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Biomedical subjects

M A Weinstock

Publications and source records attributed to M A Weinstock.

At least 55 records · Page 3Linked to original sources
PubMed1997

Reliability of the histopathologic diagnosis of melanocytic dysplasia. The Dysplastic Nevus Panel.

OBJECTIVE: To determine the reliability of the histopathologic diagnosis of melanocytic dysplasia among diverse dermatopathologists who had no joint training, agreed to abide by predetermined criteria, and who were provided reference photomicrographs illustrative of the criteria. DESIGN, SETTING, AND PARTICIPANTS: A stratified random sample of 112 melanocytic tumors were chosen from the files of the pathology department of a large staff-model health maintenance organization. The original diagnoses included typical and dysplastic melanocytic nevi and melanoma. A single representative slide for each case was interpreted independently by each of the 5 panel dermatopathologists and 2 melanoma specialists. They had no prior knowledge of the original diagnosis or the diagnoses of the other panel members. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Interrater reliability was measured by intraclass and Pearson correlation coefficients. Each case was graded on a 5-point scale from no dysplasia to melanoma. RESULTS: The intraclass correlation among the panel members was 0.67 (95% confidence interval, 0.59-0.73). The Pearson correlations of each of the 5 panel dermatopathologists with the mean of the 2 melanoma specialists ranged from 0.67 to 0.84, and the correlations of the mean of the panel with the 2 melanoma specialists were 0.79 and 0.82; the mean reading of the melanoma specialists correlated 0.89 with the mean panel reading. Apparent protocol violations occurred in 6.5% of the readings. CONCLUSIONS: Agreement was substantial to excellent for the histopathologic diagnosis of 112 melanocytic tumors by dermatopathologists. Using predetermined criteria, melanocytic dysplasia can be reproducibly graded among diverse general dermatopathologists.

Case-Control Studies↗
PubMed1997

Theoretical and empirical arguments in relation to elective lymph node dissection for melanoma.

Nearly a century of clinical inquiry has failed to incontrovertibly resolve the question of whether elective lymph node dissection is therapeutically beneficial in the management of clinically localized melanoma. The controversy has been renewed by a recent interim update from the Intergroup Melanoma Surgical Program, sponsored by the National Cancer Institute, which has indicated a small survival benefit in a narrowly defined subgroup of patients with primary melanoma. That report stimulated this review of the data, which are presented in the historical context that originally prompted the Intergroup study. Case selection bias has intractably hindered firm conclusions from the numerous nonrandomized studies of elective lymphadenectomy. The two original randomized trials that were executed during the 1970s failed to uncover any significant effect of the procedure on survival. Definitive conclusions from the recent Intergroup report are limited by the likelihood that the observed therapeutic benefits are a chance occurrence resulting from uncorrected multiple subgroup comparisons. It remains uncertain whether elective lymphadenectomy can be therapeutically beneficial in the management of melanoma. Nevertheless, it is clear that the procedure, or preferably sentinel lymphatic mapping with selective lymphadenectomy, can provide clinically relevant prognostic information, as well as the staging data requisite to adjuvant interferon alfa-2b therapy or enrollment into other adjunctive trials for patients at high risk of clinical relapse.

Elective Surgical Procedures↗
PubMed1997

Death from skin cancer among the elderly: epidemiological patterns.

BACKGROUND: Melanoma has been the focus of early detection efforts of skin cancer because it is the leading cause of death from skin disorders. OBJECTIVE: To document the patterns of mortality from skin cancer throughout life. DESIGN: Population-based mortality registration. SETTING: United States, 1979 through 1991. PATIENTS: Decedents from skin cancer. INTERVENTION: None. MAIN OUTCOME MEASURE: Distribution of deaths from skin cancer by cause of death, age, gender, and race. RESULTS: Skin cancer was responsible for 61458 deaths during the 8 years studied, 72% of which were attributed to melanoma. Melanoma accounted for about 90% of deaths from skin cancer among whites younger than 50 years, but only a minority of deaths among blacks and among whites older than 85 years. CONCLUSION: Efforts at early detection among the elderly white population should focus on both melanoma and nonmelanoma skin cancers.

Adolescent↗
PubMed1996

Melanoma of oronasal mucosa. Population-based analysis of occurrence and mortality.

OBJECTIVES: To document the incidence and trends of oronasal melanoma with time, place, and person and to provide population-based estimates of survival and prognostic factors. DESIGN: Descriptive analysis of 9 population-based cancer registries in the United States for the years 1973 to 1991. SUBJECTS: All patients with primary melanoma of the oronasal mucosa who resided in the registry areas, which included approximately 10% of the US population. INTERVENTIONS: None. RESULTS: The incidence of oronasal melanoma was 0.041/10(5) per year. There were no significant race or gender differences in incidence. Melanomas of the nasal cavity were more common in the northern registry areas, and increased in incidence during the 19-year study period. Oral melanomas were less common in the North, and did not change significantly in incidence. The median survival with oronasal melanoma was 2 years, and the 5-year survival (+/- SE) was 25% (+/- 4%). Advanced age and stage were adverse prognostic features, but no significant differences in the prognosis were noted by anatomic subsite. CONCLUSIONS: We have documented the incidence and prognosis of oronasal melanoma based on a large population-based sample. The prognosis is poor. The epidemiologic features differ substantially from those of cutaneous melanoma.

