Publications by authors named "Rosalie Elenitsas"

134 Publications

Age and Mitogenicity are Important Predictors of Sentinel Lymph Node Metastasis in T1a Melanoma.

Ann Surg Oncol 2021 Apr 8. Epub 2021 Apr 8.

Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

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http://dx.doi.org/10.1245/s10434-021-09929-5DOI Listing
April 2021

Perforating and granulomatous exogenous ochronosis.

J Cutan Pathol 2021 Jan 20. Epub 2021 Jan 20.

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13807DOI Listing
January 2021

Cutaneous follicular mucinous nevus presenting with congenital grouped papules and plaques initially misdiagnosed as a cutaneous myxoma.

J Cutan Pathol 2021 Jan;48(1):1-5

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13701DOI Listing
January 2021

Nail Unit Schwannoma: An Important Consideration in the Differential Diagnosis of Soft Tissue Tumors Affecting the Nail Apparatus.

Skin Appendage Disord 2020 Nov 14;6(6):370-373. Epub 2020 Aug 14.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Schwannoma is a tumor of schwann cell proliferation which presents as a solitary, soft, skin-colored dermal or subcutaneous papulo-nodule most commonly on the flexor part of extremities and head and neck areas. Here, we report a case of nail unit schwannoma, which is a rare tumor of the nail apparatus with only 4 other prior reports in the literature. This case illustrates the importance of including subungual schwannoma in the clinical differential diagnosis of subungual soft tissue tumors. We include a literature review which catalogs and summarizes the current knowledge regarding this unusual nail unit neoplasm.
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http://dx.doi.org/10.1159/000509041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706483PMC
November 2020

A progressive, diffuse atrophic and dyspigmented eruption.

Pediatr Dermatol 2020 Nov;37(6):1153-1155

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1111/pde.14345DOI Listing
November 2020

Persistent Agminated CD30+ Lymphoproliferative Disorder.

J Drugs Dermatol 2020 10;19(10):1005-1007

Lymphomatoid papulosis (LyP) is a chronic skin condition, characterized by recurrent eruptions of papules and nodules with or without central necrosis that spontaneously resolve. This condition was originally described by Macaulay in 1968 as a self-healing rhythmical paradoxical eruption that was clinically benign yet histologically malignant.1 Clinically, it is defined by papules that wax and wane, are generally less than 1cm in diameter, and heal spontaneously after 6–8 weeks with subsequent scarring.2
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October 2020

CD30-positive atypical lymphocytes in perniosis: a potential diagnostic pitfall in a benign inflammatory dermatosis.

J Cutan Pathol 2020 09;47(9):781-784

Department of Dermatology, University of Pennsylvania, Philadelphia, PA.

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http://dx.doi.org/10.1111/cup.13697DOI Listing
September 2020

Hypohidrosis as an immune-related adverse event of checkpoint inhibitor therapy.

Immunotherapy 2020 Sep 10;12(13):951-956. Epub 2020 Aug 10.

Department of Dermatology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.

Immune checkpoint blockade therapies including cytotoxic-T-lymphocyte antigen 4 (CTLA-4) and programmed cell death protein-1 (PD-1) inhibitors have become indispensable tools for treating melanoma and other cancers. An increasing number of diverse cutaneous adverse reactions to immunotherapy have been documented in the literature and have been reported to affect up to 40% of patients treated with targeted therapies. Herein, we report a case of a patient with metastatic melanoma treated with checkpoint inhibitor therapy who developed vitiligo, gastritis and hepatitis, all identified as adverse immune events and attributable to his immunotherapy regimen. He subsequently developed acquired idiopathic generalized hypohidrosis with biopsy of lesional skin demonstrating a peri-eccrine lymphocytic infiltrate. These findings suggest this acquired generalized hypohidrosis represents a lymphocyte-mediated adverse immune event related to this patient's checkpoint inhibitor therapy.
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http://dx.doi.org/10.2217/imt-2020-0002DOI Listing
September 2020

A solitary, firm, growing pink papule on the back of an infant.

