Publications by authors named "Matthew J Lin"

35 Publications

Botulinum toxin improves forehead scars after Mohs surgery: a randomized, double-blinded, controlled study.

J Am Acad Dermatol 2021 Apr 10. Epub 2021 Apr 10.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.

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http://dx.doi.org/10.1016/j.jaad.2021.03.110DOI Listing
April 2021

Reply.

J Am Acad Dermatol 2021 Feb 4. Epub 2021 Feb 4.

private practice, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2021.02.002DOI Listing
February 2021

Brief Educational Video Improves Patient Understanding of Mohs Surgery: A Randomized Controlled Trial.

Dermatol Surg 2020 Dec 15;Publish Ahead of Print. Epub 2020 Dec 15.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Albany Medical College, Albany, New York.

Background: Patient's retention and recall of material discussed in a medical consultation is often inadequate.

Objective: To assess patient's knowledge, anxiety, and understanding of Mohs surgery after viewing a brief educational video.

Method: A prospective, investigator-blinded, randomized controlled trial of 120 consecutive patients before the first Mohs surgery procedure. Sixty subjects viewed an instructional video and 60 subjects did not. A survey was administered to both groups, measuring knowledge, anxiety, and understanding of Mohs surgery.

Results: The video group scored higher than the control group on the knowledge portion of the survey (median score 78% vs 56%, p < .01), but there were no differences in anxiety or understanding scores between groups. The percentage of subjects who answered each knowledge question correctly was greater in the video group than in the control group. In the subgroup of patients who had not previously had a consultation with a Mohs surgeon, the video group had higher median knowledge scores (67% vs 44%, p < .01), higher median understanding scores (8 vs 6, p = .05), and lower median visual analogue anxiety scores (4 vs 6, p = .01) compared with the control group.

Conclusion: A brief educational video increases patient's knowledge of Mohs surgery. For patients who have not yet had a consultation with a Mohs surgeon, the video may also reduce anxiety.
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http://dx.doi.org/10.1097/DSS.0000000000002843DOI Listing
December 2020

A Critical Role for Fas-Mediated Off-Target Tumor Killing in T-cell Immunotherapy.

Cancer Discov 2021 Mar 17;11(3):599-613. Epub 2020 Dec 17.

Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.

T cell-based therapies have induced cancer remissions, though most tumors ultimately progress, reflecting inherent or acquired resistance including antigen escape. Better understanding of how T cells eliminate tumors will help decipher resistance mechanisms. We used a CRISPR/Cas9 screen and identified a necessary role for Fas-FasL in antigen-specific T-cell killing. We also found that Fas-FasL mediated off-target "bystander" killing of antigen-negative tumor cells. This localized bystander cytotoxicity enhanced clearance of antigen-heterogeneous tumors , a finding that has not been shown previously. Fas-mediated on-target and bystander killing was reproduced in chimeric antigen receptor (CAR-T) and bispecific antibody T-cell models and was augmented by inhibiting regulators of Fas signaling. Tumoral expression alone predicted survival of CAR-T-treated patients in a large clinical trial (NCT02348216). These data suggest strategies to prevent immune escape by targeting both the antigen expression of most tumor cells and the geography of antigen-loss variants. SIGNIFICANCE: This study demonstrates the first report of Fas-dependent bystander killing of antigen-negative tumors by T cells, a phenomenon that may be contributing to the high response rates of antigen-directed immunotherapies despite tumoral heterogeneity. Small molecules that target the Fas pathway may potentiate this mechanism to prevent cancer relapse..
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http://dx.doi.org/10.1158/2159-8290.CD-20-0756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933082PMC
March 2021

Intraoperative Electrosurgical Depilation of a Skin Graft.

J Cutan Aesthet Surg 2020 Jul-Sep;13(3):257-258

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, USA.

Full-thickness skin grafts harvested from hair-bearing areas may negatively impact cosmetic outcomes if the recipient site is hairless. Intraoperative depilation of unwanted hair follicles using an electrosurgical device can permanently remove hair with a single treatment and improve overall cosmesis.
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http://dx.doi.org/10.4103/JCAS.JCAS_31_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646417PMC
November 2020

Basal cell nevus syndrome: From DNA to therapeutics.

