Susan M Swetter

VA Palo Alto Health Care System, Palo Alto, California, United States

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Publications (93)395.58 Total impact

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    ABSTRACT: While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection.
    Journal of the American Academy of Dermatology 10/2014; 71(4):599.e1-599.e12. · 4.91 Impact Factor
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    ABSTRACT: New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.
    Journal of the American Academy of Dermatology 10/2014; 71(4):611.e1-611.e10. · 4.91 Impact Factor
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    ABSTRACT: Evidence for the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on non-melanoma skin cancer (NMSC) risk is inconsistent. We prospectively examined whether regular, inconsistent, or no/low-use of NSAIDs is associated with lower NMSC risk among 54,728 postmenopausal Caucasian women in the Women's Health Initiative Observational Study enrolled between 1993-1998.
    Preventive medicine. 08/2014;
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    ABSTRACT: Eruptive melanocytic nevi (EMN) are characterized by the sudden onset of numerous melanocytic nevi and have been traditionally described in the setting of immunosuppression. Selective BRAF inhibitors, such as vemurafenib cause multiple cutaneous adverse effects, including the formation of cutaneous squamous cell carcinoma, as well as EMN. We describe the first reported case, to our knowledge, of involution of BRAF inhibitor-induced EMN following the concomitant addition of a MEK inhibitor, cobimetinib.
    JAMA dermatology. 08/2014;
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    ABSTRACT: Morphologic heterogeneity among melanocytic proliferations is a common challenge in the diagnosis of melanoma. In particular, atypical melanocytic lesions in children, adolescents, and young adults may be difficult to classify because of significant morphologic overlap with melanoma. Recently a four-probe fluorescence in situ hybridization (FISH) protocol to detect chromosomal abnormalities in chromosomes 6 and 11 has shown promise for improving the classification of melanocytic lesions. We sought to determine the correlation between FISH results, morphology, and clinical outcomes in a series of challenging melanocytic proliferations in young patients. We retrospectively performed the standard four-probe FISH analysis on 21 melanocytic neoplasms from 21 patients younger than 25 years of age (range 5-25 years, mean 14.6 years) from Stanford University Medical Center who were prospectively followed for a median of 51 months (range 1-136 months). The study cohort included patients with 5 confirmed melanomas, 2 melanocytic tumors of uncertain malignant potential (MelTUMPs), 10 morphologically challenging atypical Spitz tumors (ASTs), and 4 typical Spitz nevi. FISH detected chromosomal aberrations in all five melanomas and in one MelTUMP, in which the patient developed subsequent lymph node and distant metastasis. All 10 ASTs, 4 Spitz nevi, and 1 of 2 MelTUMPs were negative for significant gains or losses in chromosomes 6 and 11q. Our findings demonstrated a strong correlation between positive FISH results and the histomorphologic impression of melanoma. This finding was also true for the MelTUMP with poor clinical outcome. Therefore FISH may serve as a helpful adjunct in the classification of controversial melanocytic tumors in young patients.
    Pediatric Dermatology 06/2014; · 1.04 Impact Factor
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    ABSTRACT: On June 1, 2011, the California Senate passed a bill banning minors from indoor tanning. We aimed to determine whether the bill’s passage was associated with longer-term media coverage regarding skin protection and the risks associated with indoor tanning. Articles from 31 English-language California newspapers between June 2010–May 2011 (PRE) and June 2011–May 2012 (POST) were searched using terms related to skin protection. Ninety articles were found for in-depth coding and analysis. There were more skin protection articles in the POST period than in the PRE period (57 vs 33; p < .05). In addition, there were more POST articles mentioning the risks of indoor tanning (33 vs 10; p < .001), and a POST article was more likely to mention the risks (58 vs 30 %; p < .05). The higher number of POST articles mentioning the risks persisted throughout all quarters. Therefore, the California indoor tanning ban was associated with increased longer-term news coverage of skin protection and the risks associated with indoor tanning. This finding has potential influence on the many states that are considering comparable legislation.
    Journal of Cancer Education 06/2014; · 0.88 Impact Factor
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    ABSTRACT: Little is known about melanoma survivors' long-term symptoms, sun protection practices, and support needs from health providers.
    Supportive Care Cancer 05/2014; · 2.65 Impact Factor
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    ABSTRACT: The NCCN Guidelines for Melanoma provide multidisciplinary recommendations for the management of patients with melanoma. These NCCN Guidelines Insights highlight notable recent updates. Dabrafenib and trametinib, either as monotherapy (category 1) or combination therapy, have been added as systemic options for patients with unresectable metastatic melanoma harboring BRAF V600 mutations. Controversy continues regarding the value of adjuvant radiation for patients at high risk of nodal relapse. This is reflected in the category 2B designation to consider adjuvant radiation following lymphadenectomy for stage III melanoma with clinically positive nodes or recurrent disease.
