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Now showing items 1 - 16 of 707

  • Automated Dermatological Diagnosis: Hype or Reality?

    Cristian Navarrete-Dechent   Stephen W. Dusza   Konstantinos Liopyris   Ashfaq A. Marghoob   Allan C. Halpern   Michael A. Marchetti  

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  • The state of melanoma: challenges and opportunities

    Glenn Merlino   Meenhard Herlyn   David E. Fisher   Boris C. Bastian   Keith T. Flaherty   Michael A. Davies   Jennifer A. Wargo   Clara Curiel‐Lewandrowski   Michael J. Weber   Sancy A. Leachman   Maria S. Soengas   Martin McMahon   J. William Harbour   Susan M. Swetter   Andrew E. Aplin   Michael B. Atkins   Marcus W. Bosenberg   Reinhard Dummer   Jeffrey E. Gershenwald   Allan C. Halpern   Dorothee Herlyn   Giorgos C. Karakousis   John M. Kirkwood   Michael Krauthammer   Roger S. Lo   Georgina V. Long   Grant McArthur   Antoni Ribas   Lynn Schuchter   Jeffrey A. Sosman   Keiran S. Smalley   Patricia Steeg   Nancy E. Thomas   Hensin Tsao   Thomas Tueting   Ashani Weeraratna   George Xu   Randy Lomax   Alison Martin   Steve Silverstein   Tim Turnham   Ze'ev A. Ronai  

    The Melanoma Research Foundation (MRF) has charted a comprehensive assessment of the current state of melanoma research and care. Intensive discussions among members of the MRF Scientific Advisory Council and Breakthrough Consortium, a group that included clinicians and scientists, focused on four thematic areas – diagnosis/early detection, prevention, tumor cell dormancy (including metastasis), and therapy (response and resistance). These discussions extended over the course of 2015 and culminated at the Society of Melanoma Research 2015 International Congress in November. Each of the four groups has outlined their thoughts as per the current status, challenges, and opportunities in the four respective areas. The current state and immediate and long‐term needs of the melanoma field, from basic research to clinical management, are presented in the following report.
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  • Cost-effective Melanoma Screening

    June K. Robinson   Allan C. Halpern  

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  • Growth-Curve Modeling of Nevi With a Peripheral Globular Pattern

    Shirin Bajaj   Stephen W. Dusza   Michael A. Marchetti   Xinyuan Wu   Maira Fonseca   Kivanc Kose   Johanna Brito   Cristina Carrera   Vanessa P. Martins de Silva   Josep Malvehy   Susana Puig   Sarah Yagerman   Tracey N. Liebman   Alon Scope   Allan C. Halpern   Ashfaq A. Marghoob  

    IMPORTANCE Although nevi with a peripheral rim of globules (peripheral globular nevi [PGN]) observed with dermoscopy are associated with enlarging melanocytic nevi, their actual growth dynamics remain unknown. Because change is a sensitive but nonspecific marker for melanoma, beginning to understand the growth patterns of nevi may improve the ability of physicians to differentiate normal from abnormal growth and reduce unnecessary biopsies. OBJECTIVE To study the growth dynamics and morphologic evolution of PGN on dermoscopy. DESIGN, SETTING, AND PARTICIPANTS A total of 84 participants with 121 PGN from September 1, 1999, through May 1, 2013, were identified retrospectively. Cohorts were recruited from the Memorial Sloan Kettering Cancer Center; Melanoma Unit of the Hospital Clinic, University of Barcelona; and Study of Nevi in Children. All 3 cohorts underwent longitudinal monitoring with serial dermoscopic imaging of their PGN. Data analysis was performed from May 1, 2014, through April 1, 2015. MAIN OUTCOMES AND MEASURES Establishment of the natural growth curve of PGN. The secondary aim was to establish the median time to growth cessation in those PGN for which the size eventually stabilized and/or had begun to decrease during the study period. RESULTS The median duration of follow-up was 25.1 (range, 2.0–114.4) months. Most of the nevi (116 [95.9%]) enlarged at some point during sequential monitoring. The rate of increase in the surface area of PGN varied among cohorts and ranged from −0.47 to 2.26mm2/mo (mean rate, 0.25 [95% CI, 0.14–0.36]mm2/mo). The median time to growth cessation in the 26 PGN that stabilized or decreased in size (21.5%) was 58.6 months. All lesions changed in a symmetric manner and 91 (75.2%) displayed a decrease in the density of peripheral globules over time. CONCLUSIONS AND RELEVANCE Nevi displaying a peripheral globular pattern enlarged symmetrically with apparent growth cessation occurring during a span of 4 to 5 years. Our results reiterate the important concept that not all growth is associated with malignancy.
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  • Vitamin D: a clinical perspective

