Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Melanoma: HELP
Articles by Anthony M. Rossi
Based on 21 articles published since 2010
(Why 21 articles?)
||||

Between 2010 and 2020, Anthony Rossi wrote the following 21 articles about Melanoma.
 
+ Citations + Abstracts
1 Editorial Health-related quality of life in skin cancer patients. 2014

Hibler, Brian / Rossi, Anthony M. ·RossiA@mskcc.org. ·Cutis · Pubmed #25474447.

ABSTRACT: -- No abstract --

2 Editorial Skin cancer in skin of color. 2012

Alexis, Andrew F / Rossi, Anthony M. · ·Cutis · Pubmed #22768430.

ABSTRACT: -- No abstract --

3 Review Atypical Melanocytic Proliferations: A Review of the Literature. 2018

Ensslin, Courtney J / Hibler, Brian P / Lee, Erica H / Nehal, Kishwer S / Busam, Klaus J / Rossi, Anthony M. ·Department of Dermatology, Johns Hopkins University, Baltimore, Maryland. · Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Department of Dermatology, Weill Cornell Medical College, New York, New York. · Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. ·Dermatol Surg · Pubmed #29059147.

ABSTRACT: BACKGROUND: Ambiguous histopathologic diagnoses represent a challenge for clinicians because of a lack of definitive diagnosis and related uncertainty about management. OBJECTIVE: To review the literature on atypical melanocytic proliferations and detail synonymous terms, epidemiology, diagnostic work-up, histopathology, treatment, and prognosis. METHODS: Databases from PubMed and Web of Science were searched for articles related to atypical melanocytic proliferations. RESULTS: Intraepidermal melanocytic proliferations with features worrisome for possible melanoma in situ (MIS) are generally excised as for MIS. Reported rates of upstaging of such cases to invasive melanoma on review of the excision are very low. Because invasion, lymph node spread, and metastasis can occur in atypical melanocytic lesions with a thick intradermal component, these are often treated as for malignant melanoma. CONCLUSION: Because the diagnosis dictates treatment, it is incumbent to establish a diagnosis as definitive as possible, obtaining second or third opinions and using ancillary studies when appropriate. When the diagnosis remains uncertain, it is difficult to provide guidelines for treatment. Clinical care decisions for patients with an uncertain diagnosis are best done on a case-by-case basis weighing probabilities of adverse outcomes against potential benefits and risks from various treatment options.

4 Review Reflectance confocal microscopy of skin in vivo: From bench to bedside. 2017

Rajadhyaksha, Milind / Marghoob, Ashfaq / Rossi, Anthony / Halpern, Allan C / Nehal, Kishwer S. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. ·Lasers Surg Med · Pubmed #27785781.

ABSTRACT: Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well-and our bet for the future is on multimodal approaches. Lasers Surg. Med. 49:7-19, 2017. © 2016 Wiley Periodicals, Inc.

5 Article Ablative fractional laser-assisted treatments for keratinocyte carcinomas and its precursors-Clinical review and future perspectives. 2020

Erlendsson, Andrés M / Olesen, Uffe H / Haedersdal, Merete / Rossi, Anthony M. ·Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, NY, United States of America; Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark. Electronic address: erlendsa@mskcc.org. · Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark. · Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, NY, United States of America. ·Adv Drug Deliv Rev · Pubmed #31923431.

ABSTRACT: Keratinocyte carcinomas (KC) are the most common malignant human neoplasms. Although surgery and destructive approaches are first-line treatments, topical therapies are commonly used. Due to limited uptake of topical agents across the skin barrier, clearance rates are often sub-optimal. In pre-clinical investigations, ablative fractional laser (AFL)-assisted drug delivery has demonstrated improved uptake of topical drugs commonly used to treat KC. In 22 clinical trials, the effect of AFL-assisted treatments has been investigated for actinic keratosis (AK; n = 14), Bowen's disease (BD; n = 5), squamous cell carcinoma (n = 1), and basal cell carcinoma (n = 7). The most substantial evidence currently exists for AFL-assisted photodynamic therapy for the treatment of AK and BD. AFL improved 12-months follow-up clearance rates of photodynamic therapy from 45.0-51.0% to 78.5-84.8% for AK and from 50.0-55.3% to 87.0-87.5% for BD. AFL-assisted pharmacological therapy is a promising tool for optimizing topical treatments of KC and its precursor lesions. Future developments include AFL-assisted immune activation, changing drug administration route of systemic therapies, and utilizing drug chemo-combinations.

