Melanoma: Bichakjian CK

Coit DG, Andtbacka R, Bichakjian CK, Dilawari RA, Dimaio D, Guild V, Halpern AC, Hodi FS, Kashani-Sabet M, Lange JR, Lind A, Martin L, Martini MC, Pruitt SK, Ross MI, Sener SF, Swetter SM, Tanabe KK, Thompson JA, Trisal V, Urist MM, Weber J, Wong MK, Anonymous00048. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #19401060 No free full text.

This publication has no abstract.

Johnson TM, Sondak VK, Bichakjian CK, Sabel MS. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA. · J Am Acad Dermatol. · Pubmed #16384752 No free full text.

This publication has no abstract.

Frankel TL, Griffith KA, Lowe L, Wong SL, Bichakjian CK, Chang AE, Cimmino VM, Bradford CR, Rees RS, Johnson TM, Sabel MS. · Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. · Ann Surg Oncol. · Pubmed #18626721 No free full text.

Abstract: INTRODUCTION: Multiple attempts have been made to identify melanoma patients with a positive sentinel lymph node (SLN) who are unlikely to harbor residual disease in the nonsentinel lymph nodes (NSLN). We examined whether the size and location of the metastases within the SLN may help further stratify the risk of additional positive NSLN. METHODS: A review of our Institutional Review Board (IRB)-approved melanoma database was undertaken to identify all SLN positive patients with SLN micromorphometric features. Univariate logistic regression techniques were used to assess potential significant associations. Decision tree analysis was used to identify which features best predicted patients at low risk for harboring additional disease. RESULTS: The likelihood of finding additional disease on completion lymph node dissection was significantly associated with primary location on the head and neck or lower extremity (P = 0.01), Breslow thickness >4 mm (P = 0.001), the presence of angiolymphatic invasion (P < 0.0001), satellitosis (P = 0.004), extranodal extension (P = 0.0002), three or more positive SLN (P = 0.02) and tumor burden within the SLN >1% surface area (P = 0.004). Sex, age, mitotic rate, ulceration, Clark level, histologic subtype, regression, and number of SLN removed had no association with finding a positive NSLN. Location of the metastases (capsular, subcapsular or parenchymal) showed no correlation with a positive NSLN. Decision tree analysis incorporating size of the metastatic burden within the SLN along with Breslow thickness can identify melanoma patients with a positive SLN who have a very low risk of harboring additional disease with the NSLN. CONCLUSION: Size of the metastatic burden within the SLN, measured as a percentage of the surface area, helps stratify the risk of harboring residual disease in the nonsentinel lymph nodes (NSLN), and may allow for selective completion lymphadenectomy.

Orringer JS, Fendrick AM, Trask PC, Bichakjian CK, Schwartz JL, Wang TS, Karimipour DJ, Johnson TM. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA. · J Am Acad Dermatol. · Pubmed #16021114 No free full text.

Abstract: OBJECTIVE: Little is known about the effects of videotape-based education on knowledge and anxiety levels among patients with melanoma. We sought to evaluate effects of a professionally produced videotape on the knowledge and distress levels among patients with newly diagnosed melanoma. Secondarily, we sought to compare these effects with those of a traditional clinic visit. METHODS: We conducted a randomized controlled trial involving 217 patients. An intervention group underwent questionnaire-based testing of melanoma knowledge and anxiety/distress levels before and after viewing an educational videotape. A control group underwent similar testing before and after a clinic visit. RESULTS: The videotape and clinical encounter significantly increased knowledge and decreased anxiety. Improvement in knowledge levels was significantly greater after viewing the videotape compared with the clinic visit, whereas anxiety levels decreased to a greater degree after the clinical encounter. Whether or not a synergistic relationship may exist between exposure to an educational videotape and a physician visit was not specifically evaluated in this study. CONCLUSION: Videotape-based education may be more effective than that provided by a clinic visit, whereas the clinical encounter appears to be more effective in alleviating patient anxiety/distress.

Karimipour DJ, Schwartz JL, Wang TS, Bichakjian CK, Orringer JS, King AL, Huang CC, Johnson TM. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA. · J Am Acad Dermatol. · Pubmed #15858469 No free full text.

Abstract: BACKGROUND: A significant portion of cutaneous melanoma may remain after subtotal incisional biopsy. The accuracy of microstaging and impact on clinical practice in this scenario are unknown. OBJECTIVE: Our purpose was to examine microstaging accuracy of an initial incisional biopsy with a significant portion of the clinical lesion remaining (> or =50%). METHODS: Patients with cutaneous melanoma, diagnosed by incisional biopsy with > or =50% of the lesion remaining, were prospectively evaluated for microstaging accuracy, comparing initial Breslow depth (BD1) to final depth (BD2) after excision of the residual lesion. Impact on prognosis and treatment was also evaluated. RESULTS: Two hundred fifty of 1783 patients (14%) presented with > or =50% residual clinical lesion after incisional biopsy. The mean BD1 was 0.66 mm; the mean BD2, 1.07 mm (P = .001). After complete excision of the residual lesion, upstaging occurred in 21% and 10% became candidates for sentinel node biopsy. CONCLUSION: An incisional biopsy with > or =50% clinical lesion remaining afterward may be inadequate for accurate microstaging of melanoma. This scenario is relatively uncommon but clinically significant.

