Browsing by Author "Rossi, Anthony M."

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    Biopsy type does not affect the number of stages during Mohs micrographic surgery: a retrospective study
    (Oxford University Press, 2023) Araneda Ortega, Paulina Belén; Donoso Mena, Francisca; Castro, Juan C.; Uribe González, Pablo Francisco; Rossi, Anthony M.; Hibler, Brian P.; Droppelmann Droppelmann, Katherine Ann; Cárdenas De La Torre, Consuelo Paz; Navarrete-Dechent, Cristian
    Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy type is more appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCCs treated with MMS. Of the 208 BCC biopsies, 42 (20.2%) were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs. 1.69 stages with the punch technique (P = 0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The biopsy type of choice is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping., In this study including 208 primary basal cell carcinomas undergoing Mohs micrographic surgery (MMS), there were no differences in the mean number of stages, regardless of which biopsy type was performed (shave vs. punch). The biopsy technique might affect correct subtype identification; however, there were also no differences in the rate of upstaging. Any tissue reaction could also result in difficult histopathological interpretation on frozen sections; however, this was not evident in our study. It seems that biopsy type, shave vs. punch, does not affect MMS performance; thus the more appropriate biopsy type is the one deemed adequate for each specific case in order to obtain a diagnosis as well as tumour subtyping.
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    Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type
    (2021) Navarrete-Dechent, Cristian; Aleissa, Saud; Connolly, Karen; Hibler, Brian P.; Dusza, Stephen W.; Rossi, Anthony M.; Lee, Erica; Nehal, Kishwer S.
    Background: There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) before complete histopathologic analysis.
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    Evaluation of a Combined Reflectance Confocal Microscopy-Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma
    (2018) Sahu, Aditi; Yélamos, Oriol; Iftimia, Nicusor; Córdova, Miguel; Alessi Fox, Christi; Gill, Melissa; Maguluri, Gopi; Dusza, Stephen; Navarrete Dechent, Cristián Patricio; González, Salvador; Rossi, Anthony M.; Marghoob, Ashfaq A.; Rajadhyaksha, Milind; Chen, C-S J.
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    Evaluation of the Response of Unresectable Primary Cutaneous Melanoma to Immunotherapy Visualized With Reflectance Confocal Microscopy A Report of 2 Cases
    (2019) Navarrete Dechent, Cristián Patricio; Córdova, Miguel; Postow, Michael A.; Pulitzer, Melissa; Lezcano, Cecilia; Halpern, Allan C.; Rossi, Anthony M.
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    In vivo imaging characterization of basal cell carcinoma and cutaneous response to high-dose ionizing radiation therapy: A prospective study of reflectance confocal microscopy, dermoscopy, and ultrasonography
    (2021) Navarrete-Dechent, Cristian; Cordova, Miguel; Liopyris, Konstantinos; Aleissa, Saud; Rajadhyaksha, Milind; Cohen, Gil'ad; Marghoob, Ashfaq A.; Rossi, Anthony M.; Barker, Christopher A.
    Background: Radiation therapy (RT) is a treatment option for select skin cancers. The histologic effects of RT on normal skin or skin cancers are not well characterized. Dermoscopy, high-frequency ultrasonography (HFUS), and reflectance confocal microscopy (RCM) are noninvasive imaging modalities that may help characterize RT response.
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    Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study
    (2023) Navarrete-Dechent, Cristian; Cordova, Miguel; Aleissa, Saud; Liopyris, Konstantinos; Dusza, Stephen W.; Kose, Kivanc; Busam, Klaus J.; Hollman, Travis; Lezcano, Cecilia; Pulitzer, Melissa; Chen, Chih-Shan J.; Lee, Erica H.; Rossi, Anthony M.; Nehal, Kishwer S.
    Background: Lentigo maligna/lentigo maligna melanoma (LM/LMM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminarily studies have used reflectance confocal microscopy (RCM) to assess LM/LMM margins.
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    Patterns of reconstruction following margin-controlled surgery for melanoma of the lentigo maligna type of the head and neck
    (Springer Nature, 2025) Navarrete Dechent, Cristian Patricio; Veldhuizen, Inge J.; Aleissa, Saud; Dusza, Stephen W.; Rossi, Anthony M.; Lee, Erica H.; Nehal, Kishwer S.
    Melanoma of the lentigo maligna (LM) type is most commonly located on the head and neck region. This subtype of melanoma poses surgical challenges due to its location on anatomically sensitive areas and frequent presence of subclinical extension. To analyze the reconstruction patterns of LM patients undergoing margin-controlled surgery. An observational study was conducted at Memorial Sloan Kettering Cancer Center, enrolling patients who underwent staged excision for the LM between November 2006 and April 2019. The study included 519 patients. Following margin-controlled surgery, the size of the surgical defects varied: <10 mm(36.2%), 10 and 30 mm (36.8%), and > 30 mm (27%). A flap reconstruction was the most common reconstructive technique (42.6%), followed by primary closure (32.6%), and graft (21.8%). Age was significantly associated with reconstruction type, with older patients more likely to undergo graft reconstructions (p = 0.014). Larger defects (> 30 mm) were reconstructed with grafts and flaps more often compared to smaller defects (p < 0.001 and p = 0.02, respectively). Understanding the scope of reconstruction is important for effective pre-surgical counseling and treatment planning. These findings highlight the importance of personalized strategies considering patients’ age and defect size.