Clin Dermatol 2020 Jul - Aug;38(4):467-476. Epub 2020 Mar 25.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Basal cell nevus syndrome, also known as Gorlin syndrome, is a hereditary cancer syndrome associated with multiple basal cell carcinomas, congenital defects, and nondermatologic tumors. This disease is autosomal dominant with variable expressivity and is caused by abnormalities in the sonic hedgehog signaling pathway. Management requires a multidisciplinary approach and should include the biopsychosocial needs of patients and their families. Genetic testing is necessary to confirm an unclear diagnosis, evaluate at-risk relatives, and assist with family planning.
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http://dx.doi.org/10.1016/j.clindermatol.2020.03.003DOI Listing
October 2020

Botulinum Toxin for Paramedian Interpolated Forehead Flaps.

J Cutan Aesthet Surg 2020 Apr-Jun;13(2):170-172

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

The forehead skin closely resembles the texture and color of the midface region. As such, the use of a paramedian forehead flap to repair a midface defect provides optimal cosmesis; however, the donor forehead site may be left with an undesirable scar in a highly visible region of the face. Cutaneous surgeons possess a variety of traditional techniques intended to minimize scarring. We have found that the addition of 50 units of botulinum toxin at the time of wound closure has improved scar outcomes for patients undergoing reconstruction with paramedian interpolated flaps. Possible mechanisms for the efficacy of botulinum toxin lie in its ability to chemically paralyze the frontalis muscle and glabella complex. This immobilization leads to a reduction in unwanted wound tension during the most vulnerable first few days of healing.
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http://dx.doi.org/10.4103/JCAS.JCAS_56_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394119PMC
August 2020

Polydioxanone Threads for Atrophic Neck Scars.

Dermatol Surg 2020 Aug 5. Epub 2020 Aug 5.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002535DOI Listing
August 2020

The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial.

J Am Acad Dermatol 2020 Nov 7;83(5):1294-1297. Epub 2020 Jul 7.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: Platelet-rich plasma (PRP) may be a useful treatment for androgenetic alopecia (AGA), although objective studies are needed.

Objective: To determine whether PRP injections improve female AGA.

Method: Prospective randomized controlled trial of 30 women diagnosed with AGA. Patients received subdermal scalp injections of Eclipse system PRP or placebo saline at weeks 0, 4, and 8. Outcome measures were changes in hair density (hair/cm), hair caliber (mm), and blinded global photographic assessment (improved or not improved) at week 24.

Results: Blinded global photographic assessment indicated that 57% of patients receiving PRP versus 7% of patients receiving saline improved at week 24 from baseline (P < .01). Compared to baseline, there was improvement in mean density in the PRP group versus the placebo group at week 8 (+71.1 vs -26.7 hairs/cm; P < .01) and week 24 (+105.9 vs -52.4 hairs/cm; P < .01). Compared to baseline, there was improvement in mean caliber in the PRP group versus the placebo group at week 8 (+0.0043 vs -0.0034 mm; P < .01) and week 24 (+0.0053 vs -0.0060 mm; P < .01). Adverse effects included headache, scalp tightness, swelling, redness, and postinjection bleeding.

Limitations: Two patients lost to follow-up.

Conclusions: PRP with the Eclipse system is a safe and effective intervention for female AGA.
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http://dx.doi.org/10.1016/j.jaad.2020.06.1021DOI Listing
November 2020

Poly-l-Lactic Acid Preinjection Aspiration as a Safety Checkpoint.

Dermatol Surg 2021 Apr;47(4):576-577

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002450DOI Listing
April 2021

Antibiotic Practices in Mohs Micrographic Surgery.

J Drugs Dermatol 2020 May;19(5):493-497

Background: Mohs micrographic surgery is a safe procedure with low rates of infection.

Objective: To establish current antibiotic prescribing practices amongst Mohs surgeons.

Methods And Materials: 16-question survey sent to American College of Mohs Surgery members.

Results: 305 respondents with collectively 7,634+ years of experience. The majority performed outpatient surgery (95.0%) and avoided oral or topical antibiotics for routine cases (67.7% and 62.8%, respectively). Prophylactic antibiotics were routinely prescribed for artificial cardiac valves (69.4%), anogenital surgery (53.0%), wedge excision (42.2%), artificial joints (41.0%), extensive inflammatory skin disease (40.1%), immunosuppression (38.9%), skin grafts (36.4%), leg surgery (34.2%), and nasal flaps (30.1%). A minority consistently swabbed the nares to check for staphylococcus aureus carriage (26.7%) and decolonized carriers prior to surgery (28.0%).