6 Article Use of paper tape to guide reflectance confocal microscopy navigation of large skin lesions. 2020

Navarrete-Dechent, Cristian / Cordova, Miguel / Aleissa, Saud / Kose, Kivanc / Lee, Erica H / Rossi, Anthony M / Nehal, Kishwer S. ·Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: nehalk@mskcc.org. ·J Am Acad Dermatol · Pubmed #31326468.

ABSTRACT: -- No abstract --

7 Article Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study. 2019

Navarrete-Dechent, Cristian / Cordova, Miguel / Aleissa, Saud / Liopyris, Konstantinos / Dusza, Stephen W / Kose, Kivanc / Busam, Klaus J / Hollman, Travis / Lezcano, Cecilia / Pulitzer, Melissa / Chen, Chih-Shan J / Lee, Erica H / Rossi, Anthony M / Nehal, Kishwer S. ·Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. · Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: nehalk@mskcc.org. ·J Am Acad Dermatol · Pubmed #31812621.

ABSTRACT: BACKGROUND: Lentigo maligna/lentigo maligna melanoma (LM/LMM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminarily studies have used reflectance confocal microscopy (RCM) to assess LM/LMM margins. OBJECTIVE: To evaluate the correlation of LM/LMM subclinical extension defined by RCM compared to the gold standard histopathology. METHODS: Prospective study of LM/LMM patients referred for dermatologic surgery. RCM was performed at the clinically-defined initial surgical margin followed by margin-controlled staged excision with paraffin-embedded tissue and histopathology was correlated with RCM results. RESULTS: Seventy-two patients were included. Mean age was 66.8 years (SD 11.1; 38 - 89 years); 69.4% were males. 70/72 (97.2%) lesions were located on the head neck with mean largest clinical diameter of 1.3cm (0.3 - 5 cm). Diagnostic accuracy for detection of residual melanoma in the tumor debulk (after biopsy) had a sensitivity of 96.7% and a specificity of 66.7% when compared to the histopathology. RCM margin assessment revealed an overall agreement with final histopathology of 85.9% (kappa 0.71; p<0.001). LIMITATIONS: No RCM imaging beyond initial planned margins was performed. CONCLUSION: RCM showed moderate to excellent overall agreement between RCM imaging of LM/LMM and histopathology of staged excision margins.

8 Article Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers. 2019

Yélamos, Oriol / Manubens, Elena / Jain, Manu / Chavez-Bourgeois, Marion / Pulijal, Sri V / Dusza, Stephen W / Marchetti, Michael A / Barreiro, Alicia / Marino, Maria L / Malvehy, Josep / Cordova, Miguel A / Rossi, Anthony M / Rajadhyaksha, Milind / Halpern, Allan C / Puig, Susana / Marghoob, Ashfaq A / Carrera, Cristina. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain. Electronic address: oyelamos@gmail.com. · Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Barcelona, Spain. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Barcelona, Spain. Electronic address: ccarrera@clinic.cat. ·J Am Acad Dermatol · Pubmed #31202873.

ABSTRACT: BACKGROUND: Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. OBJECTIVES: We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. METHODS: Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. RESULTS: We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P < .001) when RCM confirmed or changed the diagnosis. Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively. LIMITATIONS: Small sample size, real-life environment, and different levels of expertise among RCM users. CONCLUSION: Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy.

9 Article Physician-Centered Outcomes for Skin Cancer Treatment: A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management. 2019

Rossi, Anthony M / Sobanko, Joseph / Lawrence, Naomi / Bordeaux, Jeremy / Cartee, Todd / Armbrecht, Eric S / Behera, Anit / Baum, Christian L / Alam, Murad / Maher, Ian A. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Weill Cornell Medical College, New York, New York. · Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. · Center for Dermatologic Surgery, Cooper University Hospital, Camden, New Jersey. · Department of Dermatology, Rowan University, Camden, New Jersey. · Department of Dermatology, Case Western Reserve University and University Hospitals, Cleveland, Ohio. · Penn State Health, Hershey, Pennsylvania. · Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri. · Department of Dermatology, Mayo Clinic, Rochester, Minnesota. · Department of Dermatology, Northwestern University, Chicago, Illinois. · Department of Dermatology, University of Minnesota, Minneapolis, Minnesota. ·Dermatol Surg · Pubmed #30807387.

