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Biomedical subjects

Glen M Bowen

Publications and source records attributed to Glen M Bowen.

8 recordsLinked to original sources
PubMed2006

Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment.

BACKGROUND: Lentigo maligna (LM) is a subtype of melanoma in situ that typically develops on sun-damaged skin. Presentation may be quite subtle and delayed diagnosis is common. Clinical margins are often ill defined. Histologic evaluation can be difficult due to the widespread atypical melanocytes that are present in the background of long-standing sun damage. Recurrence following standard therapies is common. OBJECTIVE: To review the clinical features, histopathology, and treatment options for LM. Emphasis is placed on recent advances in the treatment of LM. METHODS AND MATERIALS: Literature review. RESULTS: The estimated lifetime risk of LM progressing to LM melanoma is 5%. Standard excision of LM with 5 mm margins is insufficient in 50% of cases. The recurrence rate with standard excision ranges from 8 to 20%. Mohs surgery and staged excision may offer better margin control and lower recurrence rates (4-5%). Estimates of recurrence rates following nonsurgical therapies such as cryosurgery, radiotherapy, electrodessication and curettage, laser surgery, and topical medications range from 20 to 100% at 5 years. CONCLUSIONS: Adequate treatment of LM requires a comprehensive knowledge of the diagnostic features, histopathology, and treatment options. Surgical modalities with meticulous evaluation of tissue margins appears to offer the lowest rates of disease recurrence.

Cryotherapy↗
PubMed2006

Usefulness (or lack thereof) of immunophenotyping in atypical cutaneous T-cell infiltrates.

Our purpose was to evaluate the interobserver concordance for the diagnoses of mycosis fungoides (MF), atypical dermatoses (AD), and benign dermatoses (BD) and the impact of T-cell immunophenotyping on the diagnoses MF, AD, and BD. Specimens of MF (n = 57), AD (n = 27), BD and normal skin (n = 54) were reviewed by 2 hematopathologists and 1 dermatopathologist to establish diagnostic interobserver concordance by routine morphologic examination. Immunophenotyping was performed to evaluate expression of CD2, CD3, CD4, CD5, CD7, CD8, CD20, CD30, and MIB-1. The interobserver concordance was fair to moderate compared with the original diagnosis. Partial deletion of CD2 alone was associated significantly with MF. Epidermal deletions of 2 or 3 T-cell antigens or 2 T-cell antigens not including CD7 were associated significantly with MF. An elevated CD4/CD8 ratio correlated with MF. Morphologic features were most diagnostic of MF. Immunophenotyping generally resulted in downgrading of the reaction pattern but was helpful in distinguishing MF from benign dermatoses.

Adult↗
PubMed2005

Mohs micrographic surgery.

Mohs micrographic surgery is an approach to skin cancer removal that aims to achieve the highest possible rates of cure and to minimize the size of the wound and consequent distortions at critical sites such as the eyes, ears, nose, and lips. Mohs micrographic surgery is a two-step, same-day procedure performed with local anesthetic. It involves removing the tumor in stages by histologically confirming clear margins on frozen sections and by addressing the resultant defect. Options for healing include second intent, primary closure, local flaps, interpolation flaps, and grafts. Larger tumors may require referral for reconstructive surgery. Mohs micrographic surgery is the treatment of choice for skin tumors in critical sites, large or recurrent tumors, tumors in sites of radiation therapy, and tumors with aggressive histologic features.

Humans↗
PubMed2004

Motivating factors for attendance of skin cancer screenings.

Skin cancer screenings have the potential to reduce melanoma morbidity and mortality, especially if participants are from high-risk subgroups. Little is known about targeting these subgroups. This study investigates the attendance motivations of screening participants, including men 50 years of age and older, who are at heightened risk.

Age Distribution↗
PubMed2003

Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant.

PURPOSE: Although metastases to the fetus via the placenta are rare, melanoma is the most common culprit. When it occurs, maternally derived melanoma metastasis in the infant is almost invariably fatal. PATIENTS AND METHODS: This article reviews current guidelines for placental evaluation in pregnant women with metastatic melanoma and presents surveillance recommendations for their infants. Comprehensive literature reviews were performed on melanoma in pregnancy and melanoma metastasis to the placenta and fetus. The use of interferon alfa in the pediatric population was also reviewed. A comprehensive search of the MEDLINE database (1966 to 2002) was performed. Articles were reviewed and additional references were obtained from the bibliographies. Translation of non-English articles was performed, and authors of previous publications were contacted. RESULTS: Eighty-seven patients with placental or fetal metastasis were identified. Twenty-seven occurrences were attributed to melanoma (31%). The fetus was affected in six of 27 melanoma patients (22%), with five of six infants dying of disease. The use of high-dose interferon alfa adjuvant therapy in pediatric patients has not been reported. CONCLUSION: The placentas of women with known or suspected metastatic melanoma should be carefully examined grossly and histologically by pathologists. With placental involvement, fetal risk of melanoma metastasis is approximately 22%. Neonates delivered with concomitant placental involvement should be considered a high-risk population. The risk-benefit ratio of adjuvant treatment for a potentially affected infant should be carefully weighed.