Conclusion: Disparity exists in antibiotic prescribing practices amongst Mohs surgeons. There may be under-prescription of antibiotics for high risk factors like nasal flaps, wedge excisions, skin grafts, anogenital/lower extremity site, and extensive inflammatory disease. Conversely, there may be over-prescription for prosthetic joints or cardiac valves. Increased guideline awareness may reduce post-operative infections and costs/side effects from antibiotic over-prescription. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4695.
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May 2020

The Impact of Submental Deoxycholic Acid Injections on Neck Surgery

J Drugs Dermatol 2019 Dec;18(12):1281

Non-invasive procedures targeting the submental fat or “double chin” have undergone a surge in popularity. Injections of deoxycholic acid, a secondary bile acid, have recently received FDA-approval for fat reduction in this area. With appropriate patient selection, this preparation of 10 mg/mL of sodium deoxycholate (Kybella®, Kythera Biopharmaceuticals, Westlake Village, CA) leads to aesthetic improvement of moderate-to-severe convexity or fullness associated with submental fat in adults.
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December 2019

Methacrylate Polymer Powder Dressing for a Nasal Surgical Defect

J Drugs Dermatol 2019 Dec;18(12):1274-1275

The fusion of technology and medicine has led to the advent of advanced wound healing techniques that may be adapted to the management of surgical defects. Shortened duration of healing and ease-of-use are two potential benefits under investigation. Here we describe a 65-year-old male with a nasal alar wound that was allowed to heal with secondary intention, assisted by a novel methacrylate polymer powder dressing. J Drugs Dermatol. 2019;18(12):1274-1275.
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December 2019

Management of Pearly Penile Papules: A Review of the Literature.

J Cutan Med Surg 2020 Jan/Feb;24(1):79-85. Epub 2019 Nov 5.

5925 Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.
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http://dx.doi.org/10.1177/1203475419887730DOI Listing
November 2020

The potential role of cannabinoids in dermatology.

J Dermatolog Treat 2020 Dec 10;31(8):839-845. Epub 2019 Oct 10.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Cannabis is increasingly being used world-wide to treat a variety of dermatological conditions. Medicinal cannabis is currently legalized in Canada, 31 states in America and 19 countries in Europe. The authors reviewed the literature on the pharmacology and use of cannabinoids in treating a variety of skin conditions including acne, atopic dermatitis, psoriasis, skin cancer, pruritus, and pain. Cannabinoids have demonstrated anti-inflammatory, antipruritic, anti-ageing, and antimalignancy properties by various mechanisms including interacting with the newly found endocannabinoid system of the skin thereby providing a promising alternative to traditional treatments.
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http://dx.doi.org/10.1080/09546634.2019.1675854DOI Listing
December 2020

Practices in the Usage and Reconstitution of Poly-L-Lactic Acid

J Drugs Dermatol 2019 Sep;18(9):880-886

BACKGROUND: Poly-L-lactic acid (PLLA) is increasingly used for a range of indications, from HIV lipodystrophy to gluteal augmentation; however, there is no clear consensus on appropriate product preparation and use. OBJECTIVE: To establish current practices for PLLA reconstitution and usage in the USA. METHODS AND MATERIALS: A 19-question survey pertaining to the reconstitution and use of PLLA was distributed to members of the American Board of Cosmetic Surgery and American Board of Facial Cosmetic Surgery and at several cosmetic conferences. 410 questionnaires were returned anonymously over a 3-month period. The results were collated and analyzed. RESULTS: The commonest indication for PLLA was HIV lipodystrophy (46.8%), followed by gluteal augmentation (42.4%). For the face, the majority used a dilution of 9-10 mL (60.4%). For the gluteal region, the majority used a dilution greater than 21 mL (51.3%). Most respondents reconstituted PLLA in sterile water (59.8%) more than 21 hours before use (51.0%) and added lidocaine to the solution (94.7%). Most physicians used topical anesthetic cream (83.2%), manual agitation (85.8%) and recommended self-massage post-treatment (99.6%). CONCLUSION: There is considerable variation in PLLA reconstitution and use. Further well-designed studies are needed to establish the safest, most effective ways to use this product. J Drugs Dermatol. 2019;18(9):880-886.
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September 2019

Response to Commentary on Intralesional Deoxycholic Acid as a Neoadjuvant Treatment of a Large Lipoma.

Dermatol Surg 2020 05;46(5):718-719

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002136DOI Listing
May 2020

Presurgical Curettage Improves Accuracy for Nonmelanoma Skin Cancer Excision.

