Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Melanoma: HELP
Articles by Arthur J. Sober
Based on 25 articles published since 2008
||||

Between 2008 and 2019, Arthur Sober wrote the following 25 articles about Melanoma.
 
+ Citations + Abstracts
1 Guideline Guidelines of care for the management of primary cutaneous melanoma. 2019

Swetter, Susan M / Tsao, Hensin / Bichakjian, Christopher K / Curiel-Lewandrowski, Clara / Elder, David E / Gershenwald, Jeffrey E / Guild, Valerie / Grant-Kels, Jane M / Halpern, Allan C / Johnson, Timothy M / Sober, Arthur J / Thompson, John A / Wisco, Oliver J / Wyatt, Samantha / Hu, Shasa / Lamina, Toyin. ·Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Electronic address: sswetter@stanford.edu. · Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts. · Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan. · Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona. · Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. · AIM at Melanoma Foundation, Plano, Texas. · Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut. · Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York. · Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington. · Department of Dermatology, Oregon Health and Science University, Portland, Oregon. · Decatur Dermatology, Decatur, Alabama. · Department of Dermatology, University of Miami Health System, Miami, Florida. · American Academy of Dermatology, Rosemont, Illinois. ·J Am Acad Dermatol · Pubmed #30392755.

ABSTRACT: The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.

2 Guideline Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. 2011

Bichakjian, Christopher K / Halpern, Allan C / Johnson, Timothy M / Foote Hood, Antoinette / Grichnik, James M / Swetter, Susan M / Tsao, Hensin / Barbosa, Victoria Holloway / Chuang, Tsu-Yi / Duvic, Madeleine / Ho, Vincent C / Sober, Arthur J / Beutner, Karl R / Bhushan, Reva / Smith Begolka, Wendy / Anonymous6410703. ·Department of Dermatology, University of Michigan Health System and Comprehensive Cancer Center, Ann Arbor, Michigan, USA. ·J Am Acad Dermatol · Pubmed #21868127.

ABSTRACT: The incidence of primary cutaneous melanoma has been increasing dramatically for several decades. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is nearly always curative with early detection of disease. In this update of the guidelines of care, we will discuss the treatment of patients with primary cutaneous melanoma. We will discuss biopsy techniques of a lesion clinically suspicious for melanoma and offer recommendations for the histopathologic interpretation of cutaneous melanoma. We will offer recommendations for the use of laboratory and imaging tests in the initial workup of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, we will provide recommendations for surgical margins and briefly discuss nonsurgical treatments. Finally, we will discuss the value and limitations of sentinel lymph node biopsy and offer recommendations for its use in patients with primary cutaneous melanoma.

3 Review Integrating Skin Cancer-Related Technologies into Clinical Practice. 2017

Winkelmann, Richard R / Farberg, Aaron S / Glazer, Alex M / Cockerell, Clay J / Sober, Arthur J / Siegel, Daniel M / Leachman, Sancy A / High, Whitney A / Markowitz, Orit / Berman, Brian / Pariser, David M / Goldenberg, Gary / Rosen, Theodore / Rigel, Darrell S. ·Department of Dermatology, OhioHealth, 75 Hospital Drive STE 250, Athens, OH 4570, USA. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, 1425 Madison Avenue, Floor 2, New York, NY 10029, USA. · National Society for Cutaneous Medicine, 35 East 35th Street #208, New York, NY 10016, USA. · Department of Dermatology, The University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard. 4th Floor, Suite 100, Dallas, TX 75390, USA. · Department of Dermatology, Harvard Medical School, 50 Staniford Street, 2nd Floor, Boston, MA 02114, USA. · Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA. · Department of Dermatology, OHSU Knight Cancer Institute, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA. · Department of Dermatology & Pathology, University of Colorado School of Medicine, 12635 E Montview Boulevard, Bioscience Park, Suite 160, Aurora, CO 80045, USA. · Department of Dermatology, Mount Sinai Medical Center, 5 E 98th Street, FL 5, New York, NY 10029, USA. · Department of Dermatology, University of Miami Miller School of Medicine, 2925 Aventura Boulevard, Suite 205, Aventura, FL 33180, USA. · Department of Dermatology, Eastern Virginia Medical School, 6160 Kempsville Circle, Suite 200A, Norfolk, VA 23502, USA. · Department of Dermatology, Baylor College of Medicine, 1977 Butler Street, Suite E6.200, Houston, Texas 77030, USA. · Department of Dermatology, NYU School of Medicine, 35 East 35th Street #208, New York, NY 10016, USA. Electronic address: dsrigel@prodigy.net. ·Dermatol Clin · Pubmed #28886814.

ABSTRACT: Early diagnosis and treatment of melanoma improve survival. New technologies are emerging that may augment the diagnosis, assessment, and management of melanoma but penetrance into everyday practice is low. In the current health care climate, greater emphasis will be placed on the incorporation of technology for clinically suspicious pigmented lesions to facilitate better, more cost-effective management.