ABSTRACT: BACKGROUND: Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care. OBJECTIVE: To identify gaps between patient and physician attitudes toward skin cancer outcomes. MATERIALS AND METHODS: A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer-related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings. RESULTS: A list of 53 skin cancer treatment-related themes and outcomes was generated. Eight items were ranked by physicians as "very high" (>80% importance), 5 as "high" (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance. CONCLUSION: Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care.

10 Article Melanoma and melanoma in-situ diagnosis after excision of atypical intraepidermal melanocytic proliferation: A retrospective cross-sectional analysis. 2019

Blank, Nina R / Hibler, Brian P / Tattersall, Ian W / Ensslin, Courtney J / Lee, Erica H / Dusza, Stephen W / Nehal, Kishwer S / Busam, Klaus J / Rossi, Anthony M. ·Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Yale School of Medicine, New Haven, Connecticut. · Department of Dermatology, Johns Hopkins University, Baltimore, Maryland. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: rossia@mskcc.org. ·J Am Acad Dermatol · Pubmed #30654079.

ABSTRACT: BACKGROUND: There is little evidence to guide surgical management of biopsies yielding the histologic descriptor atypical intraepidermal melanocytic proliferation (AIMP). OBJECTIVE: Determine frequency of and factors associated with melanoma and melanoma in-situ (MIS) diagnoses after excision of AIMP and evaluate margins used to completely excise AIMP. METHODS: Retrospective, cross-sectional study of 1127 biopsies reported as AIMP and subsequently excised within one academic institution. RESULTS: Melanoma (in situ, stage 1A) was diagnosed after excision in 8.2% (92/1127) of AIMP samples. Characteristics associated with melanoma/MIS diagnosis included age 60-79 years (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.5-26.2), age ≥80 years (OR 7.2, 95% CI 1.7-31.5), head/neck location (OR 4.9, 95% CI 3.1-7.7), clinical lesion partially biopsied (OR 11.0, 95% CI 6.7-18.1), and lesion extending to deep biopsy margin (OR 15.1, 95% CI 1.7-136.0). Average ± standard deviation surgical margin used to excise AIMP lesions was 4.5 ± 1.8 mm. LIMITATIONS: Single-site, retrospective, observational study; interobserver variability across dermatopathologists. CONCLUSION: Dermatologists and pathologists can endeavor to avoid ambiguous melanocytic designations whenever possible through excisional biopsy technique, interdisciplinary communication, and ancillary studies. In the event of AIMP biopsy, physicians should consider the term a histologic description rather than a diagnosis, and, during surgical planning, use clinicopathologic correlation while bearing in mind factors that might predict true melanoma/MIS.

11 Article Evaluation of the Response of Unresectable Primary Cutaneous Melanoma to Immunotherapy Visualized With Reflectance Confocal Microscopy: A Report of 2 Cases. 2019

Navarrete-Dechent, Cristian / Cordova, Miguel / Postow, Michael A / Pulitzer, Melissa / Lezcano, Cecilia / Halpern, Allan C / Rossi, Anthony M. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. · Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Weill Cornell Medical College, New York, New York. · Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. ·JAMA Dermatol · Pubmed #30624578.

ABSTRACT: Importance: Melanoma incidence and the use of systemic treatments for it are rising. Current treatment monitoring uses clinical examination and radiologic examinations; however, cutaneous involvement and cutaneous metastasis may not be well visualized. Reflectance confocal microscopy (RCM) is a US Food and Drug Administration-approved, noninvasive technology that enables visualization of the skin with quasihistological resolution. Objective: To evaluate the feasibility of using RCM to monitor advanced melanomas treated with immunotherapy. Design, Setting, and Participants: This case report study took place from March 2017 to June 2018 and included 2 patients with locally advanced melanoma who were not candidates for surgery or were not willing to have surgery and who were started on an immunotherapy regimen at a tertiary care cancer hospital. Main Outcomes and Measures: Clinical and RCM findings correlated with histopathology. Results: In the patients, locally advanced melanoma with cutaneous involvement was treated with immunotherapy (pembrolizumab in 1 patient and an ipilimumab-nivolumab combination in the other) with resulting clearance of the lesions. Use of RCM showed the disappearance of clear melanoma features seen at baseline; these findings correlated with histopathology. The response was not seen with radiologic images, such as magnetic resonance imaging and computed tomography. Conclusions and Relevance: Although RCM will not replace larger field imaging (such as magnetic resonance imaging, positron emission tomography, and computed tomography) in the management and follow-up of melanoma or other tumors, for imaging of cutaneous involvement and disease monitoring, RCM holds promise as a novel noninvasive technique.