J Cutan Med Surg 2019 Nov/Dec;23(6):617-623. Epub 2019 Aug 17.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions.

Objective: To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size.

Materials And Methods: One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary.

Results: Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas.

Conclusion: Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.
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http://dx.doi.org/10.1177/1203475419871048DOI Listing
August 2020

Acellular Porcine Transitional Cell Matrix Xenograft for Genital Wounds.

Dermatol Surg 2020 09;46(9):1245-1246

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002096DOI Listing
September 2020

Nitrous Oxide Reduces Pain Associated With Local Anesthetic Injections.

J Cutan Med Surg 2019 Nov/Dec;23(6):602-607. Epub 2019 Aug 12.

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Local anesthetic injections can be painful and distressing.

Objective: The aim of this study was to determine whether nitrous oxide, ice, vibration, or topical anesthetic improves analgesia for local anesthetic injections.

Method: A cohort study of 400 patients undergoing Mohs micrographic surgery with local anesthetic was conducted. Patients received no intervention ( = 200), ice ( = 50), topical anesthetic cream ( 50), vibration device ( = 50), or nitrous oxide ( = 50). Pain was rated using the Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale.

Results: Without intervention, mean VAS was 4.2 and FACES was 4.6. Nitrous oxide was the most successful in reducing pain (mean VAS 1.6 vs. 4.2, < .01, FACES 1.2 vs. 4.6, < .01). Topical ice reduced pain (mean VAS 3.0 vs. 4.2, < .01, FACES 3.0 vs. 4.6, < .01). Vibration reduced pain (mean VAS 3.5 vs. 4.2, < .01, FACES 3.6 vs. 4.6, < .01). Higher pain scores were associated with age <50 ( = .02), male sex ( = .05), and surgery on the nose, lip, ear, or eyelid ( = .02).

Conclusion: Nitrous oxide, ice, and vibration reduce injection pain. These interventions are especially useful for younger males undergoing surgery on the nose, lip, ear, or eyelid.
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http://dx.doi.org/10.1177/1203475419867606DOI Listing
August 2020

Intralesional Deoxycholic Acid as Neoadjuvant Treatment of a Large Lipoma.

Dermatol Surg 2020 05;46(5):715-717

Division of Dermatologic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000002034DOI Listing
May 2020

Disseminated cutaneous-only histoplasmosis in a patient with AIDS.

Australas J Dermatol 2019 Nov 28;60(4):e330-e332. Epub 2019 Jun 28.

The Alfred Hospital, Prahran, Victoria, Australia.

Histoplasmosis is an opportunistic fungal infection that occurs predominantly in immunocompromised patients. Cutaneous lesions in histoplasmosis are rare and typically occur in the absence of extra-cutaneous manifestations. We present a rare case of disseminated cutaneous-only histoplasmosis in a patient with recently diagnosed AIDS.
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http://dx.doi.org/10.1111/ajd.13108DOI Listing
November 2019

Poly-L-Lactic Acid for Minimally Invasive Gluteal Augmentation.

Dermatol Surg 2020 03;46(3):386-394

Division of Dermatologic and Cosmetic Surgery, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: There is increased emphasis on the importance of the gluteal region in the perception of beauty. Biodegradable fillers provide a nonsurgical method of augmenting and rejuvenating this area.

Objective: To review pertinent aspects of anatomy, patient evaluation, injection technique, and complications for gluteal augmentation using injectable biodegradable fillers.

Methods: The authors review the literature for poly-L-lactic acid-based gluteal augmentation.

Results: Like many aesthetic procedures, there is a paucity of literature on this emerging treatment modality (Level 4, Centre for Evidence-Based Medicine, Oxford). However, the collective clinical experience is that poly-L-lactic acid fillers are an effective treatment for patients seeking noninvasive gluteal enhancement with minimal downtime. Physicians must understand gluteal anatomy and avoid injecting deeply in the danger triangle to prevent intravascular injection into the gluteal vessels or injury to the sciatic nerve. Other safety elements include the use of blunt cannulas, reduced pressures, smaller volumes, and retrograde delivery.

Conclusion: Gluteal augmentation with fillers can safely and effectively improve gluteal firmness, shape, proportion, and projection. Practitioners injecting fillers in the gluteal region must be aware of appropriate patient selection, regional anatomy, and safe injection techniques. Given the increasing demand for this procedure, further high-quality studies are needed.
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http://dx.doi.org/10.1097/DSS.0000000000001967DOI Listing
March 2020

Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition.