    Journal of the National Comprehensive Cancer Network: JNCCN 05/2014; 12(5):621-9. · 5.11 Impact Factor
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    ABSTRACT: IMPORTANCE Apart from the atypical mole phenotype, development of new melanocytic nevi in older individuals is uncommon and considered worrisome for melanoma. We performed a retrospective case series in a Veterans Affairs population from 1991 to 2013 to characterize blue nevi (BN) by patient age at biopsy, location, self-reported duration, and relation to prior or subsequent development of cutaneous melanoma. OBSERVATIONS A total of 204 BN were identified in 194 predominantly male patients (90.7%) who had a mean (SD) age of 62.8 (14.4) years. Clinical duration of 10 years or less was reported by 90.3% of patients with available data (32.0%). Histopathologic examination classified 74.0% of BN as common, 1.5% as cellular, and 24.5% as combined type. No malignant BN were identified; however, 18 primary melanomas were diagnosed, most (72.2%) prior to blue nevus biopsy, including 38.9% in situ and 61.1% with mean (SD) Breslow thickness of 1.02 (0.99) mm. CONCLUSIONS AND RELEVANCE The later patient-reported onset of BN suggests a potential alternative mechanism of nevogenesis compared with common acquired nevi and differs from prior reports of BN development in younger adults. The lack of association with melanoma in older individuals suggests that most benign-appearing BN may be safely observed, even in a cohort at higher risk for skin cancer.
    JAMA dermatology. 04/2014;
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    ABSTRACT: Background Knowledge of the factors that influence early detection of melanoma is important in developing strategies to reduce associated mortality.Objectives To identify sociodemographic, behavioural and medical care-related factors associated with melanoma thickness in a low incidence population but with a high case fatality.Methods In a multi-center, retrospective, survey-based study of 202 patients with a recent diagnosis of invasive melanoma (< 1 year), we collected data on demographic and behavioural factors, attitudes towards prevention, access to medical care, frequency of skin self-examination (SSE) and physician skin examination (PSE) in relation to melanoma thickness.ResultsThinner tumours (≤ 1 mm) (80 melanomas) were associated with female gender (P ≤ 0∙049), non-nodular (SSM, LMM and ALM) histologic subtypes (P < 0∙001), absence of ulceration (P ≤ 0∙001), and location other than lower extremity or trunk location (P ≤ 0∙004). Patients married at the time of diagnosis or who performed SSE during the year prior to diagnosis were more likely to have thinner tumours than those who did not (OR 3∙45; 95% CI 1∙48-8∙04 and OR 2∙43; 95% CI 1∙10-5∙34, respectively). Full body skin examination by a physician was not significantly associated with thinner melanoma (OR 1∙99; 95% CI 0∙66-6∙07).ConclusionsSSE was shown to be an important factor in the detection of thin melanoma, in contrast to partial or full body PSE which did not show any statistically significant effect on tumour thickness.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 04/2014; · 3.76 Impact Factor
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    Journal of the American Academy of Dermatology 02/2014; 70(2):e47-8. · 4.91 Impact Factor
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    ABSTRACT: The 2011 International Melanoma Congress, incorporating the annual meetings of the Society for Melanoma Research, the International Melanoma and Skin Cancer Centres, and the International Melanoma Pathology Working Group, was held in Tampa, Florida, USA on 9–13 November 2011. This meeting involved numerous topics of interest to those who treat and study melanoma. A summary of the meeting topics of greatest interest to the dermatologist is presented herein.
    Expert Review of Dermatology 01/2014; 7(2).
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    ABSTRACT: The management of pediatric melanoma (PM) has largely been extrapolated from adult data. However, the behavior of PM appears to differ from its adult counterparts. Therefore, an international PM registry was created and analyzed. Twelve institutions contributed deidentified clinicopathologic and outcome data for patients diagnosed with PM from 1953 through 2008. Overall survival (OS) data were reported for 365 patients with invasive PM who had adequate follow-up data. The mean age of the patients was 16 years (range 1 year-21 years). The 10-year OS rate, 80.6%, tended to vary by patient age: 100% for those aged birth to 10 years, 69.7% for those aged > 10 years to 15 years, and 79.5% for those aged > 15 years to 20 years (P = .147). Patients with melanomas measuring ≤ 1 mm had a favorable prognosis (10-year OS rate of 97%), whereas survival was lower but similar for patients with melanomas measuring > 1 mm to 2 mm, > 2 mm to 4 mm, and > 4 mm (70%, 78%, and 80%, respectively; P = .0077). Ulceration and lymph node metastasis were found to be correlated with worse survival (P = .022 and P = .017, respectively). The 10-year OS rate was 94.1% for patients with American Joint Committee on Cancer stage I disease, 79.6% for those with stage II disease, and 77.1% for patients with stage III disease (P < .001). Tumor thickness, ulceration, lymph node status, and stage were found to be significant predictors of survival in patients with PM, similar to adult melanoma. There is a trend toward increased survival in children aged ≤ 10 years versus adolescents aged > 10 years. Further analyses are needed to probe for potential biological and behavioral differences in pediatric versus adult melanoma. Cancer 2013. © 2013 American Cancer Society.