Adolescent↗
PubMed1996

Congenital nevomelanocytic nevi: proportionate area expansion during infancy and early childhood.

BACKGROUND: The way in which congenital nevomelanocytic nevi (CNN) expand relative to anatomic region during growth is relevant to decisions about optimal timing for surgical excision and assessment for malignant change. OBJECTIVE: Our purpose was to determine how CNN area expands relative to anatomic region during infancy and early childhood. METHODS: Forty-one small CNN in as many subjects were studied from the newborn period. Relative area (CNN area/anatomic region area) was derived for each measure. Proportionate expansion (PE), defined as change in relative area per unit time as a proportion of initial relative area, was calculated. Relative to anatomic region, area expansion of CNN is greater when PE is greater than 0, less when PE is less than 0, and at least double when PE is +1.0 or greater. RESULTS: From the newborn period to last measure (2 to 71 months), PE ranged from -0.7 to +8.8 (median, +0.1). For 66% of CNN (27 of 41), PE was greater than 0. Nine of 39 CNN (15.4%) had PE values of +1.0 or greater during the first 6 months, compared with 1 of 26 cases (3.8%) for the interval beginning at or after 6 months. CONCLUSION: Disproportionately rapid area expansion of CNN may occur during early infancy, related to transient benign neoplasia, delayed pigmentation, and/or error of the methods used in the analysis.

Child, Preschool↗
PubMed1995

Overview of ultraviolet radiation and cancer: what is the link? How are we doing?

Sun exposure has now been established as the most important avoidable cause of nonmelanoma skin cancer (NMSC) and melanoma. With specific reference to melanoma, there are several key issues that remain to be resolved. These include definition of the action spectrum, the importance of systemic effects of sun exposure, whether a tan is protective, the risk of tanning booth exposures, and the efficacy of sunscreens. Also the role, if any, of sun exposure in noncutaneous malignancies remains to be established. Melanoma incidence and mortality have increased dramatically over the past several decades, but these increases have now slowed, and for mortality among those 15 to 45 years of age, decreasing rates are now observed. Improving the coverage of the Surveillance, Epidemiology, and End Results (SEER) registries by requiring pathology laboratories in non-SEER areas to report cancers among SEER area residents will allow correct interpretation of these trends in the future at minimal cost. The available data on trends in NMSC incidence and mortality are suboptimal but suggest a pattern of declining mortality despite increasing incidence. Trends in NMSC morbidity have not been defined. Establishing NMSC registries in a few diverse sentinel areas would allow more reliable inference and monitoring. Techniques are being developed for reducing sun exposures and increasing early detection of skin cancers in the general population, but improved monitoring of incidence, mortality, and morbidity is required to monitor the effects of current and future ozone depletion and to evaluate prevention and early detection measures.

Adolescent↗
PubMed1995

Epidemiology of human papillomaviruses.

The inherent difficulties in the study of HPV infection have made the epidemiology of this common infection complex. The early natural history of HPV infection is similar for all genital and nongenital tissues. Genital HPV infection, however, especially cervical infection, is strongly linked to carcinoma. With the advent of molecular diagnosis of infection, and possible future serologic assays, the natural history of HPV-induced disease and its relationship to the development of invasive carcinoma can lead to more appropriate surveillance and treatment of patients at risk for progression.

Child↗
PubMed1995

Preventing skin cancer through behavior change. Implications for interventions.

Sun exposure is the only major causative factor for skin cancer for which prevention is feasible. Both individual and community-based interventions have been effective in changing sun exposure knowledge and attitudes but generally have not been effective in changing behaviors. An integrative model of behavior change is described that has been successful in changing behavior across a wide range of health conditions. This model holds promise for developing a rational public health approach to skin cancer prevention based on sound behavioral science.

Adolescent↗
PubMed1995

Human papillomavirus and widespread cutaneous carcinoma after PUVA photochemotherapy.

BACKGROUND: Oral psoralen with UV-A (PUVA) photochemotherapy is known to cause cutaneous malignancies and has been associated with cutaneous immunosuppression. Human papillomavirus infection has also been associated with cutaneous malignancies and with immunosuppressed individuals. We therefore sought evidence of human papillomavirus infection in a patient with a long history of PUVA therapy and multiple cutaneous malignancies. OBSERVATIONS: During a 15-year period, an otherwise healthy patient with psoriasis who had undergone a 10-year course of PUVA photochemotherapy developed 13 squamous cell carcinomas, eight lesions diagnosed as "squamous cell carcinoma vs keratoacanthoma," 14 other keratoacanthomas, six basal cell carcinomas, one melanoma in situ, and 18 other keratinocytic dysplasias. Twenty-two of the 30 lesions tested for human papillomavirus DNA by polymerase chain reaction were positive for type 16/18, including six of the seven basal or squamous cell carcinomas tested. CONCLUSION: We hypothesize that PUVA therapy-induced immunosuppression may play an important role in PUVA-related carcinogenesis by affecting the extent and pathogenicity of human papillomavirus infection.