Australas J Dermatol 2019 Nov 6;60(4):278-283. Epub 2019 Jun 6.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.

Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.
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http://dx.doi.org/10.1111/ajd.13090DOI Listing
November 2019

Acellular porcine transitional cell matrix xenograft for surgical defects.

Australas J Dermatol 2019 Nov 22;60(4):e345-e346. Epub 2019 May 22.

Division of Dermatologic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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http://dx.doi.org/10.1111/ajd.13080DOI Listing
November 2019

Dermoscopy improves diagnostic accuracy for clinically amelanotic nodules.

Australas J Dermatol 2019 Feb 19;60(1):45-49. Epub 2018 Aug 19.

Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.

Background/objectives: Amelanotic nodular melanomas are notoriously difficult to diagnose and are responsible for a disproportionate burden of melanoma mortality. It is important to distinguish them from other amelanotic nodules. This study aimed to describe the dermoscopic features of a series of nodular melanomas and other amelanotic nodules and to determine whether dermoscopy improves diagnostic accuracy.

Method: Retrospective analysis of 150 clinically amelanotic nodules with macroscopic and dermoscopic images.

Results: In terms of classifying the nodules as malignant, dermoscopy was superior to unaided eye (specificity 89%; 95% CI 71-98% vs 67%; 95% CI 46-83%, P = 0.03). Dermoscopy enhanced sensitivity for the diagnosis of both amelanotic melanoma and SCC. In 19% of cases, using dermoscopy, the most likely diagnosis was changed from incorrect to correct. This included 26% of amelanotic melanomas which had a macroscopic misdiagnosis overturned to the correct diagnosis. Polymorphous vascular structures were more common in malignant nodules. 76% of amelanotic melanomas/Merkel cell carcinomas had polymorphous vessels compared with 38% of SCCs/KAs/BCCs and 22% of benign nodules (P < 0.001).

Conclusion: Dermoscopy improves diagnostic accuracy for amelanotic melanomas and other amelanotic nodules. Although dermoscopy improves diagnostic accuracy for amelanotic melanomas, these aggressive melanomas remain diagnostically difficult.
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http://dx.doi.org/10.1111/ajd.12902DOI Listing
February 2019

Fluconazole-induced Sweet's syndrome: A novel association.

Australas J Dermatol 2018 May 11;59(2):e160-e161. Epub 2017 Sep 11.

Department of Dermatology, Alfred Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ajd.12709DOI Listing
May 2018

Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy.

J Am Acad Dermatol 2016 Jan 23;74(1):102-7. Epub 2015 Oct 23.

Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.

Objective: We sought to better understand the role of wide local excision (WLE) in the treatment of cutaneous melanoma by analyzing residual or locally metastatic disease in WLE specimens of melanomas initially diagnosed with a complete excisional biopsy.

Methods: This was a retrospective review of 807 consecutive WLEs of melanomas diagnosed after complete excisional biopsy. All specimens were reviewed by a single dermatopathologist. Risk of residual or locally metastatic disease was analyzed using univariate and multivariate logistic regression models.

Results: In the 807 WLE specimens, further melanoma was found in 34 cases (4.2%; 95% confidence interval [CI] 2.9-5.8). Residual primary melanoma was found in 33 of these. On univariate analysis, features associated with residual or locally metastatic disease were histologic subtype (odds ratio 3.0; 95% CI 1.3-7.1, P = .01) and tumor location (odds ratio 7.3; 95% CI 2.0-26.6, P < .01). On multivariate analysis, lentigo maligna was independently associated with melanoma remaining in WLE specimens (odds ratio 2.7; 95% CI 1.0-7.3, P = .04).

Conclusion: Residual melanoma in WLE specimens after histologically assessed complete excisional biopsy is not uncommon. Patients with lentigo maligna subtype melanomas are most at risk. Our findings indicate that the procedure of WLE is most important therapeutically for its role in controlling the primary tumor, rather than in preventing local metastatic recurrence.
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http://dx.doi.org/10.1016/j.jaad.2015.08.065DOI Listing
January 2016

An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma.

Australas J Dermatol 2016 May 12;57(2):97-101. Epub 2015 Nov 12.

Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.

Background: Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed.

Methods: A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed.

Results: Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found.

Conclusions: NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.
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http://dx.doi.org/10.1111/ajd.12416DOI Listing
May 2016

Letter to the editor.

Australas J Dermatol 2015 Feb;56(1):66

Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ajd.12234DOI Listing
February 2015