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Biomedical subjects

Allan C Halpern

Publications and source records attributed to Allan C Halpern.

46 records · Page 3Linked to original sources
PubMed2003

The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999.

BACKGROUND: In response to the precipitous increase of melanoma, the American Academy of Dermatology (AAD) has coupled melanoma/skin cancer education with free skin cancer screening programs throughout the United States since 1985. The purpose of this analysis is to investigate the risk factors, access to dermatologic services, and screening results of participants in AAD-sponsored programs during the first 15 years that this service was available to the US public. METHODS: Before screening, participants completed a standardized AAD screening form. Screening forms were counted in the AAD central office and recorded in annual summaries. Forms were sent for keypunching and returned to the AAD on a computer disk annually. In 1999, disks were sent to Boston University and a master file was created. RESULTS: Computerized records were available for 819,019 screening forms and 639,835 individuals. In all, 65% of screenees had at least 1 risk factor and 33% had at least 2 risk factors. Of screenees, 33% reported a changing mole and 37% had skin type I or II. Among all screenees, nearly 80% did not have a regular dermatologist, 78% reported no prior AAD skin cancer screening, 60% had never had their skin checked by any doctor, and 51% would not have seen a doctor for skin cancer without the free screening. Nearly 30% of screenees had a presumptive diagnosis of skin cancer or a precursor lesion. Melanomas confirmed by postscreening biopsy were more likely than those in population-based registries to be less than 1.50 mm in thickness. CONCLUSIONS: AAD national screening and educational programs have expanded to all 50 states, provided educational messages about sun protection and early detection to millions, and served many US citizens with an above average risk for skin cancer and suboptimal access to dermatologic care. Screenees had a disturbingly high point prevalence of malignant and premalignant skin lesions. Sustained commitment by the AAD leadership and membership to the screening program is critical to reducing the morbidity and mortality of skin cancer.

Adolescent↗
PubMed2003

Standardized positioning of patients (poses) for whole body cutaneous photography.

Whole body photography (WBP) has been used for decades by some specialized pigmented lesion clinics as an aid to early melanoma detection in high-risk persons. The recent advent of digital imaging systems for acquiring and archiving whole body skin images has resulted in greater dissemination of this technique. This in turn has led to the recent establishment of a Category III Current Procedural Terminology code for WBP. Here we present a proposed set of standardized body poses for WBP on the basis of the extant literature and the experience of a panel of experts in the field. The proposed poses were developed with consideration of patient comfort and technical efficiency. The poses were optimized to comply with a predetermined set of desirable technical parameters as assessed in a series of 20 consecutive patients. The resulting set of poses is presented as a first step toward the increased standardization of dermatologic WBP.

Current Procedural Terminology↗
PubMed2002

Use of nonphysician health care providers for skin cancer screening in the primary care setting.

BACKGROUND: Nonphysician health care providers are in an optimal position to provide cancer prevention and screening services. METHODS: We conducted a survey of primary care physicians to determine physician use and amenability to use of nonphysician health care providers to perform skin cancer screening in comparison with other cancer screening examinations. RESULTS: A total of 1,363 eligible physicians completed the survey. Of these, 631 physicians (46%) reported a nurse practitioner or physician assistant performing at least one type of cancer screening examination on their patients. Twenty-nine and 22% of all physicians reported nurse practitioners or physician assistants performing skin cancer screening, respectively. Family physicians were more likely to use nurse practitioners and physician assistants to perform these cancer screening examinations than internists (chi(2) test, P = 0.001 for each examination). Skin examinations were performed less frequently by nurse practitioners and physician assistants than all other cancer screening examinations. A total of 73-79% of family physicians and 60-70% of internists were amenable to having a nonphysician health care provider perform one or more of these examinations. CONCLUSIONS: Primary care physicians are currently utilizing nonphysician health care providers to perform cancer screening examinations and the majority of those surveyed are amenable to the use of these providers for such examinations. This suggests that one possible strategy for increasing skin cancer screening is through an expanded role of nonphysician health care providers.

Clinical Competence↗
PubMed2002

Melanoma or pigmented basal cell carcinoma: a clinical-pathologic correlation with dermoscopy, in vivo confocal scanning laser microscopy, and routine histology.

BACKGROUND/PURPOSE: New techniques are being explored for improving diagnostic accuracy of pigmented skin lesions. Confocal scanning laser microscopy (CSLM) may represent such a novel technique. The purpose of this report was to demonstrate the potential application of CSLM as an aid in the diagnosis of a pigmented skin lesion that is clinically suspicious for melanoma. METHODS: An irregular pigmented lesion was examined clinically and dermoscopically. The lesion was imaged by CSLM and subsequently excised for histologic examination. Findings from CSLM were correlated with features observed on the dermoscopic and histologic examination. RESULTS: Confocal scanning laser microscopy (CSLM) allowed for the non-invasive visualization of the histologic features of superficial pigmented BCC, including buds and "islands" of tumor cells at the dermoepidermal junction and melanin-laden macrophages. Conventional histology confirmed the diagnosis of pigmented BCC. CONCLUSION: Confocal scanning laser microscopy (CSLM) may serve as an aid in the non-invasive diagnosis of pigmented skin lesions clinically suspicious for melanoma.

Aged↗
PubMed2002

Use of dynamic telepathology in Mohs surgery: a feasibility study.