4 Review Early detection of melanoma: reviewing the ABCDEs. 2015

Anonymous4130821 / Tsao, Hensin / Olazagasti, Jeannette M / Cordoro, Kelly M / Brewer, Jerry D / Taylor, Susan C / Bordeaux, Jeremy S / Chren, Mary-Margaret / Sober, Arthur J / Tegeler, Connie / Bhushan, Reva / Begolka, Wendy Smith. ·Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico. · Department of Dermatology, University of California, San Francisco, California. · Society Hill Dermatology and Cosmetic Center, Philadelphia, Pennsylvania. · Department of Dermatology, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio. · Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California. · American Academy of Dermatology, Schaumburg, Illinois. · American Academy of Dermatology, Schaumburg, Illinois. Electronic address: wsmithbegolka@aad.org. ·J Am Acad Dermatol · Pubmed #25698455.

ABSTRACT: Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.

5 Review Prognostic factors for melanoma. 2012

Wisco, Oliver J / Sober, Arthur J. ·Dermatology Clinic, 81st Medical Group, 81 MDOS/SGOMD, 301 Fisher Street, Keesler AFB, MS 39534, USA. wiscooj@gmail.com ·Dermatol Clin · Pubmed #22800552.

ABSTRACT: The current melanoma staging system, as defined by the American Joint Committee on Cancer (AJCC), is the standard by which melanoma prognosis is determined. This article focuses on the components of the AJCC melanoma staging system regarding patient prognosis. In addition, this article summarizes the other commonly researched clinical and histologic melanoma prognostic factors and reviews the recent advancements in genetic biomarkers associated with prognosis.

6 Article Clinical spectrum of cutaneous melanoma morphology. 2019

Klebanov, Nikolai / Gunasekera, Nicole S / Lin, William M / Hawryluk, Elena B / Miller, David M / Reddy, Bobby Y / Christman, Mitalee P / Beaulieu, Derek / Rajadurai, Suvithan / Duncan, Lyn M / Sober, Arthur J / Tsao, Hensin. ·Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. · Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. · Pathology Service, Massachusetts General Hospital, Boston, Massachusetts. · Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: htsao@mgh.harvard.edu. ·J Am Acad Dermatol · Pubmed #30165162.

ABSTRACT: BACKGROUND: Melanoma can mimic other cutaneous lesions, but the full spectrum and prevalence of these morphologic variants remain largely unknown. OBJECTIVE: To classify nonacral cutaneous melanomas into distinct morphologic clusters and characterize clusters' clinicopathologic features. METHODS: All pathologic melanoma diagnoses (occurring during 2011-2016) were reviewed for routine prebiopsy digital photographs (n = 400). Six dermatologists independently assigned lesions into 1 of 14 diagnostic classes on the basis of morphology. Image consensus clusters were generated by K-means; clinicopathologic features were compared with analysis of variance and χ RESULTS: Five morphologic clusters were identified: typical (n = 136), nevus-like (n = 81), amelanotic/nonmelanoma skin cancer (NMSC)-like (n = 70), seborrheic keratosis (SK)-like (n = 68), and lentigo/lentigo maligna (LM)-like (n = 45) melanomas. Nevus-like melanomas were found in younger patients. Nevus-like and lentigo/LM-like melanomas tended to be thinner and more likely identified on routine dermatologic examinations. NMSC-like melanomas were tender, thicker, more mitotically active, and associated with prior NMSC. Typical and SK-like melanomas had similar clinicopathologic features. LIMITATIONS: Cluster subdivision yielded diminished sample sizes. Visual assignment was performed without clinical context. CONCLUSION: When primary cutaneous melanomas were assigned into diagnostic groups and subjected to novel consensus clustering, recurrent morphologic patterns emerged. The spectrum of these morphologies was unexpectedly diverse, which might have implications for visual training and possibly clinical diagnosis.

7 Article Contrasting features of childhood and adolescent melanomas. 2018

Bartenstein, Diana W / Kelleher, Cassandra M / Friedmann, Alison M / Duncan, Lyn M / Tsao, Hensin / Sober, Arthur J / Hawryluk, Elena B. ·School of Medicine, Harvard University, Boston, MA, USA. · School of Medicine, Tufts University, Boston, MA, USA. · Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA. · Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA. · Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA. · Pathology Service, Massachusetts General Hospital, Boston, MA, USA. ·Pediatr Dermatol · Pubmed #29569376.

ABSTRACT: BACKGROUND/OBJECTIVES: Melanoma in children and adolescents is uncommon, and there are limited data on pediatric outcomes. Several studies have shown comparable survival rates in children and adults, but other research demonstrates that prepubescent children have more favorable outcomes. This study aims to compare childhood and adolescent melanoma. METHODS: Retrospective cohort study of children who received a melanoma diagnosis at the Massachusetts General Hospital between January 1, 1995, and December 21, 2016. Childhood melanoma is defined as disease occurring in patients younger than 11 years old, and adolescent melanoma is defined as disease occurring in patients 11 to 19 years old. Patients diagnosed with ocular melanoma and borderline tumors of uncertain malignant potential were excluded. This analysis compares clinical, histopathologic, and outcome characteristics of childhood and adolescent melanoma. RESULTS: Thirty-two children with melanoma were identified (12 children, 20 adolescents). The spitzoid melanoma subtype was significantly more common in children (6/12) than adolescents (2/20) (P = .01). Four adolescents and no children with melanoma died from melanoma, and survival was significantly different between the age groups (P = .04). Median follow-up time for survivors was 3.6 years. CONCLUSIONS: These results suggest that children and adolescents present with different melanoma subtypes and that adolescents have a more aggressive disease course than children.