12 Article Association of Quality of Life With Surgical Excision of Early-Stage Melanoma of the Head and Neck. 2019

Mori, Shoko / Blank, Nina R / Connolly, Karen L / Dusza, Stephen W / Nehal, Kishwer S / Rossi, Anthony M / Lee, Erica H. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · State University of New York Downstate College of Medicine, Brooklyn, New York. ·JAMA Dermatol · Pubmed #30422228.

ABSTRACT: Importance: Surgical excision is the standard-of-care treatment for Tis and T1a melanomas of the head and neck. Currently, however, the association of diagnosis and surgical treatment of these typically slowly progressive and nonfatal melanomas with a patient's health-related quality of life (HRQoL) is unknown. Objective: To characterize and assess HRQoL in patients with Tis and T1a head and neck melanoma, evaluate changes in HRQoL over the surgical treatment course, and identify patient characteristics associated with lower HRQoL. Design, Setting, and Participants: This longitudinal, prospective cohort study involved patients with Tis or T1a melanoma of the head and neck who underwent staged excision at a single tertiary care center (Memorial Sloan Kettering Cancer Center, New York, New York) and were recruited from June 1, 2016, to February 28, 2017. Patients were followed up for 1 year after their surgical procedure. Participants were asked to complete 2 patient-reported outcome measure questionnaires, Skindex-16 and Skin Cancer Index (SCI), at 4 time points: baseline, perioperative (1 to 2 weeks after surgery), and 6-month and 1-year follow-up. Main Outcomes and Measures: Scores on the Skindex-16 and SCI questionnaires. Results: In total, 56 patients were included in the study, among whom 24 (43%) were female and 32 (57%) were male, with a mean (range) age of 67.2 (32-88) years; all patients self-identified as white. Forty-one (73%) questionnaires at perioperative, 49 (88%) at 6-month postoperative, and 41 (73%) at 1-year postoperative time points were completed. At baseline, female patients and those younger than 65 years had statistically significantly worse HRQoL on the Skindex-16 questionnaire (mean score, 14.2 [95% CI, 9.1-21.9] and 16.1 [95% CI, 9.8-26.4]) and on the SCI questionnaire (mean score, 57.2 [95% CI, 48.3-67.6] and 53.2 [95% CI, 44.1-64.3]) compared with males (mean Skindex-16 score, 7.0 [95% CI, 4.8-10.3]; mean SCI score, 73.5 [95% CI, 66.0-81.7]) and those aged 65 years or older (mean Skindex-16 score 7.1 [95% CI, 5.0-10.0]; mean SCI score, 74.3 [95% CI, 67.7-81.6]). Questions that demonstrated the worst scores at baseline were worry about skin condition (Skindex-16) and worry about future skin cancers (SCI). The emotions subscale scores on the Skindex-16 questionnaire showed the greatest improvement from baseline to 1-year follow-up levels (26.6 vs 15.3; P < .001) and so did the appearance subscale scores on the SCI questionnaire (64.0 vs 84.6; P < .001). The score difference in HRQoL by sex diminished over time, whereas the score difference by age persisted through the first year. Conclusions and Relevance: Improvement in HRQoL at the 6-month and 1-year follow-up was associated with surgical excision in patients with early-stage head and neck melanoma, and younger and female patients experienced worse HRQoL. These results may be used in tailoring counseling for this patient population.

13 Article Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma. 2017

Yélamos, Oriol / Cordova, Miguel / Blank, Nina / Kose, Kivanc / Dusza, Stephen W / Lee, Erica / Rajadhyaksha, Milind / Nehal, Kishwer S / Rossi, Anthony M. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. ·JAMA Dermatol · Pubmed #29049429.

