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J Bolognia

Publications and source records attributed to J Bolognia.

13 recordsLinked to original sources
PubMed2004

Estimating the relative risk of developing melanoma in INK4A carriers.

Estimation of the relative risk of cancer due to rare germline mutations using population-based epidemiological techniques is challenging, since studies with very large numbers of subjects are required. In this pilot study using a novel study design, we evaluated the role of INK4A mutations in melanoma by comparing patients with multiple primary melanomas to those with single primaries. Patients were ascertained from the Surgery and Dermatology Clinics at Memorial Sloan-Kettering Cancer Center and at the Yale University Pigmented Lesion Clinic. Subjects completed a questionnaire covering risk factors for melanoma and were tested for INK4A mutations. Five (8%) of 65 patients with multiple primaries had a mutation, compared with none of 88 patients with single primaries (P=0.03). Examination of other factors, such as number of nevi on the arms of the patients, fair skin, hair and eye colour, and other phenotypic characteristics associated with the risk of melanoma, demonstrates that these factors exhibit higher prevalence in the multiple primary cases than in the single primaries. These results provide evidence of the utility of the new study design in evaluating the impact of rare but highly penetrant cancer risk factors.

Adolescent↗
PubMed1999

Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma.

BACKGROUND: Guidelines for follow-up of melanoma patients are not established. In 1987, a follow-up protocol was instituted at the Yale Melanoma Unit to improve upon the detection of disease recurrence in patients with American Joint Committee on Cancer Stage I-III cutaneous melanoma. The follow-up protocol consists of a patient education program and a surveillance schedule based on stage of disease. METHODS: The authors retrospectively reviewed the records of 373 patients who were seen and followed according to the surveillance protocol in the Yale Melanoma Unit between January 1988 and December 1994 to determine 1) the time interval between the initial visit and recurrence; 2) the most common method of detecting recurrences; 3) whether the surveillance schedule or the patient detects more recurrences, i.e., asymptomatic recurrences versus symptomatic recurrences; 4) whether there is any survival difference between asymptomatic and symptomatic recurrences. RESULTS: The 5-year overall survival rates for Stage I, II, and III patients were 95%, 72%, and 52%, respectively. Of the 78 recurrences, 44 (56%) were detected by physician-directed surveillance examinations and 34 (44%) by patients. Most recurrences were found within the first (47%) or second (32%) year of follow-up. The estimated 6-month hazard rates for death or recurrence were 0.0044, 0.0088, and 0.0278 for Stage I, II, and III patients, respectively. The group of asymptomatic patients with recurrence had a survival advantage over the symptomatic recurrence group. In addition, patients with locoregional recurrence had better survival than those with distant recurrence. CONCLUSIONS: Although many recurrences arise rapidly and are recognized early by patients, in this study more than half were found by surveillance examinations before symptoms were manifest. Based on the hazard ratio for recurrences, the authors recommend the following surveillance schedules in addition to the patient education program for detection of recurrences: 1) Stage I, annually; 2) Stage II, every 6 months for Years 1-2 and annually thereafter; 3) Stage III, every 3 months for Year 1, every 4 months for Year 2, and every 6 months for Years 3-5; 4) at Year 6 and beyond, all patients should have surveillance annually, due to the risk of late recurrence and/or metachronous multiple primaries.

Adolescent↗
PubMed1999

UV light and MSH receptors.

Ultraviolet B (UVB) radiation in the skin induces pigmentation that protects cells from further UVB damage and reduces photocarcinogenesis. Although the mechanisms are not well understood, our laboratory has shown that UVB radiation causes increased MSH receptor activity by redistributing MSH receptors from internal pools to the external surface, with a resultant increase in cellular responsiveness to MSH. By this means, UVB and MSH act synergistically to increase melanin content in the skin of mice and guinea pigs. In humans, MSH causes increased skin pigmentation, predominantly in sun-exposed areas. We have shown recently that UVB irradiation and exposure to MSH or to dbcAMP, stimulates production of mRNAs for both alpha MSH receptors and POMC in human melanocytes and keratinocytes. This indicates that at least one action of UVB on the pigmentary system is mediated through increased MSH receptor production, as well as through the production of the signal peptides, MSH and ACTH, that can further activate MSH receptors. The results add support to the hypothesis that the effects of UVB on cutaneous melanogenesis are mediated through a series of coordinated events in which MSH receptors and POMC-derived peptides play a central role.

