Publications by authors named "Shane A Meehan"

121 Publications

Impact of COVID-19 on melanoma diagnosis.

Melanoma Res 2021 Feb 18. Epub 2021 Feb 18.

The Ronald O. Perelman Department of Dermatology, Dermatopathology Section, NYU Grossman School of Medicine, New York Piedmont Plastic Surgery & Dermatology, Cornelius, North Carolina Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, USA.

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http://dx.doi.org/10.1097/CMR.0000000000000717DOI Listing
February 2021

Histopathologic reaction patterns to differentially cross-linked hyaluronic acid fillers: A retrospective case series.

J Cutan Pathol 2020 Dec 22. Epub 2020 Dec 22.

The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA.

Background: Hyaluronic acid (HA) filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler.

Methods: The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to HA from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded.

Results: From 2014 to 2019, there were 15 cases of granulomatous reactions to HA filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of HA filler.

Conclusion: A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.
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http://dx.doi.org/10.1111/cup.13947DOI Listing
December 2020

A case of primary cutaneous marginal zone lymphoma presenting with rosacea-like eruption.

JAAD Case Rep 2020 Sep 22;6(9):902-904. Epub 2020 Jul 22.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.07.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452266PMC
September 2020

A case of facial composite tissue allograft rejection.

JAAD Case Rep 2020 Sep 12;6(9):845-847. Epub 2020 Jul 12.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2020.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452299PMC
September 2020

The "bumpy" adolescent nose: Acne associated angiofibroma-like nasal papules.

Pediatr Dermatol 2021 Jan 7;38(1):45-49. Epub 2020 Aug 7.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.

Background/objective: Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity.

Methods: In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded.

Results: We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thin-walled blood vessels, typical of angiofibromas.

Conclusion: We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.
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http://dx.doi.org/10.1111/pde.14319DOI Listing
January 2021

Dermatopathology education during the COVID-19 pandemic: Virtual simulation of the multiheaded microscope.

J Am Acad Dermatol 2020 09 1;83(3):e243-e244. Epub 2020 Jun 1.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2020.05.127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262529PMC
September 2020

Neutrophilic panniculitis arising from hematogenous spread of methicillin-resistant Staphylococcus aureus.

Pediatr Dermatol 2020 May 2;37(3):531-533. Epub 2020 Mar 2.

The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA.

Infectious panniculitis from hematogenous spread is uncommon and usually occurs in immunocompromised patients. Dissemination of gram-positive organisms to the subcutaneous tissue is rare with only several reports of disseminated panniculitis caused by Streptococcal species. We report a case of an immunocompetent 2-year-old boy presenting with diffuse neutrophilic panniculitis arising from methicillin-resistant Staphylococcus aureus septicemia. This case represents a highly atypical manifestation of severe MRSA infection and serves as a reminder to consider MRSA as a cause of disseminated neutrophilic panniculitis, particularly in high-risk populations.
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http://dx.doi.org/10.1111/pde.14123DOI Listing
May 2020

Learning Analytics to Enhance Dermatopathology Education Among Dermatology Residents

J Drugs Dermatol 2019 Dec;18(12):1231-1236

BACKGROUND: With the advent of digital microscopy, learning analytics can be leveraged to advance teaching of dermatopathology in dermatology residency. OBJECTIVE: To analyze the acquisition and decay of dermatopathology visual recognition skills and areas of diagnostic confusion amongst residents using learning metrics generated by a web-based learning tool. METHODS: This was a prospective, longitudinal study of dermatology residents who studied digital photomicrographs of 18 routine diagnostic entities using an online software platform. Residents at different years of training were given 60 minutes to complete assessments on three occasions (initial test with follow-ups at one and three months). RESULTS: 4,938 responses were analyzed. Accuracy and time to diagnosis improved within each assessment and between the first and second assessments. First year residents showed knowledge decay when tested at three months (67% vs 64%; P=0.002) while third year residents retained knowledge and continued to improve upon their accuracy after three months (83% to 91%, <0.001). Learning analytics highlighted diagnostically challenging cases for residents that contradicted experts’ predictions (R=0.48). CONCLUSIONS: The use of learning analytics and interactive digital platforms enhances dermatopathology curriculum development by identifying challenging diagnostic entities, assessing mastery of subject material, and optimizing review schedules. J Drugs Dermatol. 2019;18(12):1231-1236.
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December 2019

Deep initial Mohs stage for scalp cutaneous squamous cell carcinoma to avoid occult tumor.