ABSTRACT: Importance: The management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM and LMM and can be used to delineate their margins. Objectives: To evaluate whether handheld RCM with radial video mosaicing (HRCM-RV) offers accurate presurgical assessment of LM and LMM margins. Design, Setting, and Participants: This prospective study included consecutive patients with biopsy-proven LM and LMM located on the head and neck area who sought consultation for surgical management from March 1, 2016, through March 31, 2017, at the Dermatology Service of the Memorial Sloan Kettering Cancer Center. Thirty-two patients underwent imaging using HRCM-RV, and 22 patients with 23 LM or LMM lesions underwent staged surgery and contributed to the analysis. Main Outcomes and Measures: Clinical lesion size and area, LM and LMM area based on HRCM-RV findings, surgical defect area estimated by HRCM-RV, and observed surgical defect area. In addition, the margins measured in millimeters estimated for tumor clearance in each quadrant based on HRCM-RV findings were calculated and compared with the surgical margins. Results: Among the 22 patients (12 men and 10 women; mean [SD] age, 69.0 [8.6] years [range, 46-83 years]) with 23 lesions included in the final analysis, the mean (SD) surgical defect area estimated with HRCM-RV was 6.34 (4.02) cm2 and the mean (SD) area of surgical excision with clear margins was 7.74 (5.28) cm2. Overall, controlling for patient age and previous surgery, surgical margins were a mean of 0.76 mm (95% CI, 0.67-0.84 mm; P < .001) larger than the HRCM-RV estimate. Conclusions and Relevance: Mapping of LM and LMM with HRCM-RV estimated defects that were similar to but slightly smaller than those found in staged excision. Thus, mapping of LM using HRCM-RV can help spare healthy tissue by reducing the number of biopsies needed in clinically uncertain areas and may be used to plan treatment of LM and LMM and counsel patients appropriately.

14 Article Automated video-mosaicking approach for confocal microscopic imaging in vivo: an approach to address challenges in imaging living tissue and extend field of view. 2017

Kose, Kivanc / Gou, Mengran / Yélamos, Oriol / Cordova, Miguel / Rossi, Anthony M / Nehal, Kishwer S / Flores, Eileen S / Camps, Octavia / Dy, Jennifer G / Brooks, Dana H / Rajadhyaksha, Milind. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. kosek@mskcc.org. · Electrical and Computer Engineering, Northeastern University, Boston, MA, USA. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. ·Sci Rep · Pubmed #28883434.

ABSTRACT: We describe a computer vision-based mosaicking method for in vivo videos of reflectance confocal microscopy (RCM). RCM is a microscopic imaging technique, which enables the users to rapidly examine tissue in vivo. Providing resolution at cellular-level morphology, RCM imaging combined with mosaicking has shown to be highly sensitive and specific for non-invasively guiding skin cancer diagnosis. However, current RCM mosaicking techniques with existing microscopes have been limited to two-dimensional sequences of individual still images, acquired in a highly controlled manner, and along a specific predefined raster path, covering a limited area. The recent advent of smaller handheld microscopes is enabling acquisition of videos, acquired in a relatively uncontrolled manner and along an ad-hoc arbitrarily free-form, non-rastered path. Mosaicking of video-images (video-mosaicking) is necessary to display large areas of tissue. Our video-mosaicking methods addresses this need. The method can handle unique challenges encountered during video capture such as motion blur artifacts due to rapid motion of the microscope over the imaged area, warping in frames due to changes in contact angle and varying resolution with depth. We present test examples of video-mosaics of melanoma and non-melanoma skin cancers, to demonstrate potential clinical utility.

15 Article Handheld reflectance confocal microscopy to aid in the management of complex facial lentigo maligna. 2017

Hibler, Brian P / Yélamos, Oriol / Cordova, Miguel / Sierra, Heidy / Rajadhyaksha, Milind / Nehal, Kishwer S / Rossi, Anthony M. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA, and Dermatology Department, Hospital Clínic, Universitat de Barcelona, Spain. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, and Department of Dermatology, Weill Cornell Medical College, New York, USA. ·Cutis · Pubmed #28632796.