Animals↗
PubMed1998

Melanoma x macrophage hybrids with enhanced metastatic potential.

Studies were conducted on the hypothesis that melanoma metastasis might be initiated through the generation of hybrids comprised of cells of the primary tumor and tumor-infiltrating leukocytes. Fusion hybrids were generated in vitro between weakly metastatic Cloudman S91 mouse melanoma cells and normal mouse or human macrophages. Hybrids were implanted s.c. in the tail and mice were monitored for metastases. Controls included parental S91 cells, autologous S91 x S91 hybrids, and B16F10 melanoma cells. Of 35 hybrids tested, most were more aggressive than the parental melanoma cells, producing metastases sooner and in more mice. A striking characteristic was heterogeneity amongst hybrids, with some lines producing no metastases and others producing metastases in up to 80% of mice. With few exceptions, hybrids with the highest metastatic potential also had the highest basal melanin content whereas those with the lowest metastatic potential were basally amelanotic, as were the parental melanoma cells. A spontaneous in vivo supermelanotic hybrid between an S91 tumor cell and DBA/2J host cell was one of the most metastatic lines. Hybrids with the highest metastatic potential also exhibited markedly higher chemotaxis to fibroblast-conditioned media. Histologically, the metastatic hybrids demonstrated vascular invasion and spread to distant organs similar to that of metastatic melanomas in mice and humans. Thus previous findings of enhanced metastasis in leukocyte x lymphoma hybrids can now be extended to include leukocyte x melanoma hybrids. Whether such hybridization is a natural cause of metastasis in vivo remains to be determined; however the fusion hybrids with genetically-matched parents described herein so closely resembled naturally-occurring metastatic melanoma cells that they could serve as useful new models for studies of this complex and deadly phenomenon.

Animals↗
PubMed1997

Regional isolated perfusion of extremities for melanoma: a 20-year experience with drugs other than L-phenylalanine mustard.

Recurrent melanoma of the extremities can lead to bulky symptomatic lesions that become difficult management problems. Treatment of these tumors with isolated limb perfusion with high dose chemotherapy may offer palliation in a number of patients. Unfortunately, the most commonly used drug, L-phenylalanine mustard, has been known to have significant associated tissue toxicity. Therefore, during the years 1976-1995, we perfused 67 limbs in 60 patients with various other drugs: 36 with dimethyltriazeno imidazole carboxamide, 6 with cisplatin, 20 with carboplatin, and 5 with thiotepa). Perfusion was performed for 16 upper extremities and 51 lower extremities using the pump oxygenator for 1 hour. Among the 60 patients, 17 were treated prophylactically for high-risk melanoma, whereas 43 were treated for local and in-transit recurrences. The technique of perfusion successfully isolated the limbs from the systemic circulation: the median leaks over time were 0.5-1.6 percent for the upper extremities, and 0.2-7.5 percent for the lower extremities. Among the 43 patients treated with therapeutic isolated limb perfusion, 11 patients (26 percent) are alive with no evidence of disease for a median of 58 months (range: 8 months to 17 years 9 months), and another 5 patients (12 percent) are alive with recurrence for a median of 45 months (range: 27 months to 10 years 7 months). Four patients required two perfusions, and two patients required three perfusions (one patient has no evidence of disease 6 years after her third perfusion for recurring in-transit disease). There were 19 complications noted after 14 of the 67 perfusions (21%): postoperative edema, 5; seroma, 4; wound separation/infection, 9; and nonfatal pulmonary embolus, 1. In our experience, aggressive treatment in selected patients with regional isolated perfusion of limbs for melanoma has provided meaningful palliation and salvage of the limbs with adequate disease-free control, and occasional survival benefit. This regional treatment modality is associated with meaningful control and with few serious complications, especially when compared with studies using L-phenylalanine mustard. This series illustrates the safety of controlling limb recurrence with this technique, even with repeat perfusions in the same patient.

Adult↗
PubMed1995

Multiple primary melanomas: data and significance.