J Am Acad Dermatol 2020 Apr 11;82(4):e129-e130. Epub 2019 Dec 11.

Laser & Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2019.12.007DOI Listing
April 2020

Photolichenoid dermatitis: a presenting sign of human immunodeficiency virus.

Cutis 2019 Oct;104(4):242-244

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA.

Photolichenoid dermatitis is an uncommon eruptive dermatitis that often occurs in association with a photosensitizing drug. Photodermatitis, in general, is an uncommon clinical manifestation of human immunodeficiency virus (HIV), most often affecting patients of African and Native American descent. Photolichenoid dermatitis has infrequently been reported in patients with HIV who have not been exposed to a photosensitizing drug. We report a case of an African patient with a photodistributed depigmenting eruption without exposure to a photosensitizing drug. Histologic examination revealed a patchy perivascular and bandlike lymphocytic infiltrate with melanophages, interface changes, and dyskeratotic keratinocytes, consistent with photolichenoid dermatitis. Laboratory examination was significant for a positive HIV-2 antibody. Photolichenoid dermatitis may be a presenting sign of HIV infection and may not necessarily be associated with exposure to a photosensitizing drug. Testing for HIV should be done in patients who present with photodistributed depigmenting eruptions, even in the absence of exposure to a photosensitizing drug, and particularly in patients of African and Native American descent.
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October 2019

Paradoxical Mucositis Associated With Anti-Tumor Necrosis Factor Therapy.

J Clin Rheumatol 2020 Dec;26(8):e309-e310

Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY.

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http://dx.doi.org/10.1097/RHU.0000000000001163DOI Listing
December 2020

Proton pump inhibitor-induced erythema dyschromicum perstans-like pigmentation.

JAAD Case Rep 2019 Aug 5;5(8):701-703. Epub 2019 Aug 5.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2019.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698607PMC
August 2019

Excision recommendation rates of atypical (dysplastic) nevi amongst experienced dermatopathologists.

J Cutan Pathol 2019 Oct 20;46(10):798-799. Epub 2019 Jun 20.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1111/cup.13513DOI Listing
October 2019

A 68-Year-Old Man on Azathioprine With New Systemic Symptoms and Widespread Skin Eruption.

Clin Infect Dis 2019 04;68(8):1427-1430

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine.

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http://dx.doi.org/10.1093/cid/ciy440DOI Listing
April 2019

Lymphomatoid papulosis.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York.

Lymphomatoid papulosis is often regarded as a low-grade variant of cutaneous T cell lymphoma (CTCL). Given the excellent long-term prognosis, recent consensus guidelines indicate that patients can be monitored off therapy. We report a case of a 67-year-old man who presented with lymphomatoid papulosis, with necrotic papules that have been intermittently present for over forty years.
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December 2018

Necrobiosis lipoidica.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

We present a case of necrobiosis lipoidica (NL) of the right abdomen in a 75-year-old man. A skin biopsy performed showed a layered infiltrate of mono and multinucleated histiocytes palisaded around degenerated collagen bundles. Laboratory workup was unremarkable. The patient was treated with topical corticosteroids with cessation of progression of his disease, although the eruption did not resolve. There are a number of treatments for NL reported in the literature, all with varying efficacy. Although NL lesions are usually asymptomatic, patients with NL must be monitored closely for signs of ulceration or malignant transformation, in which case more aggressive treatment options may be warranted.
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December 2018

Generalized essential telangiectasia.

Dermatol Online J 2018 Dec 15;24(12). Epub 2018 Dec 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

The pathophysiology of generalized essential telangiectasia is not well understood. Generalized essential telangiectasia is an uncommon disorder in which widespread telangiectasias of unknown cause develop without associated systemic or antecedent dermatologic disease. We report a case of generalized essential telangiectasia in an otherwise healthy 49-year-old man.
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December 2018

Id reaction associated with red tattoo ink.

Cutis 2018 Nov;102(5):E32-E34

Metro Dermatology, Elmhurst, New York, USA.

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November 2018

Mirtazapine-induced hyperpigmentation with type II histopathologic findings.

JAAD Case Rep 2018 Nov 14;4(10):1077-1079. Epub 2018 Nov 14.

Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250903PMC
November 2018

Durable response to anti-PD-1 immunotherapy in epithelioid angiomyolipoma: a report on the successful treatment of a rare malignancy.

J Immunother Cancer 2018 10 1;6(1):97. Epub 2018 Oct 1.

Department of Medicine, NYU Langone Health, New York, NY, USA.