Sabel MS, Strecher VJ, Schwartz JL, Wang TS, Karimipour DJ, Orringer JS, Johnson T, Bichakjian CK. · Department of Surgery, University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor, Michigan, USA. · J Am Acad Dermatol. · Pubmed #15858466 No free full text.

Abstract: BACKGROUND: Patients with cancer and their families frequently, and increasingly, turn to outside sources for information, particularly the World Wide Web. Our objective was to examine the use of the Internet and its impact among patients with melanoma. METHODS: A prospective survey was obtained from 1613 consecutive patients with cutaneous melanoma seen at our institution between August 2001 and February 2003. Main outcome measures included the ability to access the Internet, Internet use to search for melanoma information, and responses to such Internet searches. Further analysis of whether there were differences based on age, sex, or disease severity was performed. RESULTS: Of patients with melanoma, 39% indicated that they had used the Internet to research their disease, 30% themselves and 9% had someone else do it for them. Nearly half (47%) of patients younger than 40 years researched melanoma on the Internet compared with only 12% of patients 60 years or older. Neither sex nor disease severity impacted Internet use. The vast majority of patients (94%) thought the Internet was useful, 67% believed it helped them better understand their condition, and 45% said they would recommend using the Internet to others to find information about medical conditions. Roughly a third thought it decreased their anxiety, whereas a similar proportion believed the Internet made them more anxious. Increased anxiety correlated with decreasing age and increasing disease severity. CONCLUSIONS: The use of the Internet is common among patients with melanoma. Anxiety attributed to online information about their disease suggests that clinicians caring for patients with melanoma should familiarize themselves with online melanoma information, and be proactive in assisting their patients in using this resource.

Bhavnani SK, Bichakjian CK, Schwartz JL, Strecher VJ, Dunn RL, Johnson TM, Lu X. · School of Information, University of Michigan, Ann Arbor, MI 48109, USA. · Proc AMIA Symp. · Pubmed #12463785 links to  free full text

Abstract: To address the growing problem of novices accessing incomplete and unreliable information on the Web, this paper begins by probing the nature of strategic knowledge known by expert healthcare searchers. The analysis reveals the existence of a strategy that is focused to a specific type of healthcare question. To investigate whether there exist other similar strategies, we conduct two pilot studies. The first leads to the development of a taxonomy for skin cancer questions based on real-world questions. This taxonomy has high inter-rater agreement when tested with new real-world questions. The second pilot helps to identify 6 strategies that are specific to question types in the taxonomy. We demonstrate how these strategies can be made available to a wide range of users through a prototypical system referred to as a Strategy Portal. In conclusion, we briefly describe our current and future research to test if such a system can make patients more effective and efficient in the retrieval of reliable and relevant healthcare information on the Web.

Bichakjian CK, Schwartz JL, Wang TS, Hall JM, Johnson TM, Biermann JS. · Department of Dermatology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0946, USA. · J Clin Oncol. · Pubmed #11773162 No free full text.

Abstract: PURPOSE: To assess the accuracy and completeness of information regarding melanoma on the Internet, retrieved by use of search engines. METHODS: The first 30 uniform/universal resource locators (URLs) from each of eight search engines using the search term "melanoma" were retrieved for evaluation of accuracy and completeness using a 35-point checklist rating system instrument. Four reviewers independently rated each of 35 sites, and one reviewer rated all 74 assessable sites. Kappa statistics were used to evaluate interrater variability. RESULTS: A total of 74 assessable Web sites were evaluated. The remainder were inaccessible, link pages only, or duplicates. Thirty-five Web sites were each independently rated by four reviewers. The remaining 39 Web sites were each rated by one reviewer. The mean kappa statistic for all variables and all rater pairs for which a kappa could be calculated was 0.824, indicating excellent overall inter-rater reliability. The majority of Web sites failed to include complete information on general information, risk factors, diagnosis, treatment, prevention, and prognosis. Ten Web sites (14%) contained a total of 13 inaccuracies, most relatively minor. CONCLUSION: Medical information retrieved with the search term melanoma was likely to lack complete basic melanoma information and contained inaccuracies in 14% of sites. Health care providers can help patients by recommending comprehensive and accurate Web sites for patient review, by working to create accurate and thorough Web-based health information material, and by educating patients and the public about the variability in completeness and accuracy.