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    Perifollicular linear projections: A dermatoscopic criterion for the diagnosis of lentigo maligna on the face
    (2024) Navarrete-Dechent, Cristian; Jaimes, Natalia; Dusza, Stephen W.; Liopyris, Konstantinos; Marchetti, Michael A.; Cordova, Miguel; Oliviero, Margaret; Villaseca, Miguel A.; Pulitzer, Melissa; Busam, Klaus J.; Rossi, Anthony M.; Rabinovitz, Harold S.; Nehal, Kishwer S.; Scope, Alon; Marghoob, Ashfaq A.
    Background: Lentigo maligna (LM) can mimic benign, flat, pigmented lesions and can be challenging to diagnose. Objective: To describe a new dermatoscopic feature termed "perifollicular linear projections (PLP)"as a diagnostic criterion for LM on the face. Methods: Retrospective study on reflectance confocal microscopy and dermatoscopy images of flat facial pigmented lesions originating from 2 databases. PLP were defined as short, linear, pigmented projections emanating from hair follicles. Dermatoscopy readers were blinded to the final histopathologic diagnosis. Results: From 83 consecutive LMs, 21/83 (25.3%) displayed "bulging of hair follicles"on reflectance confocal microscopy and 18 of these 21 (85.7%), displayed PLP on dermatoscopy. From a database of 2873 consecutively imaged and biopsied lesions, 252 flat-pigmented facial lesions were included. PLP was seen in 47/76 melanomas (61.8%), compared with 7/176 lesions (3.9%) with other diagnosis (P \ .001). The sensitivity was 61.8% (95% CI, 49.9%-72.7%), specificity 96.0% (95% CI, 92.9%-98.4%). PLP was independently associated with LM diagnosis on multivariate analysis (OR 26.1 [95% CI, 9.6%-71.0]). Limitations: Retrospective study. Conclusion: PLP is a newly described dermatoscopic criterion that may add specificity and sensitivity to the early diagnosis of LM located on the face. We postulate that PLP constitutes an intermediary step in the LM progression model. ( J Am Acad Dermatol 2024;90:52-7.)
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    Staging System Performance and Clinical Outcomes for Cutaneous Squamous Cell Carcinoma of the Ear: A Single-Center Retrospective Study
    (2023) Navarrete-Dechent, Cristian; Mori, Shoko; Connolly, Karen; Shah, Kalee; Dusza, Stephen W.; Rossi, Anthony M.; Lee, Erica H. H.; Busam, Klaus J.; Nehal, Kishwer S.
    BACKGROUNDCutaneous squamous cell carcinoma (cSCC) of the ear is associated with poor outcomes. No studies have evaluated current staging system performance in this specific location.OBJECTIVEDescribe clinicopathologic characteristics and outcomes of ear cSCC and evaluate the performance of current staging systems.METHODSRetrospective study including cases diagnosed and treated at a cancer center from January 2000 to December 2014. Demographic, clinical, and pathologic data were collected from clinical records. Biopsy slides were rereviewed and patients were staged according to the American Joint Committee on Cancer (AJCC) seventh, eighth, and Brigham Women's Hospital (BWH) staging.RESULTSOf 125 patients, the mean age at diagnosis was 71.9 years (SD 12.5), with most men (89.6%, n = 112). Median follow-up was 22.3 months. Local recurrence and survival risk factors were similar to cSCC outside the ear. The Akaike's Information Criterion (AIC) estimates showed that the BWH system better predicted outcomes than the AJCC seventh, and the AJCC eighth, with AIC values of 189.9, 270.5, and 274.1, respectively. Limitations of the study include retrospective design, single center study, and no control group.CONCLUSIONCurrent staging systems perform well at stratifying risk in ear cSCC.
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    Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study
    (2021) Navarrete-Dechent, Cristian; Aleissa, Saud; Cordova, Miguel; Hibler, Brian P.; Erlendsson, Andres M.; Polansky, Max; Cordova, Frank; Lee, Erica H.; Busam, Klaus J.; Hollmann, Travis; Lezcano, Cecilia; Moy, Andrea; Pulitzer, Melissa; Leitao, Mario M., Jr.; Rossi, Anthony M.
    BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). Limitations Relatively small sample size. CONCLUSION Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD.
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    Tumor Board Conferences for Multidisciplinary Skin Cancer Management: A Survey of US Cancer Centers
    (2018) Mori, Shoko; Navarrete Dechent, Cristián Patricio; Petukhova, Tatyana A.; Lee, Erica H.; Rossi, Anthony M.; Postow, Michael A.; Dunn, Lara A.; Roman, Benjamin R.; Yin, Vivian T.; Coit, Daniel G.; Hollmann, Travis J.; Busam, Klaus J.; Nehal, Kishwer S.|
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    Ultraviolet-induced fluorescent dermoscopy for biopsy site identification prior to dermatologic surgery: a retrospective study
    (2023) Navarrete-Dechent, Cristián; Pietkiewicz, Pawel; Dusza, Stephen W.; Andreani, Sebastian; Nehal, Kishwer S.; Rossi, Anthony M.; Córdova, Miguel; H. Lee, Erica; Chih-Shan J. Chen; Abarzúa Araya, Álvaro Rodrigo; Uribe González, Pablo Francisco; Castro, Juan C.; Droppelmann, Katherine; Cárdenas de la Torre, Consuelo; Marghoob, Ashfaq A.