Background: Malignant angiomyolipoma is an uncommon tumor of the class of perivasciular epithelioid cell neoplasms (PEComas). These tumors are characteristically driven by deleterious mutations in the tumor suppressors TSC1 and TSC2, whose gene products typically act to inhibit mTOR. There are several cases of malignant angiomyolipoma which exhibit transient responses to mTOR inhibitors, forming the basis of current practice guidelines in malignant PEComa. However the tumors ultimately acquire resistance, and there is no well-established second-line option. Despite the increasing prevalence of immunotherapy across a wide range of solid tumors, little is known about the immune infiltrate and PD-L1 expression of angiomyolipoma. Furthermore, there is no reported case on the treatment of malignant angiomyolipoma with an immune checkpoint inhibitor.

Case Presentation: A 38 year-old man presented with gross hematuria and was diagnosed with renal epithelioid angiomyolipoma. Despite surgical resection, the tumor recurred and metastasized. Targeted genomic sequencing revealed a deleterious mutation in TSC2, and the patient was treated with the mTOR inihbitor everolimus. The patient went on to have a partial response but ultimately progressed. He was then treated with the anti-PD-1 immune checkpoint inhibitor nivolumab, and achieved a durable near-complete response which is ongoing after two years of treatment. Immunohistochemical staining of tumor tissue revealed strong PD-L1 expression and a brisk T-cell infiltrate.

Conclusions: We report on the first durable systemic treatment of malignant epithelioid angiomyolipoima with the use of PD-1 antibody nivolumab. Given the absence of prospective clinical trials in this exceedingly rare disease, particularly in the second-line setting, immune checkpoint inhibitors like nivolumab should be considered.
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http://dx.doi.org/10.1186/s40425-018-0415-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167873PMC
October 2018

55-year-old man with ulcers in inguinal fold and intergluteal cleft found to have systemic Langerhans cell histiocytosis.

JAAD Case Rep 2018 Sep 18;4(8):837-840. Epub 2018 Sep 18.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2018.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143693PMC
September 2018

Margin Assessment for Punch and Shave Biopsies of Dysplastic Nevi.

J Drugs Dermatol 2018 Jul;17(7):810-812

Introduction: Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies.

Methods: We performed a retrospective analysis of 50 consecutive punch and shave biopsy specimens (1) diagnosed as DN, and (2) reported as having clear margins in the planes of section examined. Identified specimen blocks were then sectioned through to examine true margin involvement.

Results: Of the 50 specimens identified, 20% (n = 10) were found to have positive margins upon additional sectioning. We found no difference between the groups with respect to biopsy technique, type of nevus, degree of atypia, or gender.

Conclusion: This study observed false negative peripheral margin status in a sizeable proportion of biopsy specimens, which did not vary significantly based on biopsy technique or pathologic characteristics. This finding reflects a limitation of standard tissue processing, in which a limited proportion of the true margin is evaluated, and may be of note to many dermatologists who base their decision to re-excise on the reporting of margin involvement. J Drugs Dermatol. 2018;17(7):810-812.
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July 2018

Concentric targetoid scaly plaques in a patient with severe rheumatoid arthritis.

Int J Dermatol 2018 Aug 11;57(8):913-914. Epub 2018 Apr 11.

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.

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http://dx.doi.org/10.1111/ijd.13991DOI Listing
August 2018

Evaluation of MITF, SOX10, MART-1, and R21 Immunostaining for the Diagnosis of Residual Melanoma In Situ on Chronically Sun-Damaged Skin.

Dermatol Surg 2018 07;44(7):933-938

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

Background: Melanocytic immunostains can assist in margin evaluation of melanoma in situ (MIS) excisions; however, their accuracy and reliability relative to hematoxylin & eosin (H&E) is yet to be determined.

Objective: The objective of this study was to evaluate the sensitivity, specificity, and concordance of 4 melanocyte-specific immunostains for diagnosing MIS occurring on chronically sun-damaged skin.

Materials And Methods: Serial permanent sections from representative areas of negative margin and residual tumor were stained using H&E, MITF, MART-1, SOX10, and R21 and examined in a blinded fashion. The study set included 100 digital microscopy images from 10 cases of MIS excisions from the face. Two board-certified dermatopathologists, 4 fellowship-trained Mohs surgeons, 2 Mohs fellows, and 2 dermatology residents independently reviewed the 100 images.

Results: The average melanocyte density was 11 versus 28 melanocytes per 0.5 mm for chronically sun-damaged skin versus residual MIS on H&E, respectively. Statistically significantly higher melanocyte densities were observed using MITF, MART-1, and SOX10 on negative margins. The sensitivity and interobserver concordance was highest using MITF and SOX10. The intraobserver agreement on 4 duplicate images was 85%.

