Ashfaq A. Marghoob

A study of large congenital melanocytic nevi and associated malignant melanomas: Review of cases in the New York University registry and the world literature

BACKGROUND Patients with large congenital melanocytic nevi (LCMN) are at greater risk for the development of malignant melanoma (MM) than are persons in the general population. OBJECTIVE Our purpose was to identify the clinical features of LCMN in those patients in whom MMs actually developed. METHODS The records of 117 patients in the New York University Registry of LCMN and the reports of 172 cases of LCMN in the world literature were studied. RESULTS Of the 289 cases of LCMN studied, 34 patients (12%) had primary cutaneous MMs within their nevi; in two additional patients, MMs developed at cutaneous sites other than within their nevi. All patients in whom MM developed within LCMN had nevi in axial locations; however, 91% of the LCMN were axial. No MM was found that had arisen in any of the 26 LCMN confined to the extremities. In addition, no MM was found that had arisen in thousands of satellite nevi. CONCLUSION When MM develops within an LCMN, it generally does so in those LCMN in an axial location. The absence of cases of MM arising in LCMN confined to the extremities suggests that such nevi represent lower risk lesions, but the number of extremity nevi analyzed was too small to allow definitive conclusions. A striking finding was the absence of MMs arising in satellite nevi.

Techniques of cutaneous examination for the detection of skin cancer.

Skin cancers are the most common cancers in humans. The American Cancer Society estimates that in the United States more than 700,000 new skin cancers are diagnosed annually. Although the majority of nonmelanoma skin cancers occur on visibly exposed anatomic areas, most malignant melanomas occur on body sites obscured by clothing. The high mortality associated with advanced melanomas emphasizes the importance of performing regular total cutaneous examinations in all patients to detect early, easily curable lesions.

Predicting ten‐year survival of patients with primary cutaneous melanoma

Recently, the Pigmented Lesion Group at the University of Pennsylvania described a 4‐variable model for predicting 10‐year survival for patients with primary cutaneous melanoma. The variables are tumor thickness, anatomic site of the lesion, age, and gender. The objective of the current study was to test the validity of this model, employing the large data base of the New York University Melanoma Cooperative Group.

Breslow thickness and Clark level in melanoma

Thickness is known to be an important survival prognosticator for cutaneous melanoma, but controversy exists as to whether Clark level of invasion retains prognostic significance once thickness has been accounted for. A recent proposal to eliminate Clark level from the staging system for melanoma of the American Joint Committee on Cancer (AJCC) prompted the authors to investigate whether level adds useful prognostic information to Breslow thickness. They used the data base of the New York University Melanoma Cooperative Group (NYU‐MCG) Registry.

Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. II: Definitive surgery for malignant melanoma

BACKGROUND During the past few decades there has been increasing interest and training in dermatologic surgery. OBJECTIVE Our purpose was to determine to what extent members of the American Academy of Dermatology (AAD) are involved in the surgical management of patients with malignant melanomas (MMs), comparing 1982 with 1992. METHODS Members of the AAD practicing in the United States (N = 7412) were sent a questionnaire that surveyed their role in the definitive treatment of patients with MMs and the surgical margins of normal-appearing skin that they used or recommended for melanomas of various thicknesses. RESULTS Sixty-four percent of the respondents stated that they performed the definitive surgery for in situ melanoma in 1992, a 14% increase from 1982. Although a significantly greater percentage of dermatologists were performing the definitive surgery for invasive melanoma in 1992 (28%) compared with 1982 (14%), the majority continued to refer their patients to surgical colleagues for definitive treatment. There has been a narrowing of surgical margins recommended or used for melanomas of all thicknesses. In addition, regional differences of the role of the dermatologist in surgical management of patients with MM were observed. CONCLUSION An increasing proportion of dermatologists are involved in the surgical management of patients with MMs. Most dermatologists appear to be in accord with the guidelines for surgical margins currently recommended in the literature.

Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. I. Survey of biopsy practices of pigmented lesions suspected as melanoma

BACKGROUND The incidence of malignant melanoma (MM) has rapidly increased during the past five decades. Relatively little information is available on whether the role of the dermatologist has increased concomitantly in the surgical management of this cancer. OBJECTIVE Our purpose was to learn how members of the American Academy of Dermatology (AAD) treat patients with lesions highly suspected as being MM and how the management of these patients may have changed over the past decade. This, the first of a two-part series, concerns biopsies. METHODS The data for the study were collected by means of a questionnaire that was sent to all members of the AAD practicing in the United States (N = 7412). RESULTS A total of 2991 valid questionnaires were returned, a response rate of 40%. The majority of respondents (89% in 1982; 90% in 1992) stated that they performed the biopsies of pigmented lesions suspected of being MMs. Excisional biopsy was the preferred technique (58% in 1982; 68% in 1992). The type of biopsy and who performed the initial biopsy of a suspected MM were associated with the following factors: (1) the number of years in practice, (2) the type of practice, and (3) whether the dermatologist subsequently performed the definitive surgery for the MM. Regional variations in biopsy practices were also noted. CONCLUSION Most AAD dermatologists who responded to the questionnaire perform the biopsies of lesions highly suspected of being MM. During the last decade an increasing proportion of dermatologists are performing excisional biopsies rather than other types of biopsies for such lesions.

Case-control study of melanocytic nevi on the buttocks in atypical mole syndrome : role of solar radiation in the pathogenesis of atypical moles

BACKGROUND It is not known why melanocytic nevi (MN) become dysmorphic (atypical) in patients with the atypical mole syndrome (AMS). A complex origin for acquired MN has been postulated. Genetic predisposition, solar radiation, and/or the formation of a sun-induced circulating mitogenic factor may contribute to the formation of MN. OBJECTIVE This study was undertaken to help elucidate the pathogenesis of atypical MN in patients with AMS. METHODS The number of common and atypical MN was determined for a defined sun-protected area on the buttocks in 150 patients with AMS (cases) and 150 control subjects without AMS. Patients and control subjects were matched for age and sex and were classified into risk groups for the development of malignant melanoma according to the Rigel classification. RESULTS MN on the buttocks were found in 23% of patients with AMS and 9% of control subjects (p < 0.003). In patients versus control subjects the mean number (1.3 vs 1.2, respectively) and mean diameter (5.7 vs 5.9 mm, respectively) of MN on the buttocks did not differ significantly. The MN in both patients and control subjects were not atypical clinically. The odds ratio for having AMS if MN were present on the buttocks was calculated to be 1.56 (95% confidence interval, 1.25 to 1.95). CONCLUSION Although the patients were 2.6 times more likely to have MN on their buttocks than the control subjects, clinically the MN did not differ significantly in number or appearance from those found on the buttocks of control subjects. It is hypothesized that the formation of some atypical MN requires direct solar radiation for their phenotypic expression.

