skin checks and self-examinations are warranted. In addition, in women given the diagnosis of melanoma during or within 1 year after childbirth, regular follow-up and monitoring for recurrence are recommended.

13 Article Indocyanine green-guided sentinel lymph node biopsy for periocular tumors. 2014

Rubinstein, Tal J / Perry, Julian D / Korn, Jason M / Costin, Bryan R / Gastman, Brian R / Singh, Arun D. ·*Department of Ophthalmology and †Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A. ·Ophthalmic Plast Reconstr Surg · Pubmed #24814276.

ABSTRACT: PURPOSE: To compare the accuracy of indocyanine green (ICG)-guided sentinel lymph node biopsy to sentinel lymph node biopsy performed with technetium-99m in eyelid and in conjunctival malignancies. METHODS: Review of a consecutive series of adult patients undergoing sentinel lymph node biopsy for eyelid and conjunctival malignancies between 2009 and 2013. Only patients undergoing both ICG-guided and technetium-99m-guided sentinel lymph node biopsies were included. RESULTS: Five patients were identified: 3 women and 2 men. Four had conjunctival melanoma and 1 had eyelid melanoma. ICG aided in localization and confirmation of the sentinel nodes identified by technetium-99m, and all sentinel lymph nodes identified by technetium-99m were identified by ICG. All patients who underwent both sentinel lymph node modalities had negative lymph node biopsies for micrometastasis, but metastatic disease eventually developed in 1 patient. No safety concerns were identified with the use of ICG in the ocular adnexal region. CONCLUSIONS: For certain periocular malignancies, ICG-guided sentinel lymph node biopsy safely identifies sentinel lymph nodes intraoperatively possibly to a similar extent compared with technetium-99m-guided methods.

14 Article Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma. 2014

Korn, Jason M / Tellez-Diaz, Alejandra / Bartz-Kurycki, Marisa / Gastman, Brian. ·Cleveland, Ohio; and Buffalo, N.Y. From the Department of Plastic Surgery, Cleveland Clinic Foundation; and the School of Medicine and Biomedical Sciences, University at Buffalo. ·Plast Reconstr Surg · Pubmed #24675193.

ABSTRACT: BACKGROUND: Sentinel lymph node biopsy is the standard of care for intermediate-depth and high-risk thin melanomas. Recently, indocyanine green and near-infrared imaging have been used to aid in sentinel node biopsy. The present study aimed to determine the feasibility of sentinel lymph node biopsy with indocyanine green SPY Elite navigation and to critically evaluate the technique compared with the standard modalities. METHODS: A retrospective review of 90 consecutive cutaneous melanoma patients who underwent sentinel lymph node biopsy was performed. Two cohorts were formed: group A, which had sentinel lymph node biopsy performed with blue dye and radioisotope; and group B, which had sentinel lymph node biopsy performed with radioisotope and indocyanine green SPY Elite navigation. The cohorts were compared to assess for differences in localization rates, sensitivity and specificity of sentinel node identification, and length of surgery. RESULTS: The sentinel lymph node localization rate was 79.4 percent using the blue dye method, 98.0 percent using the indocyanine green fluorescence method, and 97.8 percent using the radioisotope/handheld gamma probe method. Indocyanine green fluorescence detected more sentinel lymph nodes than the vital dye method alone (p = 0.020). A trend toward a reduction in length of surgery was noted in the SPY Elite cohort. CONCLUSIONS: Sentinel lymph node mapping and localization in cutaneous melanoma with the indocyanine green SPY Elite navigation system is technically feasible and may offer several advantages over current modalities, including higher sensitivity and specificity, decreased number of lymph nodes sampled, decreased operative time, and potentially lower false-negative rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

15 Minor Reply to: "Comment on 'Determination of the impact of melanoma surgical timing on survival using the National Cancer Database'". 2018

Conic, Rosalynn R Z / Gastman, Brian R. ·Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. · Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: gastmab@ccf.org. ·J Am Acad Dermatol · Pubmed #29860045.

ABSTRACT: -- No abstract --

16 Minor Tolerability of immune checkpoint inhibition cancer therapy in a cardiac transplant patient. 2016

Gastman, B R / Ernstoff, M S. ·Department of Plastic Surgery gastmab@ccf.org. · Departments of Immunology, Cleveland Clinic Foundation, Cleveland. · Departments of Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, USA. ·Ann Oncol · Pubmed #27502714.

ABSTRACT: -- No abstract --