8 Article Association of nevus count with prevention attitudes and behaviors before melanoma diagnosis. 2016

Mayer, Jonathan E / Swetter, Susan M / Miller, Donald R / Sober, Arthur J / Johnson, Timothy M / Geller, Alan C. ·aDepartment of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland bDepartment of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford cVeterans Affairs Palo Alto Health Care System, Palo Alto, California dDepartment of Health Policy and Management, Boston University School of Public Health eDepartment of Dermatology, Massachusetts General Hospital fDepartment of Dermatology, Harvard Medical School gDepartment of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts hDepartment of Dermatology, University of Michigan, Ann Arbor, Michigan, USA. ·Melanoma Res · Pubmed #27387129.

ABSTRACT: Although melanoma risk factors are commonly known to healthcare professionals, the extent to which the at-risk public is either aware of these factors or perceives their risk accordingly has rarely been studied. We sought to investigate whether the presence of known melanoma risk factors, such as high total nevus and atypical nevus counts, was associated with increased prevention attitudes and behaviors, such as skin self-examinations and physician skin examinations. This was a retrospective study of 566 individuals recently diagnosed with melanoma in two large academic centers. Most prevention attitudes and behaviors did not vary on the basis of total nevi or atypical nevi counts. However, younger patients (<60 years) with many total nevi (>50) were more likely than those with fewer nevi (<20) to believe that they were at-risk for melanoma (42 vs. 23%; P<0.05), and more likely to state that they had been instructed on the signs of melanoma (36 vs. 21%; P<0.05). Patient and health provider recognition of the impact of nevus count on melanoma risk presents a unique and mostly untapped opportunity for earlier detection.

9 Article Total Nevi, Atypical Nevi, and Melanoma Thickness: An Analysis of 566 Patients at 2 US Centers. 2016

Geller, Alan C / Mayer, Jonathan E / Sober, Arthur J / Miller, Donald R / Argenziano, Giuseppe / Johnson, Timothy M / Swetter, Susan M. ·Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. · Department of Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Dermatology, Massachusetts General Hospital, Boston. · Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts. · Dermatology Unit, Second University of Naples, Naples, Italy. · Department of Dermatology, University of Michigan, Ann Arbor. · Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California8Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California. ·JAMA Dermatol · Pubmed #26934430.

ABSTRACT: IMPORTANCE: Nevi are among the strongest risk factors for melanoma. However, little is known about the association of many total nevi (TN) or atypical nevi (AN) with tumor thickness. OBJECTIVES: To examine the association between age and the number of TN and AN and to explore whether there was a relationship between TN or AN and tumor thickness, controlling for multiple variables. DESIGN, SETTING, AND PARTICIPANTS: Survey of patients with melanoma at 2 academic sites and an affiliated Veteran Affairs medical center. Participants included 566 patients surveyed within 3 months of diagnosis. Patients were surveyed in the melanoma clinics from May 17, 2006, through March 31, 2009, within 3 months of diagnostic biopsy. The dates of the analysis were April 1, 2015, to August 1, 2015. MAIN OUTCOMES AND MEASURES: Counts of TN and AN were performed at the first visit after diagnosis and were categorized as 0 to 20, 20 to 50, or more than 50 for TN and as 0, 1 to 5, or more than 5 for AN. Tumor thickness was categorized as 2.00 mm or less or as 2.01 mm or greater. All analyses were stratified by patient age (<60 or ≥60 years). Logistic regression was used to test associations, controlling for age, sex, anatomic location of melanoma, institution, histologic subtype, marital status, performance of skin self-examination, number of health care visits in the past year, mode of melanoma discovery, and receipt of skin examination by a physician. RESULTS: The study population included 566 patients. Their mean (SD) age was 56.7 (15.9) years, and 39.0% (n = 221) were female. Of 566 patients, the number of TN was classified as 0 to 20 (66.4% [n = 376]), 20 to 50 (20.5% [n = 116]), or more than 50 (13.1% [n = 74]). Atypical nevus counts were 0 (73.3% [n = 415]), 1 to 5 (14.5% [n = 82]), or more than 5 (12.2% [n = 69]). For those younger than 60 years, the presence of more than 50 TN was associated with a sharply reduced risk of thick melanoma (odds ratio, 0.32; 95% CI, 0.12-0.81), and the presence of more than 5 AN compared with no AN was associated with thicker melanoma (odds ratio, 2.43; 95% CI, 1.02-5.75). CONCLUSIONS AND RELEVANCE: Most patients with melanoma had few nevi and no AN. In younger patients (<60 years), thick melanomas were commonly found in those with fewer TN but more AN, suggesting that physicians and patients should not rely on the total nevus count as a sole reason to perform skin examinations or to determine a patient's at-risk status. Younger patients should be educated on the increased risk of thicker melanomas that is associated with having more AN.