An Atlas of Dermoscopy

History of Skin Surface Microscopy and Dermatoscopy, W. Stolz, O. Braun-Falco, U. Semmelmayer, and A. W. Kopf Principles of Dermoscopy, M. Binder Dermoscopy and Beyond: The Instruments. The Evolution from the Dermoscope to Computer Analysis of Dermoscopic Images, F.A. Sanchez Negron, A.W. Kopf, and A.A. Marghoob Histopathological Correlation in Dermoscopy, G. Kaya and R.P. Braun Differential Diagnosis of Pigmented Lesions of the Skin, R.P. Braun and J.-H. Saurat Pigmented Basal Cell Carcinoma, D. Polsky Dermoscopic Patterns of Solar Lentigenes and Seborrheic Keratoses, S.Q. Wang, H. Rabinovitz, and M.C. Oliviero Vascular Lesions, Hemangiomas/angiokeratomas, B. Katz, B. Rao, and A.A. Marghoob Dermatofibroma, B. Katz, B. Rao and A.A. MARGHOOB Pigmented Actinic Keratosis, B.Katz and B. Rao ABCD Rule, U. Semmelmayer, W.H.C. Burgdorf, and W. Stolz The Menzies Method, S.W. Menzies The Seven-Point Checklist, G. Argenziano Pattern Analysis, M. Dawid, H. Pehamberger, R.P. Braun, and H. Rabinovitz ABC-Point-List of Dermoscopy, A. Blum, H. Luedtke, U. Ellwanger, G. Rassner, and G. Garbe The ABCD-E Scoring System and the Three-Point Checklist, A.A. Marghoob and J.M. Fu Dermoscopic Features of Congenital Melanocytic Nevi, A.A. Marghoob, J.M. Fu, and D. Sachs Dysplastic Nevus (atypical mole), J.M.Tripp and A.W. Kopf Benign Patterns of Clinically Atypical Nevi: A Hypothesis, J.M. Tripp, S.Q. Wang, D. Polsky, and A.W. Kopf Dermscopic Features of Common Melanocytic Nevi of the Junctional, Compound, and Dermal Type, J. Bauer and A. Blum Blue Nevus/Combined Nevus, B. Katz, B. Rao , and A.A. Marghoob Spitz and Reed Nevi, A. Blum, G. Metzler, R.P. Braun, A.A. Marghoob, and J. Bauer Recurrent (persistent) Nevi, A.A. Marghoob and A. Korzenko Superficial Spreading Melanoma, S.W. Menzies Acrolentigious Melanoma, T. Saida, A. Miyazaki , and C.M. Grin Nodular Melanoma, S.W. Menzies Lentigo Maligna Melanoma, U. Semmelmayer, W.H.C. Burgdorf, and W. Stolz Diagnosis of Amelanotic Melamoma by Dermoscopy AND VASCULAR ASPECTS, J.F. Kreusch and A.A. Marghoob Breslow Depth Prediction by Dermoscopy, J. Malvehy and S. Puig Pigmented Lesions of the Palms and Soles, C.M. Grin and T. Saida Dermoscopy on the Face, R. Schiffner Dermoscopic Examination of Melanonychia Striata, L. Thomas and S. Ronger-Savle Other Uses of Dermoscopy, F. Vazquez-Lopez and J.F. Kreusch Nailfold Capillaries, J.F. Kreusch Diagnostic Accuracy of Dermoscopy/Dermatoscopy, H. Kittler Computer-assisted Diagnosis of Pigmented Skin Lesions, W. Stolz, W.H.C. Burgdorf, and U. Semmelmayer Automated Diagnosis: Illustrated by the Melafind(R) System, M. Elbaum Teledermoscopy, D. Piccolo, A. Ferrari, K. Peris, and S. Chimenti Follow-up of Melanocytic Skin Lesions with Digital Dermoscopy, H. Kittler Websites and CD-ROMS on Dermoscopy, M.L. Nestor

Anatomic Distribution of Cutaneous Melanomas and Painful Sunburns in Adults

Background: Data show that intermittent painful sunburns are an important causative factor for cutaneous malignant melanoma. Objective: This study was undertaken to determine whether the differences in the anatomic distribution of melanomas in men, compared to women, could be accounted for by the distribution of sunburns and whether the high incidence of melanomas on the lower extremities of women is associated with the distribution of sunburns. Methods: One hundred and fifty nonmelanoma patients, men and women aged 20 to 60 years, recalled having painful sunburns within the previous 6 months. The locations of the sunburns were indicated on body surface diagrams. The locations of 1168 melanomas as recorded in the NYU-Melanoma Cooperative Group data base were plotted on anatomic diagrams. The anatomic distribution of melanomas and of sunburns for men and women were compared. Results: There was no statistically significant difference in the distribution of sunburns on any anatomic location in men as compared to women. However, there was a disproportionately high number of melanomas on the backs of men and on the legs of women. In both men and women, there was a significant difference between the anatomic distribution of painful sunburns and melanomas. Conclusion: Since the anatomic distribution of painful sunburns is similar in men and women, whereas the anatomic distribution of melanomas differ, it would appear that factors in addition to sunburns in adults account for the differences in the anatomic distribution of melanomas in men and women.