    Allan C. Halpern  

    Vitamin D has been the focus of considerable recent scientific study and media attention because of a growing appreciation of its potential importance in extra-skeletal health. This ‘Perspective’ presents data supporting the viewpoint that physicians should not routinely test vitamin D levels in the general population but should routinely endorse vitamin D supplementation at levels recommended by the Institute of Medicine. It further reasons that it is unadvisable to recommend intentional limited sun exposure as a source of vitamin D.
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  • The study of nevi in children: Principles learned and implications for melanoma diagnosis

    Alon Scope   Michael A. Marchetti   Ashfaq A. Marghoob   Stephen W. Dusza   Alan C. Geller   Jaya M. Satagopan   Martin A. Weinstock   Marianne Berwick   Allan C. Halpern  

    Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.
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  • The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014

    Jean-Phillip Okhovat   Derek Beaulieu   Hensin Tsao   Allan C. Halpern   Dominique S. Michaud   Shimon Shaykevich   Alan C. Geller  

    Background The incidence of melanoma is rising faster than that of any other preventable cancer in the United States. The American Academy of Dermatology has sponsored free skin cancer education and screenings conducted by volunteer dermatologists in the United States since 1985. Objective We aimed to assess the American Academy of Dermatology's national skin cancer screening program from 1986 to 2014 by analyzing the risk factor profile, access to dermatologic services, and examination results. Methods We conducted several detailed statistical analyses of the screening population. Results From 1986 to 2014, records were available for 2,046,531 screenings, 1,963,141 (96%) of which were subjected to detailed analysis. Men comprised 38% of all participants. The number of annual screenings reached approximately 100,000 in 1990 and remained relatively stable thereafter. From 1991 to 2014 (data for 1995, 1996 and 2000 were unavailable), clinical diagnoses were rendered for 20,628 melanomas, 156,087 dysplastic nevi, 32,893 squamous cell carcinomas, and 129,848 basal cell carcinomas. Only 21% of screenees had a regular dermatologist. Those with a clinical diagnosis of skin cancer were more likely than the general screening population to be uninsured. Limitations Inability to verify clinical diagnoses histopathologically. Conclusion Our findings suggest that the SPOTme program has detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.
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  • Reference values for skin microanatomy: A systematic review and meta-analysis of ex vivo studies

    Haoming Xu   Maira Fonseca   Zachary Wolner   Esther Chung   Xinyuan Wu   Shamir Geller   Stephen W. Dusza   Antonio P. DeRosa   Ashfaq A. Marghoob   Klaus J. Busam   Allan C. Halpern   Michael A. Marchetti  

    Background Few studies have characterized reference values of normal human skin microanatomy parameters. Objective To quantify histologic measurements of epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density as a function of age and anatomic site. Method We searched the PubMed, Embase, Web of Science, and Cochrane databases for articles published through May 25, 2017. Two reviewers independently screened 2016 articles; 327 relevant articles and 151 additional articles found via forward or reference citations underwent full-text review by 1 of 4 reviewers for relevance, data extraction, and critical appraisal. Weighted averages, meta-analysis, and meta-regression were used in statistical analysis. Results A total of 56 articles were included; when all anatomic locations were used, the overall estimates for epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density were 99.75 μm (95% confidence interval [CI], 83.25-116.25), 955.05 cells/mm 2 (95% CI. 880.89-1029.21), 1.40 hairs/mm 2 (95% CI. 0.91-1.89), and 1.28 glands/mm 2 (95% CI. 0.91-1.64), respectively. Limitations There was significant data heterogeneity across studies, possibly because of differences in histological techniques and absence of standardized microanatomy definitions. Conclusions We established summary estimates for normal human skin microanatomy parameters.
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  • Total body skin imaging as an aid to melanoma detection