10 Article Clinical significance of microscopic melanoma metastases in the nonhottest sentinel lymph nodes. 2015

Luo, Su / Lobo, Alice Z C / Tanabe, Kenneth K / Muzikansky, Alona / Durazzo, Tyler / Sober, Arthur / Tsao, Hensin / Cosimi, A Benedict / Lawrence, Donald P / Duncan, Lyn M. ·Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston. · Pathology Service and Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, Boston3Dermatology Department, University of Sao Paulo, Sao Paulo, Brazil. · Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. · Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston. · Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. · Center for Melanoma, Massachusetts General Hospital, Harvard Medical School, Boston. · Pathology Service and Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, Boston. ·JAMA Surg · Pubmed #25831227.

ABSTRACT: IMPORTANCE: A practice gap exists in the surgical removal of sentinel lymph nodes, from removal of only the most radioactive (hottest) lymph node to removal of all lymph nodes with radioactivity greater than 10% of the hottest lymph node. OBJECTIVE: To determine the clinical significance of melanoma in sentinel lymph nodes that are not the hottest sentinel node and to determine the risk for disease progression based on sentinel lymph node status and primary tumor characteristics. DESIGN, SETTING, AND PARTICIPANTS: Consecutive patients with cutaneous melanoma with sentinel lymph nodes resected from January 5, 2004, to June 30, 2008, with a mean follow-up of 59 months, at Massachusetts General Hospital were included in this retrospective review. The last year of follow-up was 2012. The operative protocol led to resection of all sentinel lymph nodes with radioactivity greater than 10% of the hottest lymph node. The number of lymph nodes removed, technetium-99m counts for each sentinel lymph node, presence or absence of sentinel lymph node metastases, primary tumor characteristics, disease progression, and melanoma-specific survival were recorded. MAIN OUTCOMES AND MEASURES: Microscopic melanoma metastases in the hottest and nonhottest sentinel lymph nodes and factors that correlate with disease progression and mortality. RESULTS: A total of 1575 sentinel lymph nodes were analyzed in 475 patients. Ninety-one patients (19%) had positive sentinel lymph nodes. Of these, 72 (79%) had metastases in the hottest sentinel lymph node. Of 19 cases with tumor present, but not in the hottest sentinel lymph node, counts ranged from 26% to 97% of the hottest node. Progression occurred in 43% of patients with sentinel node metastasis, regardless of whether the hottest lymph node was positive. In patients with negative sentinel lymph nodes, 11% developed metastases beyond the sentinel lymph node basin and 3.4% recurred in the basin. Mitogenicity of the primary tumor was associated with mortality (odds ratio, 2.435; 95% CI, 1.351-4.391; P < .001). Removing only the hottest sentinel lymph node would have led to false-negative results in 19 of 475 (4%) of all patients and 19 of 91 patients (21%) with positive sentinel lymph nodes. The 8-year survival in patients with at least 1 positive sentinel lymph node was less than 55%. The presence of more than 1 mitosis per square millimeter in the primary cutaneous melanoma was associated with decreased survival. CONCLUSIONS AND RELEVANCE: Microscopic melanoma metastases was associated with disease progression and mortality, whether present in the hottest sentinel lymph node or not. These observations emphasize the importance of removing the less hot nodes, addressing a practice gap in the surgical approach to patients with melanoma.

11 Article Outcome of patients with de novo versus nevus-associated melanoma. 2015

Lin, William M / Luo, Su / Muzikansky, Alona / Lobo, Alice Z C / Tanabe, Kenneth K / Sober, Arthur J / Cosimi, A Benedict / Tsao, Hensin / Duncan, Lyn M. ·Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Pathology Service and Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Pathology Service and Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: duncan@helix.mgh.harvard.edu. ·J Am Acad Dermatol · Pubmed #25440436.

ABSTRACT: BACKGROUND: Prior reports indicate a wide range of melanomas in histopathologic contiguity with a nevus, and an associated nevus has unclear prognostic implications in melanoma. OBJECTIVE: We sought to investigate the relationship among nevus-associated melanomas, sentinel lymph node status, and overall survival. METHODS: We conducted a retrospective analysis of 850 patients with cutaneous melanoma and sentinel lymph node removed at Massachusetts General Hospital from 1998 through 2008 and meta-analysis of the literature. RESULTS: Nevus-associated melanomas represented 28% (235/850) of cases and were significantly correlated with younger age (P = .03), truncal site (P = .0005), superficial spreading type (P < .0001), and absent ulceration (P = .005). There was no association with sentinel lymph node status (P = .94) and no survival difference between nevus-associated versus de novo melanoma (P = .41). Meta-analysis of over 4000 cases revealed a similar percentage of associated nevi (32%). LIMITATIONS: This was a retrospective study. CONCLUSIONS: Approximately 30% of melanomas are associated with a nevus. The presence of a nevus associated with a melanoma has no prognostic implication in sentinel lymph node status or overall survival.

12 Article The utility of re-excising mildly and moderately dysplastic nevi: a retrospective analysis. 2014

Strazzula, Lauren / Vedak, Priyanka / Hoang, Mai P / Sober, Arthur / Tsao, Hensin / Kroshinsky, Daniela. ·Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. · Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dkroshinsky@mgh.harvard.edu. ·J Am Acad Dermatol · Pubmed #25262175.