Pediatr Dermatol 2020 07;37(4):e37-e39

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

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http://dx.doi.org/10.1111/pde.14190DOI Listing
July 2020

Urethral involvement is associated with higher mortality and local recurrence in vulvar melanoma: a single institutional experience.

Hum Pathol 2020 10 20;104:1-8. Epub 2020 Jul 20.

Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. Electronic address:

Vulvar malignant melanoma (VMM), although uncommon, comprises 5-10% of all vulvar malignancies. Local control is notoriously poor in VMM with recurrence rates of 30-50% compared with approximately 3% in cutaneous melanomas. We studied clinicopathologic features of 37 women with VMM, after reviewing three decades of clinical follow-up data in our institutional databases. Most patients were Caucasian (n = 35) with an average age at diagnosis of 60.6 years (range 23-83). The most common subtype was mucosal lentiginous melanoma (n = 25). We compared Kaplan-Meier survival curves of 31 patients defined by clinical and microscopic attributes using exact log-rank tests. Younger patients at diagnosis (23-64 years), those with thin melanomas (≤1 mm), and those with Clark's level II or III tumors had better 5-year survival rates than older patients (65-83 years) and those with thick melanomas (>1 mm) and those with Clark's level IV or V (P ≤ 0.05), respectively, by exact log-rank test. Local recurrence of melanoma occurred in 15 patients. Nine patients (24%) had eventual urethral involvement by malignant melanoma, and this feature was associated with significantly shorter survival (P = 0.036). Patients with urethral involvement had shorter median time to death and worse 5-year survival rates. Given that spread to the urethra is common in VMM and urethral recurrence is also associated with mortality, pathology excision specimens should be carefully reviewed with attention to urethral involvement as a potentially important prognostic factor.
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http://dx.doi.org/10.1016/j.humpath.2020.07.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669565PMC
October 2020

Histologic features of melanoma associated with germline mutations of CDKN2A, CDK4, and POT1 in melanoma-prone families from the United States, Italy, and Spain.

J Am Acad Dermatol 2020 Sep 10;83(3):860-869. Epub 2020 Apr 10.

Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.

Background: CDKN2A, CDK4, and POT1 are well-established melanoma-susceptibility genes.

Objective: We evaluated melanoma histopathology for individuals with germline mutations of CDKN2A, CDK4, and POT1.

Methods: We assessed histopathology for melanomas diagnosed in melanoma-prone families (≥2 individuals with melanoma) from the United States, Italy, and Spain. Comparisons between mutation carriers and noncarriers (no mutation) were adjusted for age, sex, Breslow depth, and correlations among individuals within the same family.

Results: Histologic slides were evaluated for 290 melanomas (139 from 132 noncarriers, 122 from 68 CDKN2A carriers, 10 from 6 CDK4 carriers, and 19 from 16 POT1 carriers). Superficial spreading was the predominant subtype for all groups. Spitzoid morphology (>25% of tumor) was observed in 10 of 15 invasive melanomas (67%) from POT1 carriers (P < .0001 vs noncarriers). This finding was independently confirmed by 3 expert melanoma dermatopathologists in 9 of 15 invasive melanomas (60%). In situ and invasive melanomas from CDKN2A and CDK4 carriers were histologically similar to melanomas from noncarriers.

Limitations: Limited sample sizes for rare melanoma-susceptibility syndromes (CDK4, POT1).

Conclusion: Spitzoid morphology was associated with POT1 mutations suggesting that telomere dysfunction (POT1 mutations) may contribute to spitzoid differentiation in melanocytic tumors.
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http://dx.doi.org/10.1016/j.jaad.2020.03.100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505133PMC
September 2020

A photo-distributed papulopustular eruption and multiple squamous cell carcinomas in a patient on ruxolitinib.

JAAD Case Rep 2019 Oct 22;5(10):895-897. Epub 2019 Oct 22.

Department of Dermatology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jdcr.2019.06.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818392PMC
October 2019

There is fat in this sclerosis: A case report of sclerotic lipoma and review of the literature.

J Cutan Pathol 2020 Mar 29;47(3):286-290. Epub 2019 Oct 29.

Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Sclerotic lipomas, a lipoma variant, are benign subcutaneous tumors, so-named because of their resemblance to sclerotic fibromas. Previous literature has suggested that these tumors may show a predilection for middle-aged adult males. We report an unusual case of a sclerotic lipoma diagnosed on the scalp of a 66-year-old female. The patient presented to the outpatient clinic with a 3- to 4-year history of an enlarging and irritated 2.6-cm nodule on the anterior crown of the scalp, clinically thought to be a pilar cyst. Histopathological examination from the excisional specimen revealed a well-circumscribed dermal to subcutaneous tumor with ample sclerotic collagen bundles, an increased number of CD34 positive spindled cells, and prominent S-100 positive mature adipocytes comprising greater than 50% of the tumor. We present this case given its atypical clinical and histopathological presentation, review the literature of sclerotic lipomas, and discuss the differential diagnosis to raise awareness of this rare entity.
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http://dx.doi.org/10.1111/cup.13593DOI Listing
March 2020

Launching lollipops? Perforating osteoma cutis in nephrogenic systemic fibrosis.

J Cutan Pathol 2019 Jul;46(7):467-470

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13409DOI Listing
July 2019

Follicular induction and CK20+ Merkel cells overlying cutaneous focal mucinosis.

J Cutan Pathol 2019 Mar 14;46(3):195-198. Epub 2019 Jan 14.

Department of Dermatology, Division of Dermatopathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Cutaneous focal mucinosis (CFM) or focal dermal mucinosis is a benign reactive process categorized as a primary mucinosis. Skin biopsy is essential for diagnosis, as the clinical appearance is often non-specific. Follicular induction is a phenomenon whereby the epidermis is induced by an underlying process to form primitive or mature hair follicles, and is commonly seen overlying dermatofibromas. Follicular induction has been rarely described in CFM.

Methods: We performed a retrospective histological review of lesions of CFM confirmed by skin biopsy from 2010 to 2015 in our department.

Results: We found that 11% (11/98) of CFM lesions showed follicular induction. Cytokeratin 20 (CK20) immunostaining was performed on all 11 of these biopsies that showed follicular induction and highlighted an increased density of CK20+ Merkel cells within the basaloid epidermal proliferations.

Conclusion: As superficial basal cell carcinomas (BCC) often show a mucinous stroma around the basaloid islands, CFM with follicular induction may closely mimic a BCC histologically, particularly in superficial shave biopsies. Therefore, it is important that dermatopathologists be aware of this phenomenon. Furthermore, CK20+ staining within the basaloid epithelial proliferations may be helpful in differentiating CFM with follicular induction from a BCC.
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http://dx.doi.org/10.1111/cup.13402DOI Listing
March 2019

NRAS Q61R and BRAF G466A mutations in atypical melanocytic lesions newly arising in advanced melanoma patients treated with vemurafenib.

J Cutan Pathol 2019 Mar 27;46(3):190-194. Epub 2018 Dec 27.

Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: BRAF inhibition has improved overall survival in patients with BRAF mutant melanoma, but this is associated with a range of known and predictable cutaneous side effects, including squamous cell carcinomas associated with RAS mutations.

Methods: We identified three severely dysplastic nevi, one atypical intraepidermal melanocytic proliferation, and four melanoma in situ lesions, newly arising in four patients undergoing treatment with vemurafenib. To characterize mutations in these atypical melanocytic lesions, we used a custom iPlex panel detecting 74 mutations in 13 genes known to play a role in melanoma pathogenesis.

Results: We identified an NRAS mutation at codon 61 (Q61R) and a rare BRAF exon 11 mutation (G466A) in atypical melanocytic lesions that arose in patients treated with vemurafenib.

Conclusion: There appears to be development or accelerated growth of atypical melanocytic lesions in the setting of BRAF inhibition. Our results underscore the need for careful surveillance for melanocytic lesions in patients on BRAF inhibitor therapy and shed light on potential mechanisms for melanoma pathogenesis in the context of BRAF pathway blockade. Further studies are warranted to show a causal relationship.
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http://dx.doi.org/10.1111/cup.13401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367041PMC
March 2019

An atypical case of papular necrobiosis lipoidica masquerading as sarcoidosis.

