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John A Carucci

Publications and source records attributed to John A Carucci.

12 recordsLinked to original sources
PubMed2006

Genomic analysis defines a cancer-specific gene expression signature for human squamous cell carcinoma and distinguishes malignant hyperproliferation from benign hyperplasia.

Using high-density oligonucleotide arrays, we measured expression of >12,000 genes in surgical excisions of invasive human squamous cell carcinomas (SCCs) versus site-matched control skin. This analysis defined >1,900 genes with altered expression in SCCs that were statistically different from controls. As SCCs are composed of epithelial cells, which are both hyperplastic and invasive, we sought to define gene sets associated with these biologic processes by comparing gene expression to psoriasis vulgaris, which is a condition of benign keratinocyte hyperplasia without invasiveness or pre-malignant potential. Through this analysis, we found genes that were commonly upregulated in both conditions and unique genes with increased expression in SCCs. Differential gene regulation in these two conditions was confirmed by real-time reverse transcription-PCR and immunohistochemistry. We found that benign hyperplasia is associated with upregulation of genes including DEFB4 (defensin B4), SERPINB3 (serine proteinase inhibitor, member 3), STAT1 (signal transducer and activator of transcription 1), K16 (keratin 16), CEACAMs (carcinoembryonic antigen-related cell adhesion molecules), and WNT 5A (wingless-type MMTV integration site family, member 5A). WNT receptor frizzled homolog 6 (FZD6) and prostaglandin-metabolizing enzyme hydroxyprostaglandin dehydrogenase were increased in SCC alone. Growth factor pleiotrophin (PTN) was expressed at higher levels in non-tumor-bearing skin adjacent to excised SCC. SCC was further characterized by upregulation of matrix metalloproteinases 1, 10, and 13, cathepsin L2, cystatin E/M as well as STAT3 and microseminoprotein, beta (MSMB), and downregulation of inducible nitric oxide synthase, granzyme B, CD8, and CD83. The current study defines a unique gene expression signature for cutaneous SCC in humans and suggests potential roles for WNT, FZD, and PTN in the pathogenesis of SCC.

Carcinoma, Squamous Cell↗
PubMed2005

Melolabial flap repair in nasal reconstruction.

Nasal reconstruction can be challenging due to the complex nature of multiple cosmetic units and functional considerations. This article discusses single- and two-staged melolabial flap repairs for nasal reconstruction following removal of skin cancers.

Humans↗
PubMed2004

Specialty clinics for the dermatologic care of solid-organ transplant recipients.

BACKGROUND: Solid-organ transplant recipients constitute a complex patient population that experiences numerous and aggressive skin cancers. Proactive, comprehensive, ongoing, and effective dermatologic care of these patients is a necessity. OBJECTIVE: The objective of this study was to emphasize the need for organized dermatologic care for transplant recipients and to collect and present various proactive paradigms established in and designed for different practice settings to manage organ transplant recipients at high risk for skin cancer. METHODS: Information about practice setting, patient demographics, and the care model used was obtained through questionnaires sent to a selection of 12 physicians known to care for transplant recipients in various practice settings. RESULTS: All 12 physicians completed the questionnaire. The organized dermatologic care of transplant recipients occurs in three basic clinic settings: multidisciplinary transplant clinics, designated dermatology transplant subspecialty clinics, and integration of transplant recipient care within existing dermatology clinics. CONCLUSIONS: Various practice settings offer both advantages and disadvantages in providing preventive and therapeutic care of organ transplant recipients at risk for skin cancer. Regardless of the clinic design used, an organized and firmly established clinic model to allow proactive and ongoing care for these patients is important for education, prevention, and early intervention.

Dermatology↗
PubMed2004

Guidelines for the management of squamous cell carcinoma in organ transplant recipients.