ABSTRACT: BACKGROUND: The management of dysplastic nevi (DN) is a highly debated and controversial topic within the dermatology community. Clinicians agree that margin-positive severely DN should be removed with a surgical margin, however, there is disagreement surrounding the appropriate management of margin-positive mildly and moderately DN. OBJECTIVE: We sought to evaluate the utility of re-excising margin-positive mildly and moderately DN. METHODS: A retrospective chart review was conducted on all adult patients given the diagnosis of a biopsy-proven DN from 2010 through 2011. The primary outcomes were defined as the presence of melanocytic residuum in re-excisional specimens and a clinically significant change in diagnosis. RESULTS: A total of 1809 mildly and moderately DN were diagnosed from 2010 through 2011. In all, 765 (42.3%) of these lesions were found to have positive surgical margins during biopsy, and 495 (64.7) of the 765 lesions were subsequently re-excised. Melanocytic residuum was present in 18.2% of re-excisional specimens. Re-excision resulted in a clinically significant alteration of the diagnosis in only 1 case (0.2%). LIMITATIONS: Limitations include retrospective design and inability to assess for malignant transformation given limited follow-up. CONCLUSIONS: Re-excising mildly and moderately DN results in a low histopathological yield and rarely results in a clinically significant change in diagnosis. As such, clinical monitoring of margin-positive lesions may be warranted.

13 Article Melanoma epidemic: an analysis of six decades of data from the Connecticut Tumor Registry. 2013

Geller, Alan C / Clapp, Richard W / Sober, Arthur J / Gonsalves, Lou / Mueller, Lloyd / Christiansen, Cindy L / Shaikh, Waqas / Miller, Donald R. ·Alan C. Geller, Harvard School of Public Health · Richard W. Clapp, Cindy L. Christiansen, and Donald R. Miller, Boston University School of Public Health · Arthur J. Sober, Massachusetts General Hospital · Donald R. Miller, Boston University School of Medicine, Boston · Cindy L. Christiansen and Donald R. Miller, Veterans Administration Center for Health Quality, Outcomes, and Economic Research, Bedford, MA · Lou Gonsalves and Lloyd Mueller, Connecticut Tumor Registry, Hartford, CT · and Waqas Shaikh, SUNY Downstate Medical Center, New York, NY. ·J Clin Oncol · Pubmed #24043747.

ABSTRACT: PURPOSE: Melanoma is the most commonly fatal form of skin cancer, with nearly 50,000 annual deaths worldwide. We sought to assess long-term trends in the incidence and mortality of melanoma in a state with complete and consistent registration. METHODS: We used data from the Connecticut Tumor Registry, the original National Cancer Institute SEER site, to determine trends in invasive melanoma (1950-2007), in situ melanoma (1973-2007), tumor thickness (1993-2007), mortality (1950-2007), and mortality to incidence (1950-2007) among the 19,973 and 3,635 Connecticut residents diagnosed with invasive melanoma (1950-2007) and who died as a result of melanoma (1950-2007), respectively. Main outcome measures included trends in incidence and mortality by age, sex, and birth cohort. RESULTS: In the initial period (1950-1954), a diagnosis of invasive melanoma was rare, with 1.9 patient cases per 100,000 for men and 2.6 patient cases per 100,000 for women. Between 1950 and 2007, overall incidence rates rose more than 17-fold in men (1.9 to 33.5 per 100,000) and more than nine-fold in women (2.6 to 25.3 per 100,000). During these six decades, mortality rates more than tripled in men (1.6 to 4.9 per 100,000) and doubled in women (1.3 to 2.6 per 100,000). Mortality rates were generally stable or decreasing in men and women through age 54 years. CONCLUSION: Unremitting increases in incidence and mortality of melanoma call for a nationally coordinated effort to encourage and promote innovative prevention and early-detection efforts.

14 Article Sentinel lymph node metastasis is not predictive of poor outcome in patients with problematic spitzoid melanocytic tumors. 2013

Hung, Tawny / Piris, Adriano / Lobo, Alice / Mihm, Martin C / Sober, Arthur J / Tsao, Hensin / Tanabe, Kenneth K / Duncan, Lyn M. ·Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, Canada, BC V5Z 1M9. ·Hum Pathol · Pubmed #22939951.

ABSTRACT: The diagnosis and clinical management of spitzoid melanocytic tumors with atypical features remain problematic and controversial. In the past decade, sentinel lymph node mapping has been advocated as a diagnostic test in this setting to discriminate melanoma from benign tumors. Recent studies, however, consistently show that despite the presence of lymph node metastases these patients almost always fare well. We investigated the outcome of patients with atypical Spitz tumors and spitzoid melanoma who received sentinel lymph node mapping to clarify current recommendations in managing patients with these diagnostically challenging tumors. A search of the electronic files of the Massachusetts General Hospital Pathology Service identified 41 patients treated with sentinel lymph node biopsy for atypical Spitz tumor or spitzoid melanoma from 1998 to 2008. These patients included 23 patients with atypical Spitz tumors and 17 patients with spitzoid melanoma. Sentinel lymph nodes were positive in 26% of patients with atypical Spitz tumors (6/23) and 35% with spitzoid melanomas (6/17). One patient with spitzoid melanoma developed in-transit metastasis; 0 of 40 patients developed metastases beyond the regional lymph node basin with a mean follow-up of 57 months. Sentinel lymph node biopsy may not be a reliable prognostic discriminatory test in patients with atypical Spitz tumors. Patients with spitzoid melanomas and positive sentinel lymph nodes have a more indolent course than those with bona fide conventional melanoma and positive sentinel nodes.