JAAD Case Rep 2018 Sep 14;4(8):802-804. Epub 2018 Sep 14.

Department of Dermatology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jdcr.2018.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141674PMC
September 2018

MART-1-labeled melanocyte density and distribution in actinic keratosis and squamous cell cancer in situ: Pagetoid melanocytes are a potential source of misdiagnosis as melanoma in situ.

J Cutan Pathol 2018 Oct 31;45(10):734-742. Epub 2018 Jul 31.

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Actinic keratosis (AK) and squamous cell carcinoma in-situ (SCCIS) within or near melanoma in situ (MIS) can complicate diagnosis due to overlapping clinical and microscopic features. This study aimed to describe basilar melanocyte density and pagetoid spread in AK and SCCIS for improved diagnostic accuracy.

Methods: A total of 22 AK and 22 SCCIS biopsies containing a margin of uninvolved epidermis were immunostained with MART-1 (melanoma antigen recognized by T-cells 1). The basilar melanocyte:keratinocyte ratio and the number and distribution of pagetoid melanocytes were compared in AK, SCCIS, and uninvolved epidermis. An in-vitro human skin model was created to assess the impact of keratinocyte atypia on melanocyte distribution.

Results: The median basilar melanocyte:keratinocyte ratio in SCCIS (1:11.49) was lower than in uninvolved epidermis (1:5.59, P = 0.0011), and the ratio in AK (1:6.94) was similar to uninvolved epidermis (P = 0.987). Pagetoid melanocytes were absent in perilesional skin but common in AK (21/22, P < 0.0001) and SCCIS (22/22, P < 0.0001). Pagetoid melanocytes at or above the mid-spinous layer were more common in SCCIS (21/22) vs AK (7/22, P < 0.0001). Pagetoid melanocytes were present in the in-vitro skin model made with neoplastic but not normal keratinocytes.

Conclusions: Pagetoid melanocytes in AK and SCCIS should be interpreted with caution to avoid overdiagnosis of MIS.
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http://dx.doi.org/10.1111/cup.13309DOI Listing
October 2018

Role of high-throughput sequencing in the diagnosis of cutaneous T-cell lymphoma.

J Clin Pathol 2018 Sep 10;71(9):814-820. Epub 2018 Apr 10.

Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Aims: Substantial clinicopathological overlap exists between cutaneous T-cell lymphoma (CTCL) and benign conditions, leading to diagnostic difficulties. We sought to delineate the utility of high-throughput sequencing (HTS) across a spectrum of histological findings in CTCL and reactive mimics.

Methods: One hundred skin biopsies obtained for clinical concern for CTCL were identified, comprising 25 cases each from four histological categories: 'definitive CTCL', 'atypical lymphoid infiltrate, concerning for CTCL', 'atypical lymphoid infiltrate, favour reactive' or 'reactive lymphoid infiltrate'. T-cell receptor gamma chain gene (TRG) PCR and T-cell receptor beta chain gene HTS were performed on both skin biopsy and concurrently collected peripheral blood; most peripheral blood samples were also analysed by flow cytometry.

Results: Histologically defined CTCL specimens had significantly higher clonality scores and T-cell fractions via HTS than all other groups (all p<0.002 and p<0.03, respectively). HTS was more diagnostically specific than TRG PCR in skin (100% vs 88%), while diagnostic sensitivity (68% vs 72%) and accuracy (84% vs 80%) were similar. TRG PCR and flow cytometry performed on blood were the least diagnostically useful assays. Some identically sized peaks detected by TRG PCR in concurrent skin and peripheral blood specimens were non-identical by HTS analysis.

Conclusions: HTS, by assessing both clonality and T-cell fractions in skin biopsies, is a powerful tool to aid in the diagnosis of CTCL. It is more specific than TRG PCR in distinguishing definitive CTCL from reactive and indeterminate histology. Identically sized peaks by TRG PCR, typically interpreted to be clonally related, are not always clonally identical by sequencing.
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http://dx.doi.org/10.1136/jclinpath-2018-205004DOI Listing
September 2018

Angiomatoid and desmoplastic Spitz nevus presenting as a keloidal nodule.