Carcinoma↗
PubMed1995

Assessing clinical outcomes in cutaneous T-cell lymphoma.

It is apparent that multiple end points are required to adequately describe the response to therapy for CTCL. Investigators may differ as to which end points are best suited for their data. In general, multiple end points provide a better overall view of response to treatment as compared with a single end point. Regardless, measures of response and end points should be clearly defined and the methods of calculating end points clearly stated.

Humans↗
PubMed1995

Epidemiology and clinical manifestations of cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) encompasses a constellation of diseases of malignant clonal T lymphocytes that present initially in the skin. Within this disease spectrum, mycosis fungoides, and the Sézary syndrome are best known. Progress in the understanding of the T-cell malignancies now places other clinical entities within this disease classification. The authors review the epidemiology and clinical manifestations of CTCL.

History, 19th Century↗
PubMed1994

Malignant melanoma of the vulva and vagina in the United States: patterns of incidence and population-based estimates of survival.

OBJECTIVES: Our purpose was to describe the incidence of vulvar and vaginal melanoma and to evaluate risk factors. We also aimed to provide population-based estimates of survival and to evaluate prognostic factors. STUDY DESIGN: We calculated incidence rates and survival curves based on 15 years' experience of population-based registries that together cover approximately 10% of the United States population. RESULTS: The incidences of vulvar and vaginal melanoma were 0.108 and 0.026/10(5) per year. White women experienced an increased incidence of vulvar melanoma but not vaginal melanoma (relative risks 2.6 and 1.0 for white women, compared with black women). For vulvar melanoma the 5-year survival was 50%; regional or distant spread, older age, and black race were adverse prognostic factors. For vaginal melanoma the 5-year survival was 19%; black race was an adverse prognostic factor. CONCLUSIONS: Vulvar melanoma and vaginal melanoma differ from nongenital cutaneous melanoma in epidemiologic features, which is consistent with the hypothesized systemic sun-induced melanoma-inhibitory factor and with melanin interference with nonultraviolet carcionogenesis. These population-based data identified prognostic factors and confirmed the poor prognosis of these tumors.

Adolescent↗
PubMed1994

Nonmelanoma skin cancer in the United States: incidence.

Because death from nonmelanoma skin cancer is uncommon, quantification of its morbidity is particularly important. Although its incidence is increasing rapidly, the most recent nationwide estimates are 16 years old. The purpose of this study was to estimate the 1994 nonmelanoma skin cancer incidence in the United States. We updated the 16-year-old incidence estimates to reflect the growth and changing age distribution of the population and the increases in age-adjusted incidence rates documented in two population-based studies. The projected 1994 incidence of nonmelanoma skin cancer in the United States is 900,000 to 1,200,000 cases, similar in magnitude to the overall incidence of noncutaneous cancers. Nonmelanoma skin cancer imposes an enormous public health burden on the U.S. population. Quantification of its morbidity and its prevention are important priorities.

Age Factors↗
PubMed1994

Epidemiology of nonmelanoma skin cancer: clinical issues, definitions, and classification.

There are many forms of nonmelanoma skin cancer, although the term usually refers to the most common forms, basal and squamous cell carcinomas of the skin. The definitions of basal and squamous carcinomas depend on histopathologic features, and clinical diagnoses are often reliable. Various classification schemes have been proposed, including those based on clinical or histologic appearance, etiology, or prognosis. The public health burden of these tumors has not been fully defined and includes mortality, morbidity, social impact, and cost. Measures of morbidity include incidence and measures of impairment, disability, and handicap. Other issues involving etiology, management, prevention, and early detection remain to be investigated further.

Carcinoma, Basosquamous↗
PubMed1994

Epidemiologic investigation of nonmelanoma skin cancer mortality: the Rhode Island Follow-Back Study.

The Rhode Island Follow-Back Study was initiated to elucidate the magnitude and characteristics of nonmelanoma skin cancer mortality. All deaths reported among Rhode Island residents during 1979 through 1987 and attributed to nonmelanoma skin cancer were investigated and medical records sought. Most were misclassified, primarily due to squamous cell carcinoma of mucosal surfaces in the head and neck. In Rhode Island and nationally, this source of misclassification is increasingly frequent. Appropriate adjustment of national statistics for misclassification reveals a consistent decline in nonmelanoma skin cancer mortality rates from 1969 through 1988, although the actual numbers of deaths are increasing due to growth and aging of the population. Examination of the records of those Rhode Island residents who did die from nonmelanoma skin cancer demonstrated that most had squamous cell carcinoma, and many of those arose from the ear. These analyses suggest that particular emphasis should be placed on the ear in public health campaigns geared toward the prevention and early detection of nonmelanoma skin cancer.

Carcinoma, Squamous Cell↗