15 Article The distribution of microscopic melanoma metastases in sentinel lymph nodes: implications for pathology protocols. 2012

Lobo, Alice Z C / Tanabe, Kenneth K / Luo, Su / Muzikansky, Alona / Sober, Arthur J / Tsao, Hensin / Cosimi, A Benedict / Duncan, Lyn M. ·Pathology Service and Dermatopathology Unit, Massachusetts General Hospital, Boston, MA 02114, USA. ·Am J Surg Pathol · Pubmed #23154770.

ABSTRACT: The utility of sectioning at multiple levels in the histopathologic analysis of sentinel lymph nodes (SLNs) for melanoma and the correlation of metastasis size with risk of subsequent metastasis were investigated. Metastatic melanoma was identified in SLNs from 91 of 475 (19%) melanoma patients with SLN sampling at the Massachusetts General Hospital between 2004 and 2008. All SLNs were evaluated by a 9-slide protocol: sets of MART-1, hematoxylin and eosin, and S100 stains at 3 distinct levels separated by 80 μm. The location and size of the tumor deposits were evaluated in the context of subsequent metastasis and overall survival. Of the 91 patients with positive sentinel nodes, all 9 protocol slides were available for review in 61 (67%). Eleven of 61 patients had no tumor present in the first set of levels; 2 of these patients died of metastatic melanoma. Patients in whom 11 or more tumor cells were detected in the sentinel node had a greater chance of developing subsequent metastases when compared with patients in whom 10 or fewer tumor cells were detected (P=0.05). Of those with either metastases >2 mm in diameter or extracapsular extension, 50% developed metastases beyond the SLN basin. Eliminating 1 of the 3 levels in the SLN detection protocol would have led to a false-negative diagnosis in 18% of patients.

16 Article Histologically challenging melanocytic tumors referred to a tertiary care pigmented lesion clinic. 2012

Hawryluk, Elena B / Sober, Arthur J / Piris, Adriano / Nazarian, Rosalynn M / Hoang, Mai P / Tsao, Hensin / Mihm, Martin C / Duncan, Lyn M. ·Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-2696, USA. ·J Am Acad Dermatol · Pubmed #22521204.

ABSTRACT: BACKGROUND: The histopathologic diagnosis of some melanocytic tumors is extraordinarily difficult. With this in mind, melanocytic tumors from patients referred to the Massachusetts General Hospital (MGH) Pigmented Lesion Clinic (PLC) are routinely reviewed in the MGH Dermatopathology Unit. OBJECTIVE: We sought to determine the frequency of diagnostically challenging cases from patients treated at the MGH PLC, as measured by a change in the diagnosis upon review of the referral materials. METHODS: We retrospectively reviewed the MGH and referral pathology reports for 478 consecutive cutaneous melanocytic tumors: 126 from 1996-1997 and 352 from 2010-2011. Differences in diagnosis and in therapeutic impact were evaluated. RESULTS: Changes in diagnosis occurred in 168 of 478 cases (35%), more frequently when the original diagnostician was a general pathologist (P = .003). A similar fraction of diagnoses were changed from malignant to benign or vice versa, in both historic and contemporary cohorts. In 64 patients (13%), changes in diagnosis led to a change in therapy. Changes in stage or grading led to the most changes in therapy (78%; 50/64) versus changes from benign to malignant or vice versa (22%; 14/64). LIMITATIONS: This is a retrospective study with the bias of a tertiary-care referral center. CONCLUSIONS: These findings demonstrate the diagnostic difficulty of a subset of melanocytic tumors and highlight the utility of review by more than one pathologist; patient treatment is affected in more than 10% of cases. Identification of melanoma prognostic factors and melanocytic nevus grading led to clinically significant changes in diagnosis leading to a change in patient management.

17 Article Long-term outcome of Spitz-type melanocytic tumors. 2011

Sepehr, Alireza / Chao, Elizabeth / Trefrey, Brie / Blackford, Amanda / Duncan, Lyn McDivitt / Flotte, Thomas J / Sober, Arthur / Mihm, Martin C / Tsao, Hensin. ·Harvard Medical School, Boston, MA 02114, USA. ·Arch Dermatol · Pubmed #21680758.