BACKGROUND: Telepathology is an emerging technology for remote pathology consultation and diagnosis. OBJECTIVE: To assess the diagnostic accuracy and utility of a dynamic telepathology system in the setting of Mohs surgery. METHODS: Using a dynamic telepathology system, a single dermatopathologist at a remote site assessed the following cases: (1) 50 fixed-tissue slides of basal and squamous cell carcinomas for pathologic diagnosis; (2) 40 frozen-section slides from Mohs surgery for the presence or absence of tumor; (3) 20 frozen-section slides from Mohs surgery for intraoperative consultation with the Mohs surgeon. All 110 slides were then randomly reviewed by the same dermatopathologist by conventional light microscopy. Telepathology and conventional light microscopy diagnoses were then compared. RESULTS: There was complete agreement between telepathology and conventional light microscopy diagnoses. CONCLUSION: Dynamic telepathology is a convenient, useful, and accurate system for remote diagnosis and consultation in the setting of Mohs surgery.

Basal Cell Carcinoma↗
PubMed2002

Intralesional corticosteroid treatment of multiple eruptive keratoacanthomas: case report and review of a controversial therapy.

BACKGROUND: Use of intralesional corticosteroids in the management of keratoacanthomas has been reported in older literature. Yet this therapy is no longer a commonly considered treatment option. OBJECTIVE: To report management of a therapeutically challenging patient with multiple eruptive keratoacanthomas with intralesional corticosteriod treatment to revive awareness of this treatment option. METHODS: A 55-year-old female with frequent episodes of multiple eruptive keratoacanthomas was treated with intralesional corticosteroids and methotrexate. RESULTS: Intralesional corticosteroids successfully treated eruptive keratoacanthomas with complete regression and minimal scarring within 2-4 weeks. CONCLUSION: Despite its limitations, intralesional corticosteroids may have a role in the treatment of select keratoacanthomas.

Arm↗
PubMed2002

P gene as an inherited biomarker of human eye color.

Human pigmentation, including eye color, has been associated with skin cancer risk. The P gene is the human homologue to the mouse pink-eye dilution locus and is responsible for oculocutaneous albinism type 2 and other phenotypes that confer eye hypopigmentation. The P gene is located on chromosome 15q11.2-q12, which is also the location of a putative eye pigmentation gene (EYCL3) inferred to exist by linkage analysis. Therefore, the P gene is a strong candidate for determination of human eye color. Using a sample of 629 normally pigmented individuals, we found that individuals were less likely to have blue or gray eyes if they had P gene variants Arg305Trp (P = 0.002), Arg419Gln (P = 0.001), or the combination of both variants (P = 0.003). These results suggest that P gene, in part, determines normal phenotypic variation in human eye color and may therefore represent an inherited biomarker of cutaneous cancer risk.

Carrier Proteins↗
PubMedDate not supplied

Skin self-examination in patients at high risk for melanoma: a pilot study.

PURPOSE/OBJECTIVES: To compare the effect of providing high-risk patients with standard brochures versus personalized photo books as part of a comprehensive nursing intervention on knowledge, awareness, and confidence with skin self-examination (SSE) performance, as well as compliance in performing SSE. DESIGN: Randomized intervention design. SETTING: The Lawrence E. Rockefeller Ambulatory Outpatient Cancer Center at Memorial Sloan-Kettering Cancer Center in New York, NY. SAMPLE: 100 patients at high risk for melanoma. METHODS: Patients completed a baseline questionnaire before their initial photographs were taken and at the end of a nurse-teaching intervention at the clinic. MAIN RESEARCH VARIABLES: Skin cancer knowledge, awareness, and self-confidence in SSE. FINDINGS: A two-way analysis of variance with repeated measures was performed to examine differences within and among groups in relation to knowledge, awareness, and confidence. The group-time interaction was not significant. In group A (nursing intervention with photo book), 10% of the patients at baseline reported performing SSE three or more times during the prior four months. Mean knowledge scores, awareness, and confidence scores all increased. In group B (nurse-teaching intervention using brochures only, without a photo book), 20% reported practicing SSE three or more times during the prior four months. Mean knowledge, awareness, and confidence scores increased. CONCLUSIONS: The main difficulty that patients experience with self-detection of melanoma is their limited recall of skin appearance; therefore, photographic records may be the most effective aid for detecting changes at longer intervals. The use of a photo book may help to diminish that difficulty. IMPLICATIONS FOR NURSING: This study supports the fact that education can increase knowledge, awareness, and confidence regarding SSE, which is consistent with the findings of other investigators. Therefore, nurses should incorporate teaching patients how to perform SSE into their practice and recognize that personal involvement in health care has become a dominant theme in the cancer education literature in recent years. With this new emphasis, important self-care activities, such as testicular self-examination, breast self-examination, and now SSE, are being stressed because early detection has shown favorable effects in improving the prognosis of cancer.

Analysis of Variance↗
PubMedDate not supplied

Overcoming obstacles to skin cancer examinations and prevention counseling for high-risk patients: results of a national survey of primary care physicians.

OBJECTIVE: Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices. METHODS: In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, internists, and general practitioners sampled from the American Medical Association's Medical Marketing Services' database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35. RESULTS: We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination (P < .01). CONCLUSIONS: Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

Health Care Surveys↗