Conclusion: In conclusion, the nuclear immunostains (MITF and SOX10) show the most promise for improving the diagnosis of MIS in chronically sun-damaged skin.
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http://dx.doi.org/10.1097/DSS.0000000000001493DOI Listing
July 2018

Line scanning, stage scanning confocal microscope (LSSSCM).

Biomed Opt Express 2017 Aug 24;8(8):3807-3815. Epub 2017 Jul 24.

Ronald O. Pearleman Department of Dermatology, New York University, 240 E. 38th St., New York, NY 10016, USA.

For rapid pathological assessment of large surgical tissue excisions with cellular resolution, we present a line scanning, stage scanning confocal microscope (LSSSCM). LSSSCM uses no scanning mirrors. Laser light is focused with a single cylindrical lens to a line of diffraction-limited width directly into the (Z) sample focal plane, which is parallel to and near the flattened specimen surface. Semi-confocal optical sections are derived from the linear array distribution (Y) and a single mechanical drive that moves the sample parallel to the focal plane and perpendicular to the focused line (X). LSSSCM demonstrates cellular resolution in the conditions of high nuclear density within micronodular basal cell carcinoma.
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http://dx.doi.org/10.1364/BOE.8.003807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560842PMC
August 2017

Novel use of apremilast for adjunctive treatment of recalcitrant pyoderma gangrenosum.

JAAD Case Rep 2017 May 14;3(3):228-229. Epub 2017 Apr 14.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jdcr.2017.02.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394202PMC
May 2017

Transformation of porokeratosis ptychotropica into invasive squamous cell carcinoma.

Int J Dermatol 2017 Jun 15;56(6):679-680. Epub 2017 Feb 15.

The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, NY, USA.

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http://dx.doi.org/10.1111/ijd.13575DOI Listing
June 2017

Dermoscopic features of a solitary fibrofolliculoma on the left cheek.

J Am Acad Dermatol 2017 Feb;76(2S1):S8-S9

The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.

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http://dx.doi.org/10.1016/j.jaad.2016.03.041DOI Listing
February 2017

Amelanotic Cellular Blue Nevus of the Eyelid.

Ophthalmic Plast Reconstr Surg 2017 Sep/Oct;33(5):e122-e123

Departments of *Ophthalmology, †Pathology, and ‡Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York, U.S.A.

The authors describe an isolated, yellowish papular lesion of the upper eyelid in a 63-year-old man. Following excision, histopathologic analysis showed the features of a benign hypopigmented cellular blue nevus, the first and only case involving the eyelid skin.
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http://dx.doi.org/10.1097/IOP.0000000000000845DOI Listing
September 2017

Immunostain use in the diagnosis of melanomas referred to a tertiary medical center: a 15-year retrospective review (2001-2015).

J Cutan Pathol 2017 Mar 23;44(3):221-227. Epub 2016 Dec 23.

Dermatopathology Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.

Background: Little is known regarding the clinical practice of immunohistochemistry in the diagnosis of melanoma. We aimed to assess the incidence of immunostain usage by referring pathologists and dermatopathologists in melanoma cases sent for consultative review. As a secondary objective, associations between immunostain use and specific melanoma characteristics were also evaluated.

Methods: This is a retrospective review of consultation reports of referred melanomas at a tertiary academic center in New York, NY from 2001 to 2015. Univariate regression analysis was performed on melanomas with accompanying immunostains and on characteristics such as Breslow's depth, location, prognostic factors and morphologic subtypes. Associations between immunostain usage and these characteristics were analyzed using Fisher's exact test.

Results: Immunostain use significantly increased over the study period (p < 0.001) and was more likely to be associated with melanomas that were thicker [odds ratio (OR) = 2.5; 1.7-3.6]; located on the head and neck (OR = 1.6; 1.4-1.9) or acral sites (OR = 1.5; 1.1-2.0); had ulceration (OR = 2.1; 1.6-2.8), dermal mitoses (OR = 1.3; 1.1-1.5), or perineural invasion (OR = 3.6; 2.0-6.5); or were of desmoplastic (OR = 7.4; 4.5-12), amelanotic (OR = 7.1; 3.6-14), or nevoid subtypes (OR = 4.0; 1.7-8.9).

Conclusions: Immunostain use in the diagnosis of melanoma has increased significantly in the past 15 years for reasons that remain unclear.
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http://dx.doi.org/10.1111/cup.12867DOI Listing
March 2017