    Allan C. Halpern  

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  • Awareness, knowledge and attitudes to non-melanoma skin cancer and actinic keratosis among the general public

    Allan C. Halpern   Laura J. Kopp  

    Abstract Background  The incidence of nonmelanoma skin cancer (NMSC) has dramatically increased worldwide. In areas of high incidence this will place a significant burden on the health system. Objectives  To establish the awareness, knowledge and attitudes of the general public to NMSC and provide an overview on their level of understanding and knowledge of preventative measures. Methods  Two thousand and one hundred Caucasian and Hispanic individuals, aged 40–75 years, from the UK, Italy, Germany, Spain, France, the USA and Australia were randomly selected to participate in this market research survey. In a structured telephone interview lasting approximately 10 min, respondents answered questions on NMSC, specifically actinic keratosis (AK) and basal cell carcinoma (BCC). Results  Overall, 6% of respondents had been diagnosed with NMSC, of which the incidence was highest in Australia and the USA. The frequency of skin cancer detection examinations was also greater within these populations. Countries with a high incidence of NSMC had greater awareness of the condition, with more awareness of BCC than AK. The majority of respondents believed there was a correlation between skin cancer and sun exposure, however, a minority of respondents associated skin cancer with ‘moderate’ tanning. Overall, 86% of respondents claimed that they always took precautions against ultraviolet exposure when in the sun, but only 26% applied sunscreen most or all of the time when they were exposed to the sun for more than 1 h. In most of the countries, outside workers reported lower sunscreen use than other respondents. Conclusion  Nonmelanoma skin cancer awareness and prevention behaviors varied significantly among the countries studied. Improved population-specific documentation of skin cancer knowledge and prevention behaviors will facilitate the development and assessment of public health campaigns.
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  • Awareness of, knowledge of and attitudes to nonmelanoma skin cancer (NMSC) and actinic keratosis (AK) among physicians

    Allan C. Halpern   Laura J. Hanson  

    Abstract Background  Nonmelanoma skin cancer (NMSC) is the most common type of cancer that affects the Caucasian population. Approximately 80% of NMSCs are basal cell carcinoma (BCC) and 20% are squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precancerous lesion that may develop into SCC. Methods  A market research survey was conducted in which dermatologists and primary care physicians (PCPs) were randomly selected from seven countries (USA, Australia, UK, Italy, France, Germany and Spain). Their knowledge of nonmelanoma skin cancer and their current clinical practice were assessed. Results  In total, 2100 physicians took part in the survey. They had practised medicine for between 1 and 30 years and saw at least 30 patients in a typical week. The majority of dermatologists (97%) were familiar with BCC and AK, and treated each condition with a minimum of referrals. PCPs were more familiar with BCC (90%) than with AK (74%). Of the PCPs that were aware of BCC, only 31% treated the condition, and of those aware of AK, 40% treated the condition. Surgery was the most common choice of treatment for BCC. The most popular treatment choice for AK lesions was cryotherapy. Eighty to 100% of physicians reported that they discussed skin cancer prevention with their patients. A much lower number of physicians (ranging from 5 to 37%) provided educational material to patients. Overall, PCPs in the two countries that have a high incidence of NMSC (USA and Australia) were more familiar with BCC and AK and more likely to treat each condition than PCPs in Europe. All physicians rated BCC as a more serious condition than AK. Facial lesions were considered more serious than lesions on the head or trunk for both conditions. Conclusions  As the burden of disease and the number of patients seeking treatment for NMSC increase, dermatologists are well placed to lead educational initiatives for PCPs and provide educational material for patients. This would increase awareness of AK and BCC and could improve early diagnosis.
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  • David Allan, Lead Processing at Leadhills, Pounding the Ore c. 1786

    McKiernan, Mike  

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  • Allan J. Yates, MD, PhD, FRCP(C) (1943–2010)

    Barth, Rolf F.   Sanders, Virginia M.   Bigner, Darell D.  

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  • Allan J. Yates, MD, PhD, FRCP(C) (1943–2010)

    Barth, Rolf F.; Sanders, Virginia M.; Bigner, Darell D.  

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  • The Province of Jurisprudence Democratizedby Allan C. Hutchinson

    David Fraser  

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  • The Province of Jurisprudence Democratizedby Allan C. Hutchinson

    David Fraser  

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