ABSTRACT: Diagnosis and management of lentigo maligna (LM) and LM melanoma (LMM) is challenging. Novel noninvasive imaging technologies such as reflectance confocal microscopy (RCM) have advanced the ability to better diagnose and monitor challenging lesions. In addition, the new handheld RCM (HRCM) together with the use of videomosaics has allowed an accurate evaluation of large lesions in concave/convex areas of the body (eg, the face). Herein, we review the impact of HRCM in the detection, treatment decision-making, and monitoring of 5 cases of complex facial LM/LMM. In the cases presented, HRCM enabled the detection of subclinical margins, presence of invasion, detection of persistence/recurrence, and monitoring of surgical and nonsurgical therapies. In this preliminary report, our results suggest that HRCM is a versatile ancillary tool in pretreatment decision-making, intraoperative surgical mapping, and posttreatment monitoring of complex facial LM/LMM.

16 Article Lentigo maligna melanoma with a history of cosmetic treatment: Prevalence, surgical outcomes and considerations. 2017

Hibler, Brian P / Connolly, Karen L / Lee, Erica H / Rossi, Anthony M / Nehal, Kishwer S. ·Memorial Sloan Kettering Cancer Center, Dermatology Service, 16 E. 60th Street, 4th Floor Dermatology, New York, New York, 10022. · Lincoln Hospital, Dermatology Service, 234 E. 149th Street, Bronx, New York, 10451. ·Lasers Surg Med · Pubmed #28555933.

ABSTRACT: INTRODUCTION: Lentigo maligna (LM) is melanoma in situ on sun-damaged skin and presents diagnostic challenges due to overlapping features with benign pigmented lesions. Cosmetic treatments may be inadvertently performed on LM. The aim of this study is to estimate the prevalence of LM with prior cosmetic treatment, and evaluate surgical outcomes. STUDY DESIGN AND METHODS: Retrospective review of biopsy-proven LM presenting over a 10-year-period (2006-2015). Prior cosmetic treatment and biopsies were recorded. Records were reviewed for demographic data, clinical characteristics, and surgical outcomes. RESULTS: 37/503 (7.4%) patients with LM reported prior cosmetic therapy. Most (95%) were on the head and neck; mean size 1.9 cm. Most patients reported cryotherapy (73%), followed by laser (29.7%), topical bleaching agents (18.9%), and electrodessication, and/or curettage (5.3%). Ten patients (27%) received two or more modalities. Eight patients (21.6%) reported prior benign biopsies. Six patients (16%) had invasive disease, two on initial biopsy and 4/34 (11.7%) upstaged upon excision. Average margin for clearance was 9.1 mm. CONCLUSION: Prior cosmetic treatment of LM is not uncommon, and may delay diagnosis and obscure borders, resulting in wider surgical margins. Clinicians should consider a biopsy confirming the benign nature of equivocal lesions prior to cosmetic treatment. Lasers Surg. Med. 49:819-826, 2017. © 2017 Wiley Periodicals, Inc.

17 Article Locally Recurrent Lentigo Maligna and Lentigo Maligna Melanoma: Characteristics and Time to Recurrence After Surgery. 2017

Connolly, Karen L / Hibler, Brian P / Lee, Erica H / Rossi, Anthony M / Busam, Klaus J / Nehal, Kishwer S. ·*Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; †Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. ·Dermatol Surg · Pubmed #28296789.

ABSTRACT: BACKGROUND: Various studies have reported local recurrence (LR) rates after surgical treatment of lentigo maligna (LM) and lentigo maligna melanoma (LMM). However, the time to LR of LM/LMM is not currently known, as few studies report time to LR and have long-term follow-up. OBJECTIVE: To define time to LR in LM/LMM after surgical treatment, and to describe features of observed LR. MATERIALS AND METHODS: Retrospective single-center study of consecutive patients presenting with locally recurrent LM/LMM. RESULTS: Six hundred forty-nine cases of LM/LMM were reviewed; 29 (21 LM, and 8 LMM) of 41 locally recurrent cases had original histology reports and were included. The mean time to LR was 57.5 months (range 7-194). For cases presenting as primary LM, LR was also in situ in 14/21 (67%) of cases. Seven of 21 LM recurred as LMM. Of the 8 primary LMM, 3/8 (37.5%) presented with subsequent LMM and all were slightly deeper on re-excision. CONCLUSION: The mean time to LR of LM/LMM is at least 57.5 months, underscoring the importance of long-term follow-up. Seven of 21 LM recurred as invasive disease, but the lack of development of LMM from LM in most recurrent cases confirms LM is slowly progressive.