Cancer statistic reports show that the incidence of melanoma has increased each decade. It is now estimated that approximately 5 percent of the patients with primary cutaneous melanoma will develop another primary melanoma in their lifetime. This report describes the information gathered from 27 patients at the Yale Melanoma Unit who have developed 59 individual primary melanomas; 22 of the patients developed a second primary melanoma, and 5 patients each developed three primary melanomas. In 8 patients (30 percent), the second primary melanoma was diagnosed within 1 month of the first malignancy and was considered synchronous. The remaining 24 melanomas in the 19 patients presented subsequently: 4 (17 percent) within the first year, 7 (29 percent) during the second year, and 13 (54 percent) beyond the second year of the first diagnosis. Although the thickness of the initial melanoma ranged from 0.2 to 6.0 mm, all subsequent melanomas were either in situ or less than 1.0 mm in thickness. This study shows that patients who developed more than one melanoma invariably had thin subsequent lesions. The implications of the multiple melanomas are not a poorer prognosis, but rather that the patients' prognosis is the same as that of the original, or thickest, melanoma.

Adult↗
PubMed1993

The effect of pre-education on patient compliance with full-body examination in a public skin cancer screening.

BACKGROUND: Public skin cancer screening has become increasingly common in recent years. However, currently there is no standardized procedure for these screenings. Full body skin examination as opposed to examination of sun-exposed areas offers several advantages, including the opportunity to diagnose early melanoma in areas normally covered by clothing. Disadvantages of full body skin examination include patient resistance because of inconvenience and concerns about privacy and modesty. The additional time involved in full body skin examination may also be an impediment. OBJECTIVE: In a randomized double-armed study, we studied whether patients were more likely to develop a positive attitude towards full body skin examination if they were advised beforehand, in writing, of the logic underlying the need for a complete examination. METHODS: Patients presenting to a public skin cancer screening were divided into two groups. Group A (N = 111) received a written explanation of the need for full body skin examination and Group B (N = 175) received no information. Patients were then surveyed, after the screening, about their attitudes towards full body skin examination. RESULTS: Those who received pre-education were less likely (P < .05) to be concerned about a genital examination. Those who were concerned about a genital exam were compared with those who were not concerned about a genital exam, the former patients were: 1) younger (P < .05); 2) more concerned about privacy (P < .001); and 3) preferred a physician of the same sex (P < .001). CONCLUSION: Providing patients with information about the need for full body skin examination decreases concern about undergoing a skin genital exam and may minimize resistance to full body skin examination in public skin cancer screenings.

Adult↗
PubMed1990

Eruptive hidradenoma.

This case report emphasizes two clinical findings that aid in the diagnosis of eruptive hidradenoma. They are the predilection of the lesions for the anterior rather than posterior surface of the trunk and the presence of milialike inclusions within the papules. Eruptive hidradenomas are appendageal tumors that differentiate toward intraepidermal eccrine ducts and the milialike papules represent dilated cystic ductal structures. This patient had concomitant involvement of the eyelids, which has been observed in some, but not all, cases of eruptive hidradenoma.

Adenoma, Sweat Gland↗
PubMed1989

UVB-induced melanogenesis may be mediated through the MSH-receptor system.

Ultraviolet B radiation (UVB) elicits an increase in melanin production in mammalian skin. The mechanisms regulating this process are not understood, although it is well documented that there is an increase in the number of melanin-producing melanocytes. The melanotropins (MSH) are a family of peptides that increase the melanin content of melanocytes through an interaction with high affinity receptors. We have obtained evidence that the effects of UVB on melanogenesis may be mediated through an increase in MSH receptor activity on melanocytes. First, exposure of Cloudman S91 mouse melanoma cells to UVB resulted in increased binding of 125I-MSH to cells within 24 h. In five separate experiments, UVB-irradiated cultures displayed 2-10-fold increases in MSH binding capacity over that of unirradiated control cultures (optimum doses 10-20 mJ/cm2). Second, UVB and MSH potentiated one another in promoting cutaneous melanogenesis in both mice and guinea pigs. In the areas of guinea pig skin that received both UVB and MSH, there was a fivefold increase in active melanocytes/mm2 over the sum of active melanocytes/mm2 in areas receiving either MSH or UVB separately. Our results suggest that UVB light causes an increase in MSH receptor activity on cutaneous melanocytes, thus increasing cellular responsiveness to MSH. Implicit in this mechanism is a transduction of radiant energy into chemical energy during the process of UVB-induced melanogenesis.

Animals↗