ABSTRACT: OBJECTIVE: Despite recent advances in our molecular understanding of Spitz-type tumors, the clinical behavior of these lesions remains unclear. We thus set out to define the clinical outcome of classic Spitz nevi, atypical Spitz tumors (ASTs), and spitzoid melanomas. DESIGN: From 1987 through 2002, data on all lesions containing the term "Spitz" or "Spitz" [AND] "melanoma" were retrieved from the pathology database at Massachusetts General Hospital, and the cases were followed up for their outcome. SETTING: The study was performed at a university-affiliated tertiary health care center in Boston, Massachusetts. PATIENTS: A total of 157 patients with Spitz-type melanocytic lesions and follow-up information were identified. MAIN OUTCOME MEASURES: Sentinel lymph node biopsy results, metastases, or fatality were assessed. RESULTS: There were 68 classic Spitz nevi, 76 ASTs, 10 spitzoid melanomas, and 3 melanomas that arose in Spitz nevi. Spitz nevi were diagnosed at a younger age than ASTs (mean age, 26.4 years vs 33.7 years) (P = .01), though both occurred earlier than melanomas (mean age, 50.4 years, P < .001). Sentinel lymph node biopsy findings were positive in 1 of 6 and 4 of 8 patients with ASTs and spitzoid melanomas, respectively. After a median follow-up of 9.1 years, only 1 patient with an AST, who had a separate intermediate-thickness melanoma, developed distant metastasis. There were 6 documented invasive melanomas among 144 patients with classic Spitz nevi or ASTs (observed/expected ratio, 8.03) (P = .01). CONCLUSIONS: Atypical Spitz tumors are associated with minimal lethal potential, an increased melanoma risk, and a moderate risk of metastasis to regional nodes. It makes clinical sense to minimize aggressive treatment but to offer careful surveillance for rare relapses and subsequent melanomas.

18 Article Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection. 2011

Lipworth, Adam D / Park, Jong Min / Trefrey, Brie L / Rubin, Krista M / Geller, Alan C / Sober, Arthur J / Tsao, Hensin. ·Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. ·J Am Acad Dermatol · Pubmed #21453985.

ABSTRACT: BACKGROUND: As melanoma rates increase, and the supply of dermatologists remains suboptimal to meet demand for services, detection of early melanoma has become an increasingly difficult challenge. Some authors advocate for shifting dermatologic resources from routine appointments to urgent visits for those with lesions concerning for melanoma. OBJECTIVE: We sought to investigate the potential of an urgent access track (UAT) embedded within a pigmented lesion clinic to improve early melanoma detection. METHODS: We conducted a retrospective review of patient records from a tertiary care hospital's pigmented lesion clinic and the associated UAT. Results of procedures for all 4495 patient visits to the routine track and all 316 visits to the UAT during the 21-month study period were included, as were detailed chart reviews of all UAT patient visits. RESULTS: UAT visits were more than 4 times as likely (4.1% vs 1.0%) to yield a diagnosis of melanoma as routine track visits (odds ratio 4.24; 95% confidence interval 2.28-7.88; P < .0001), and almost 25 times as likely (2.2% vs 0.1%) to yield a diagnosis of metastatic melanoma (odds ratio 25.4; 95% confidence interval 7.4-87.4; P < .0001). LIMITATIONS: This was a preliminary analysis with only limited data extracted from the routine track pigmented lesion clinic patient visits. CONCLUSION: This initial analysis of UAT strategy suggests that UATs have potential to detect patients with earlier melanomas; further research is needed to specifically delineate how resources should be best allocated between routine surveillance and urgent care to maximize melanoma early detection and survival.

19 Article Implications of the 2009 American Joint Committee on Cancer Melanoma Staging and Classification on dermatologists and their patients. 2010

Nading, Mary Alice / Balch, Charles M / Sober, Arthur J. ·Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA. ·Semin Cutan Med Surg · Pubmed #21051007.

ABSTRACT: The Melanoma Staging and Classification system was recently revised by the American Joint Committee on Cancer (AJCC) and implemented effective January 2010 with changes reflecting new prognostic data gleaned by the significantly larger patient population studied for the 7th edition. This newest analysis yields important long-term outcome data as many of the patients were followed for nearly 2 decades. Additions to edition 7 of the AJCC Melanoma Staging classification highlight several important prognostic factors, particularly the addition of mitotic rate for classifying thin melanomas, the presence of microtumor burden in lymph nodes for stage III disease, and elevated lactate dehydrogenase levels in patients with distant metastatic disease. Although the basic tumor-nodes-metastases (ie, TNM) cancer classification model remains unchanged in this newest edition, the current AJCC Melanoma Staging System has incorporated the latest prognostic data to accurately stratify patients into staging categories. It is important for clinicians and dermatopathologists to familiarize themselves with these changes so that patients are suitably managed and referred to medical and surgical oncologists when appropriate.

20 Article Martin C. Mihm, Jr and the history of the Pigmented Lesion Clinic at the Massachusetts General Hospital. 2010

Sober, Arthur J / Tsao, Hensin. ·Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA. asober@partners.org ·J Cutan Pathol · Pubmed #20482670.

ABSTRACT: -- No abstract --

21 Article Sentinel lymph node biopsy and melanoma: 2010 update Part II. 2010

Stebbins, William G / Garibyan, Lilit / Sober, Arthur J. ·Massachusetts General Hospital, Department of Dermatology, 55 Fruit St, Bartlett Hall 616, Boston, MA 02114, USA. bstebbins@gmail.com ·J Am Acad Dermatol · Pubmed #20398811.

ABSTRACT: LEARNING OBJECTIVES: At the completion of this learning activity, participants should be able to discuss the data regarding early surgical removal of lymph nodes and its effect on the overall survival of melanoma patients, be able to discuss the potential benefits and morbidity associated with complete lymph node dissection, and to summarize the ongoing trials aimed at addressing the question of therapeutic value of early surgical treatment of regional lymph nodes that may contain micrometastases.