18 Article Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): A prospective study. 2016

Menge, Tyler D / Hibler, Brian P / Cordova, Miguel A / Nehal, Kishwer S / Rossi, Anthony M. ·University of Michigan Medical School, Ann Arbor, Michigan. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: rossia@mskcc.org. ·J Am Acad Dermatol · Pubmed #26826051.

ABSTRACT: BACKGROUND: Reflectance confocal microscopy (RCM) provides real-time noninvasive imaging of cell structure and may be useful in diagnosing lentigo maligna (LM). Few studies have compared performance of RCM with histopathology in diagnosing LM, and specific features influencing RCM interpretation are not well described. OBJECTIVE: We sought to determine concordance rate between RCM and histopathology in the evaluation of suspected LM and to identify factors that may obscure diagnosis. METHODS: We designed a prospective study involving 17 participants seen for evaluation at a large tertiary referral center. Cases included primary lesions and possible recurrent and/or previously treated lesions. A total of 63 clinically equivocal sites were assessed by RCM and histopathology. RESULTS: RCM and histopathology interpretations were concordant in 56 of 63 sites (89%). There were no false-negative and 7 false-positive results using RCM (sensitivity 100%, specificity 71%, positive predictive value 85%, negative predictive value 100%). Features suggestive of LM in the false-positive group included the presence of numerous hyperreflectile large cells at the dermoepidermal junction and follicular localization of these cells. LIMITATIONS: A larger test set is needed to more reliably distinguish LM from benign lesions using RCM and to improve specificity. CONCLUSION: RCM shows excellent sensitivity for detecting LM although features of benign macules on a background of actinically damaged skin can obscure diagnosis and limit its specificity.

19 Article Radiation therapy for synchronous basal cell carcinoma and lentigo maligna of the nose: Response assessment by clinical examination and reflectance confocal microscopy. 2015

Hibler, Brian P / Connolly, Karen L / Cordova, Miguel / Nehal, Kishwer S / Rossi, Anthony M / Barker, Christopher A. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Multidisciplinary Skin Cancer Management Program, Memorial Sloan Kettering Cancer Center, New York, New York. · Multidisciplinary Skin Cancer Management Program, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: barkerc@mskcc.org. ·Pract Radiat Oncol · Pubmed #26142026.

ABSTRACT: -- No abstract --

20 Minor Nevi and lasers: Practical considerations. 2018

Rogers, Tova / Krakowski, Andrew C / Marino, Maria L / Rossi, Anthony / Anderson, Richard R / Marghoob, Ashfaq A. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · DermOne, LLC, West Conshohocken, Pennsylvania. · Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·Lasers Surg Med · Pubmed #29159963.

ABSTRACT: Lasers are increasingly used for elective ablation of melanocytic nevi (MN). However, the associated risks of treating MN with lasers are debated and not well studied. Theoretical risks include inadvertently treating a melanoma mistaken for a nevus, the inability to remove all nevus cells and the possibility for residual cells to undergo malignant transformation, and the difficulty in clinically monitoring the remnant nevus for melanoma progression. Additional concerns include the morphological suitability of a lesion for laser removal and managing patients' expectations about the variable cosmetic outcomes. These potential issues have prompted us to outline some practical suggestions for clinicians and patients to consider when determining the suitability of a nevus for laser ablation. The choice to perform laser removal of a nevus is personal, both from the perspective of the treating physician and that of the person being treated. While acknowledging some uncertainty, we believe that these suggestions can help mitigate risk and improve patient outcomes. Lasers Surg. Med. 50:7-9, 2018. © 2017 Wiley Periodicals, Inc.

21 Minor Intraoperative real-time reflectance confocal microscopy for guiding surgical margins of lentigo maligna melanoma. 2015

Hibler, Brian P / Cordova, Miguel / Wong, Richard J / Rossi, Anthony M. ·Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York. ·Dermatol Surg · Pubmed #26050216.

ABSTRACT: -- No abstract --