Female↗
PubMed2003

Histopathologic recognition of involved margins of lentigo maligna excised by staged excision: an interobserver comparison study.

OBJECTIVES: To assess interobserver and intraobserver concordance for identifying positive and negative margins in staged excisions of lentigo maligna and lentigo maligna melanoma and to determine if control biopsy specimens are useful to improve concordance. DESIGN: Retrospective, randomized interobserver and intraobserver comparison study of archived pathologic specimens. The study was conducted in 3 phases, and slides were evaluated blindly and independently by 5 pathologists: in phase 1, all slides were randomized and diagnosed as positive or negative. In phase 2, every third slide was evaluated again and diagnosed as positive or negative. In phase 3, slides were organized into cases, allowing evaluation of each margin in the context of the positive control (tumor from the center of the lesion) and negative control (control biopsy specimen), if available. SETTING: University referral center. STUDY MATERIAL: A total of 301 glass microscopic slides from 27 patients who underwent staged excision for lentigo maligna or lentigo maligna melanoma from March 1997 to April 2001. MAIN OUTCOME MEASURES: Interobserver and intraobserver concordance between original diagnoses and study diagnoses rendered on all slides by 5 pathologists. RESULTS: Phase 1 and 3 agreement was moderate (kappa range, 0.4-0.5). Phase 2 (intraobserver) agreement was moderate to good for all pathologists (kappa range, 0.6-0.9). Subset analysis revealed a statistically significant increase in agreement with the use of a control strip biopsy specimen for difficult slides. CONCLUSIONS: Interobserver concordance for margin analysis in lentigo maligna and lentigo maligna melanoma is moderate, and intraobserver concordance is moderate to good. A control strip biopsy specimen may improve concordance in some cases.

Adult↗
PubMed2002

Histologic evaluation of lentigo maligna with permanent sections: implications regarding current guidelines.

BACKGROUND: Obtaining clear margins of resection of lentigo maligna (LM), a subtype of melanoma in situ, from sun-damaged skin of the head and neck continues to be a surgical challenge. The margins may be uncertain both clinically and histologically, causing difficulty in determining the surgical excision perimeter. OBJECTIVE: We sought to determine whether the current National Institutes of Health consensus conference (1992) recommendation of 5-mm margins is adequate for the removal of LM and to evaluate at what stage tumor-free margins are ultimately attained by using polygonal, staged excisions. METHODS: Ninety-two cases of LM were evaluated and treated in a university tertiary care setting. Straight-edge polygonal resections in a staged fashion of LM variants of MIS were evaluated by means of permanent serial histopathologic sections. Each stage of resection used a 5-mm margin. Specimens were color-coded and mapped. Any sites of tumor at resected margins were identified by a dermatopathologist and noted on the map of the excised specimen. Positive margins and areas with markedly atypical melanocytes were further resected, color-coded, mapped, and evaluated as previously described until margins free of tumor were attained. RESULTS: The patient distribution was 37% female and 63% male, with ages ranging from 24 to 100 years (median age, 70 years). Sixty-nine patients had a biopsy-proven diagnosis of LM involving the head and neck (75%), and 23 patients (25%) had LM elsewhere. Thirty-nine patients (42%) were tumor-free after one stage, 25 (27%) required 2 stages, 14 (15%) required 3 stages, 6 (7%) required 4 stages, and 8 (9%) needed 5 or more stages to achieve tumor-free margins. The central portion of the submitted polygonal excisions revealed an invasive component in 16% of cases. CONCLUSIONS: Use of polygonal perimeter excisions with serial histopathologic permanent sections in a staged fashion is an accurate and thorough method of evaluating and treating LM. This study demonstrates that the standard recommendation of 5-mm margins is adequate in less than 50% of cases and reiterates the need for the careful evaluation of peripheral margins in LM. Because an invasive component can be present and would alter recommended surgical depths and margins, all of the tumor should be submitted at the first stage rather than peripheral margins only.

Adult↗