Pediatr Dermatol 2018 Jul 26;35(4):e228-e230. Epub 2018 Mar 26.

Department of Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Angiomatoid and desmoplastic Spitz nevi are rare histologic variants of Spitz nevi that present most frequently on the extremities of children and young adults. Although Spitz nevi are clinically heterogeneous, one presenting as a keloidal nodule has not been previously published. We present a case of an angiomatoid and desmoplastic Spitz nevus clinically akin to a keloid on an African-American teenager and describe its unique histopathologic features.
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http://dx.doi.org/10.1111/pde.13479DOI Listing
July 2018

Surreptitious apple cider vinegar treatment of a melanocytic nevus: Newly described histologic features.

J Cutan Pathol 2018 04 2;45(4):307-309. Epub 2018 Feb 2.

Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/cup.13102DOI Listing
April 2018

Conjunctivitis, mucosal erosions, and moist cutaneous plaques.

JAAD Case Rep 2018 Mar 12;4(2):117-119. Epub 2018 Jan 12.

Department of Medicine, Section of Dermatology, Pritzker School of Medicine at the University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.1016/j.jdcr.2017.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767905PMC
March 2018

Lupus-like cutaneous reaction following pembrolizumab: An immune-related adverse event associated with anti-PD-1 therapy.

J Cutan Pathol 2018 Jan 10;45(1):74-77. Epub 2017 Nov 10.

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

PD-1 (programmed cell death-1) inhibitors, used to treat metastatic melanoma and other malignancies, are associated with development of immune-related adverse events in the skin. Such reactions include morbilliform eruptions, vitiligo, alopecia areata and bullous pemphigoid. In this report, we describe a patient who developed a lupus-like cutaneous reaction in the setting of pembrolizumab therapy for metastatic melanoma, adding to the spectrum of reactions which may be observed in association with PD-1 inhibitor therapy.
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http://dx.doi.org/10.1111/cup.13059DOI Listing
January 2018

Cutaneous Metastases of Melanoma Mimicking Interstitial Granulomatous Processes.

Am J Dermatopathol 2018 09;40(9):706-707

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

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http://dx.doi.org/10.1097/DAD.0000000000000996DOI Listing
September 2018

Reply to: "Statistical and methodological issues".

J Am Acad Dermatol 2017 10;77(4):e115-e116

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jaad.2017.05.030DOI Listing
October 2017

Risk factors for positive or equivocal margins after wide local excision of 1345 cutaneous melanomas.

J Am Acad Dermatol 2017 Aug;77(2):333-340.e1

Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.

Background: Positive or equivocal margins after wide local excision (WLE) complicate surgical management of cutaneous melanoma.

Objective: To identify the frequency of and risk factors for positive or equivocal margins after WLE of cutaneous melanoma.

Methods: Retrospective, single-center, cross-sectional study of 1345 consecutive melanomas treated with WLE.

Results: The overall frequency of positive or equivocal margins was 4.2% (56/1345), ranging from 2.2% to 22.6%, depending on the size of the surgical margins, patient characteristics, biopsy history, and the clinicopathology of the melanoma. In descending order, independent risk factors associated with the greatest odds for positive or equivocal margins after multivariate analysis were noncompliance with recommended surgical margins (odds ratio [OR] 5.57, P = .002); anatomic location on the head, neck, hands, feet, genitals, or pretibial leg (OR 5.07, P < .001); histologic regression (OR 2.78, P = .007); in situ melanoma (OR 2.27, P = .011); multiple biopsies at the tumor site before WLE (OR 1.92 [per biopsy], P = .004); and increasing age (OR 1.049 [per year], P < .001).

Limitations: This was a single-site, retrospective observational study.

Conclusions: Clinicopathologic factors, especially location in cosmetically or functionally sensitive areas and noncompliance with recommended surgical margins, identified melanomas at increased risk for positive or equivocal margins after WLE.
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http://dx.doi.org/10.1016/j.jaad.2017.03.025DOI Listing
August 2017