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Prahran, Australia

DeFazio J.L.,Sloan Kettering Cancer Center | Marghoob A.A.,Sloan Kettering Cancer Center | Pan Y.,Victorian Melanoma Service | Dusza S.W.,Sloan Kettering Cancer Center | Halpern A.,Sloan Kettering Cancer Center
Archives of Dermatology | Year: 2010

Objective: To assess current practices and recommendations of US physicians regarding depth of excision for melanomas of varying histologic thicknesses. Design: A 2-page, 13-question survey of depth of excision practices for the treatment of melanoma was developed and distributed. Setting: Both private and academic settings. Participants: A total of 1184 US physicians (1000 dermatologists and 184 melanoma specialists) were sent the survey. The 184 melanoma specialists included dermatologists, oncologists, and surgeons working in pigmented lesion clinics. Main Outcome Measures: Depth of excision practices reported for melanomas of varying histologic thicknesses and comparison of treating physician groups. Results were tabulated, and descriptive frequencies were used to describe demographics and survey responses. Results: The final study analysis included 498 completed surveys. The overall response rate was 45% (498 of 1097 [1184 total respondents - 87 ineligibles]). The response rate for the specialists was 63% (115 of 183 [184 total respondents - 1 ineligible]), and for nonspecialist dermatologists it was 43% (383 of 892 [1000 total respondents - 108 ineligibles]). Specialists were more likely to practice in an urban setting than were nonspecialist dermatologists (78% vs 46%) (P < .001). Fifty-eight percent of nonspecialist dermatologists reported more than 400 patient visits per month compared with only 16% of specialists (P < .001). While specialists reported fewer patient visits per month, 51% reported diagnosing over 20 invasive melanomas in the previous year compared with 11% of nonspecialist dermatologists. There was no significant difference in excision depth reported among the specialties for melanoma in situ (P = .15). For invasive melanoma, significant differences were observed among treating groups, with the greatest incongruence reported for thin invasive melanoma (< 0.50 mm, P = .02; 0.50-0.75 mm, P < .001; and 0.76-1.00 mm, P < .001). Specialist nondermatologists consistently reported excising more deeply than specialist dermatologists and nonspecialist dermatologists. More specialist nondermatologists report excising to the fascia for thin invasive melanoma than do both specialist and nonspecialist dermatologists. For thicker melanomas (> 1.00 mm), differences in excision depths among treating physician groups decreased: most physicians in each group reported excising to the fascia. Conclusions: There is considerable variation among physician groups with regard to depth of excision practices for the treatment of melanoma. Given the current lack of clinical data available, studies assessing depth of excision and patient outcomes are needed to better define our surgical management of melanoma. ©2010 American Medical Association. All rights reserved. Source

Le Q.,Victorian Melanoma Service | Cahill J.,Skin and Cancer Foundation Victoria | Palmer-Le A.,Skin and Cancer Foundation Victoria | Nixon R.,Skin and Cancer Foundation Victoria
Australasian Journal of Dermatology | Year: 2015

Shellac is a newly available type of long-wearing nail polish, which is becoming increasingly popular. We describe four cases of allergic contact dermatitis (ACD) to acrylates found in Shellac nail products, involving three beauticians and one consumer who purchased the product over the internet. Increasing use of these new acrylic nail products means that dermatologists need to be aware of the possibility of ACD occurring. Testing with hydroxyethyl methacrylate alone, which is included in the Australian Baseline Series, is adequate for screening for acrylate allergy. © 2015 The Australasian College of Dermatologists. Source

Kalkhoran S.,State University of New York at Stony Brook | Milne O.,Alfred Hospital | Zalaudek I.,Medical University of Graz | Puig S.,Institute dInvestigacions Biomediques August Pi i Sunyer | And 3 more authors.
Archives of Dermatology | Year: 2010

Background: Nodular melanoma (NM), representing 15% to 30% of all melanomas, constitutes nearly half of all melanomas thicker than 2 mm. Nodular melanoma frequently lacks clinical features seen in other melanoma subtypes and has a faster growth rate. We reviewed a series of cases of NM that was less than 1.3 mm thick to identify historical, clinical, and dermoscopic factors that may facilitate earlier diagnosis of NM, with the hope of reducing its associated morbidity and mortality. Observations: The thin NM lesions we analyzed had a rather subtle clinical appearance, often lacking the ABCD (asymmetry, border irregularity, color variegation, and diameter greater than 6 mm) criteria. On dermoscopy, most lesions had a homogeneous disorganized asymmetric pattern or a featureless pattern with atypical vessels. Although many dermoscopic features seen in other melanoma subtypes were frequently absent, some features such as a blue-white veil, structureless areas, and atypical vascular structures were often identified. Conclusions: The often unremarkable clinical presentation of NM necessitates physicians and patients to be wary of new or changing lesions. Dermoscopy may help increase suspicion in early NM because dermoscopic features are typically more suggestive of malignancy than clinical ones. We hope that secondary prevention efforts combined with prompt dermatologic consultations will allow for the timely diagnosis and management of NM. ©2010 American Medical Association. All rights reserved. Source