BACKGROUND: Solid-organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma (SCC) and often develop multiple and aggressive tumors. There are few published studies or reviews, which provide guidance to the clinician in the treatment of these patients. OBJECTIVE: The objective was to develop useful clinical guidelines for the treatment of skin cancer in organ transplant recipients (OTRs). METHODS: The members of the Guidelines Committee of the International Transplant-Skin Cancer Collaborative (ITSCC) carried out a computerized search utilizing the databases of the National Library of Medicine for reports in the literature on SCC in OTRs. These reports were collectively examined by the group and combined with experiences from the members' clinical practices in the development of the guidelines. RESULTS: More than 300 articles relating to SCC in OTRs were reviewed. In general, reports concerning the prevention and treatment of SCC in OTRs are of individual cases or small case series. They are retrospective in nature, statistically nonrigorous, and lack the complete epidemiologic data necessary to derive definitive conclusions. Combining these studies and collective clinical experience, however, is at present the best available method for devising guidelines for the treatment of SCC in OTRs. CONCLUSION: Guidelines developed for the treatment of skin cancer in OTRs, supported by the best available data and collective clinical experience, may assist in the management of OTRs with SCC. The development of clinical pathways and complete documentation with rigorous prospective study is necessary to improve and refine future guideline development.

Carcinoma, Squamous Cell↗
PubMed2004

In-transit metastasis from primary cutaneous squamous cell carcinoma in organ transplant recipients and nonimmunosuppressed patients: clinical characteristics, management, and outcome in a series of 21 patients.

BACKGROUND: In-transit metastases from cutaneous squamous cell carcinoma (SCC) may occur in organ transplant recipients and may indicate aggressive disease and poor prognosis. OBJECTIVE: The objective of this study was to describe in-transit metastases from cutaneous SCC and to identify factors associated with this phenomenon in a series of 21 patients. We also attempted to evaluate outcome with respect to status as an organ transplant recipient or nonorgan transplant recipient. METHODS: A multicenter case series of patients was reviewed; factors included clinical presentation, management, and outcome. RESULTS: Twenty-one patients, 15 organ transplant recipients, and 6 nontransplant recipients with in-transit metastases were reviewed. In-transit metastases presented most commonly as discrete, dermal papules distinct from but in the vicinity of the primary tumor site. Histologic differentiation was variable. At a mean follow up of 24 months, 33% the transplant patients had no evidence of disease compared with 80% of nontransplant patients. Thirty-three percent were dead from disease and 33% were alive with nodal or distant metastases. In contrast, 80% of nonimmunosuppressed patients had no evidence of disease and none had died at mean follow-up of 24 months. CONCLUSION: In-transit metastasis from cutaneous SCC is a unique presentation of metastatic SCC, more commonly described in organ transplant recipients, and is associated with poor prognosis in that group. This description represents the largest experience with in-transit metastases from cutaneous SCC in the literature.

Adult↗
PubMed2003

Management of squamous cell carcinoma in organ transplant recipients.

The number of skin cancers continues to rise with well over one million cases of skin cancer expected in the United States this year. Optimal management depends on early detection and treatment. The consequences of skin cancer may be particularly devastating in organ transplant recipients. In this article, management of squamous cell carcinoma in the organ transplant recipient is discussed.

Carcinoma, Squamous Cell↗
PubMed2002

Mohs' micrographic surgery for the treatment of melanoma.

Surgical excision with clear margins remains the treatment of choice for melanoma. Under appropriate conditions MMS may offer a means of achieving clear margins while sparing normal tissue. This requires a Mohs' surgeon expert in interpretation of melanocytic lesions and excellent technical support. As the popularity of special histologic stains continues to grow these may offer and additional means to increase sensitivity and specificity in the detection of melanoma.

Biopsy, Needle↗
PubMed2002

Human cadaveric allograft for repair of nasal defects after extirpation of Basal cell carcinoma by Mohs micrographic surgery.

BACKGROUND: Immediate reconstruction after removal of skin cancer by Mohs micrographic surgery (MMS) may not be feasible in patients unwilling or unable to undergo an extensive procedure. Human cadaveric allograft (HCA) may offer a useful alternative to granulation. OBJECTIVE: To examine the usefulness of HCA in resurfacing nasal defects after extirpation of basal cell carcinoma (BCC) by MMS. METHODS: Case histories of seven patients treated with HCA were reviewed with respect to primary skin cancer histology, defect size, medical status, healing time, and cosmesis. RESULTS: Five of seven tumors were infiltrative BCCs. Defects ranged from 2.7 to 20 cm2. Average healing times for wounds with and without exposed cartilage were 42 and 35 days, respectively. There were no wound infections. Hypergranulation tissue was noted in three patients and had no effect on cosmesis, which was adequate in five patients and poor in two patients. CONCLUSION: HCA may be a useful alternative to granulation following MMS for treatment of skin cancers involving the nose.

Aged↗