22 Article Sentinel lymph node biopsy and melanoma: 2010 update Part I. 2010

Stebbins, William G / Garibyan, Lilit / Sober, Arthur J. ·Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. bstebbins@gmail.com ·J Am Acad Dermatol · Pubmed #20398810.

ABSTRACT: LEARNING OBJECTIVES: After completing this learning activity, participants should be able to describe the concept of sentinel lymph node biopsy, to discuss the risks and benefits associated with this procedure, and to summarize the role of sentinel lymph node biopsy in management of patients with melanoma.

23 Article Estimating CDKN2A carrier probability and personalizing cancer risk assessments in hereditary melanoma using MelaPRO. 2010

Wang, Wenyi / Niendorf, Kristin B / Patel, Devanshi / Blackford, Amanda / Marroni, Fabio / Sober, Arthur J / Parmigiani, Giovanni / Tsao, Hensin. ·Stanford Genome Technology Center, Department of Biochemistry, Stanford University, Stanford, California, USA. ·Cancer Res · Pubmed #20068151.

ABSTRACT: Personalized cancer risk assessment remains an essential imperative in postgenomic cancer medicine. In hereditary melanoma, germline CDKN2A mutations have been reproducibly identified in melanoma-prone kindreds worldwide. However, genetic risk counseling for hereditary melanoma remains clinically challenging. To address this challenge, we developed and validated MelaPRO, an algorithm that provides germline CDKN2A mutation probabilities and melanoma risk to individuals from melanoma-prone families. MelaPRO builds on comprehensive genetic information, and uses Mendelian modeling to provide fine resolution and high accuracy. In an independent validation of 195 individuals from 167 families, MelaPRO exhibited good discrimination with a concordance index (C) of 0.86 [95% confidence intervals (95% CI), 0.75-0.97] and good calibration, with no significant difference between observed and predicted carriers (26; 95% CI, 20-35, as compared with 22 observed). In cross-validation, MelaPRO outperformed the existing predictive model MELPREDICT (C, 0.82; 95% CI, 0.61-0.93), with a difference of 0.05 (95% CI, 0.007-0.17). MelaPRO is a clinically accessible tool that can effectively provide personalized risk counseling for all members of hereditary melanoma families.

24 Article Final version of 2009 AJCC melanoma staging and classification. 2009

Balch, Charles M / Gershenwald, Jeffrey E / Soong, Seng-Jaw / Thompson, John F / Atkins, Michael B / Byrd, David R / Buzaid, Antonio C / Cochran, Alistair J / Coit, Daniel G / Ding, Shouluan / Eggermont, Alexander M / Flaherty, Keith T / Gimotty, Phyllis A / Kirkwood, John M / McMasters, Kelly M / Mihm, Martin C / Morton, Donald L / Ross, Merrick I / Sober, Arthur J / Sondak, Vernon K. ·Department of Surgery, Oncology and Dermatology, Johns Hopkins Medical Institutions, 600 N. Wolfe St, Osler 624, Baltimore, MD, 21287, USA. balchch@jhmi.edu ·J Clin Oncol · Pubmed #19917835.

ABSTRACT: PURPOSE: To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database. METHODS: The melanoma staging recommendations were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria. RESULTS: Findings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm(2)), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level. CONCLUSION: Using an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.

25 Article The impact of primary tumor size, lymph node status, and other prognostic factors on the risk of cancer death. 2009

Chen, L Leon / Nolan, Matthew E / Silverstein, Melvin J / Mihm, Martin C / Sober, Arthur J / Tanabe, Kenneth K / Smith, Barbara L / Younger, Jerry / Michaelson, James S. ·Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. ·Cancer · Pubmed #19658184.

ABSTRACT: BACKGROUND: : Although many prognostic factors are associated with differences in cancer lethality, it may not be obvious whether a factor truly makes an independent contribution to lethality or simply is correlated with tumor size. There is currently no method for integrating tumor size, lymph node status, and other prognostic information from a patient into a single risk of death estimate. METHODS: : The SizeOnly equation, which captures the relation between tumor size and risk of death, makes it possible to determine whether a prognostic factor truly makes an independent contribution to cancer lethally or merely is associated with tumor size (SizeAssessment method). The magnitude of each factor's lethal contribution can be quantified by a parameter, g, inserted into the SizeOnly equation (PrognosticMeasurement method). A series of linked equations (the Size+Nodes+PrognosticFactors [SNAP] method) combines information on tumor size, lymph node status, and other prognostic factors from a patient into a single estimate of the risk of death. RESULTS: : Nine prognostic factors were identified that made marked, independent contributions to breast carcinoma lethality: grade; mucinous, medullary, tubular, and scirrhous adenocarcinoma; male sex; inflammatory disease; Paget disease; and lymph node status. In addition, it was determined that lymph node status made an independent contribution to melanoma lethality. The SNAP method was able to accurately estimate the risk of death and to finely stratify patients by risk. CONCLUSIONS: : The methods described provide a new framework for identifying and quantifying those factors that contribute to cancer lethality and provide a basis for web-based calculators (available at: http://www.CancerMath.net accessed July 29, 2009) that accurately estimate the risk of death for each patient. Cancer 2009. (c) 2009 American Cancer Society.