Ng J.C.,Monash University | Swain S.,Victorian Melanoma Service | Wolfe R.,Monash University | Simpson P.,Monash University | Kelly J.W.,Monash University
Archives of Dermatology | Year: 2010

Objective: To compare partial and excisional biopsy techniques in the accuracy of histopathologic diagnosis and microstaging of cutaneous melanoma. Design: Prospective case series. Setting: Tertiary referral, ambulatory care, institutional practice. Patients: Consecutive cases from 1995 to 2006. Interventions: Partial and excisional biopsy. Other factors considered were anatomic site, physician type at initial management, hypomelanosis, melanoma subtype, biopsy sample size, multiple biopsies, and tumor thickness. Main Outcome Measures: Histopathologic diagnosis (false-negative misdiagnosis - overall or with an adverse outcome - and false-positive misdiagnosis) and microstaging accuracy. Odds ratios (ORs) and 95% confidence intervals (CIs) obtained from multinomial logistic regression. Results: Increased odds of histopathologic misdiagnosis were associated with punch biopsy (OR, 16.6; 95% CI, 10-27) (P<.001) and shave biopsy (OR, 2.6; 95% CI, 1.2-5.7) (P=.02) compared with excisional biopsy. Punch biopsy was associated with increased odds of misdiagnosis with an adverse outcome (OR, 20; 95% CI, 10-41) (P<.001). Other factors associated with increased odds of misdiagnosis included acral lentiginous melanoma (OR, 5.1; 95% CI, 2-13) (P<.001), desmoplastic melanoma (OR, 3.8; 95% CI, 1.1-13.0) (P=.03), and nevoid melanoma (OR, 28.4; 95% CI, 7-115) (P<.001). Punch biopsy (OR, 5.1; 95% CI, 3.4-7.6) (P<.001) and shave biopsy (OR, 2.3; 95% CI, 1.5-3.6) (P<.001) had increased odds of microstaging inaccuracy over excisional biopsy. Tumor thickness was the most important determinant of microstaging inaccuracy when partial biopsy was used (odds of significant microstaging inaccuracy increased 1.8-fold for every 1mmincrease in tumor thickness; 95% CI, 1.4-2.4) (P<.001). Conclusions: Among melanoma seen at a tertiary referral center, histopathologic misdiagnosis is more common for melanomas that have been assessed with punch and shave biopsy than with excisional biopsy. Regardless of biopsy method, adverse outcomes due to misdiagnosis may occur. However, such adverse events are more commonly associated with punch biopsy than with shave and excisional biopsy. The use of punch and shave biopsy also leads to increased microstaging inaccuracy. ©2010 American Medical Association. All rights reserved. Source

Lin M.J.,Victorian Melanoma Service | Mar V.,Victorian Melanoma Service | Mar V.,Monash University | McLean C.,Victorian Melanoma Service | Kelly J.W.,Victorian Melanoma Service
Journal of the American Academy of Dermatology | Year: 2014

Background: To calculate melanoma rate of growth (ROG), previous studies have relied on subjective patient recall to estimate time delay to diagnosis. Objective: To objectively calculate ROG by measuring the rate of increase in melanoma thickness between 2 sequential biopsy specimens over time. Methods: This was a retrospective review of 51 melanomas in which pathologic misdiagnosis of a partial biopsy specimen caused a delay before referral and excisional biopsy between January 1998 and January 2013. ROG was calculated as rate of increase in tumor thickness between biopsy specimens. Results: The median delay between the 2 biopsy specimens was 27 months (range, 3-89 months). Biopsy specimens of melanomas that were obtained initially in their in situ phase were thinner at excision compared to those that were first obtained as invasive tumors (median, 0.7 vs. 3.2 mm; P<.01) and had a lower ROG (median, 0.04 vs. 0.11 mm/month; P = .05). Faster growth was associated with increased tumor thickness, higher mitotic rate, symptoms, elevation, and amelanosis. Limitations: Partial biopsy specimens may not be representative of deepest tumor thickness. Conclusion: We have demonstrated an objective measure of melanoma growth rate using sequential biopsy specimens. The correlation between faster growth and aggressive tumor features supports what others have found and validates the historical measure of growth rate as a reliable clinical marker. Source

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