    Cancer 09/2013; · 5.20 Impact Factor
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    ABSTRACT: Enumerating actinic keratosis (AKs) for clinical and research purposes is highly variable Findings suggest a specific type of AK counting as being more reproducible This information will better capture the outcome of AK treatment. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2013; · 3.76 Impact Factor
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    ABSTRACT: IMPORTANCE Spitz nevi are benign melanocytic proliferations that can sometimes be clinically and histopathologically difficult to distinguish from melanoma. Agminated Spitz nevi have been reported to arise spontaneously, in association with an underlying nevus spilus, or after radiation or chemotherapy. However, to our knowledge, the genetic mechanism for this eruption has not been described. OBSERVATIONS We report a case of agminated Spitz nevi arising in a nevus spilus and use exome sequencing to identify a clonal activating point mutation in HRAS (GenBank 3265) (c.37G→C) in the Spitz nevi and underlying nevus spilus. We also identify a secondary copy number increase involving HRAS on chromosome 11p, which occurs during the development of the Spitz nevi. CONCLUSIONS AND RELEVANCE Our results reveal an activating HRAS mutation in a nevus spilus that predisposes to the formation of Spitz nevi. In addition, we demonstrate a copy number increase in HRAS as a "second hit" during the formation of agminated Spitz nevi, which suggests that both multiple Spitz nevi and solitary Spitz nevi may arise through similar molecular pathways. In addition, we describe a unique investigative approach for the discovery of genetic alterations in Spitz nevi.
    JAMA dermatology (Chicago, Ill.). 07/2013;
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    ABSTRACT: IMPORTANCE Worse survival among patients with melanoma has been demonstrated in middle-aged and older men compared with women, but few studies have explored survival differences by sex in adolescents and young adults, in whom melanoma is the third most common cancer. Focusing on sex disparities in survival among younger individuals may provide further evidence of biological rather than behavioral factors that affect melanoma outcome. OBJECTIVE To determine whether long-term survival varies between white male and female adolescents and young adults with melanoma (15 to 39 years of age at diagnosis) in the United States. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort with a mean follow-up of 7.5 years of 26 107 non-Hispanic white adolescents and young adults with primary invasive melanoma of the skin diagnosed from January 1, 1989, through December 31, 2009, and reported to the Surveillance, Epidemiology, and End Results network of cancer registries. MAIN OUTCOME AND MEASURE Melanoma-specific survival. RESULTS There were 1561 melanoma-specific deaths in the study population. Although adolescent and young adult males accounted for fewer overall melanoma cases (39.8%) than females, they comprised 63.6% of melanoma-specific deaths. Adolescent and young adult males were 55% more likely to die of melanoma than age-matched females after adjustment for tumor thickness, histologic subtype, presence and extent of metastasis, and anatomical location (hazard ratio, 1.55; 95% CI, 1.39-1.73). Males were also more likely to die within each age range assessed (eg, 15-24, 25-29, 30-34, and 35-39 years), and even those with thin melanomas (≤1.00 mm) were twice as likely to die as age-matched females (hazard ratio, 1.95; 95% CI, 1.57-2.42). Adjustment for health insurance and socioeconomic status in a subanalysis did not significantly alter these results. CONCLUSIONS AND RELEVANCE Male sex is associated with worse survival among white adolescents and young adults with melanoma after controlling for thickness and other prognostic factors. Continued public health efforts are necessary to raise awareness of the outcome of melanoma in young men. Further investigation of possible biological mechanisms that account for these sex differences is merited.
    JAMA dermatology (Chicago, Ill.). 06/2013;
  • Mina S Ally, Susan M Swetter, Jean Y Tang
    Future Oncology 06/2013; · 3.20 Impact Factor
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    ABSTRACT: The NCCN Guidelines for Melanoma provide multidisciplinary recommendations on the clinical management of patients with melanoma. This NCCN Guidelines Insights report highlights notable recent updates. Foremost of these is the exciting addition of the novel agents ipilimumab and vemurafenib for treatment of advanced melanoma. The NCCN panel also included imatinib as a treatment for KIT-mutated tumors and pegylated interferon alfa-2b as an option for adjuvant therapy. Also important are revisions to the initial stratification of early-stage lesions based on the risk of sentinel lymph node metastases, and revised recommendations on the use of sentinel lymph node biopsy for low-risk groups. Finally, the NCCN panel reached clinical consensus on clarifying the role of imaging in the workup of patients with melanoma.
    Journal of the National Comprehensive Cancer Network: JNCCN 04/2013; 11(4):395-407. · 5.11 Impact Factor
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    ABSTRACT: BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with decreased risk of gastric, colorectal, and breast cancer. However, the impact of NSAIDs on the risk of melanoma has been inconsistent. The authors evaluated the association between NSAID use and cutaneous melanoma risk in the Women's Health Initiative (WHI) Observational Study (OS). METHODS: At study entry, use of aspirin (acetylsalicylic acid [ASA]) and nonaspirin NSAIDs was assessed among 59,806 postmenopausal Caucasian women ages 50 to 79 years. Cox proportional hazards models were constructed after adjusting for participant skin type, sun exposure history, and medical indications for NSAID use among other confounders. RESULTS: During a median follow-up of 12 years, 548 incident melanomas were confirmed by medical review. Women who used ASA had a 21% lower risk of melanoma (hazard ratio, 0.79; 95% confidence interval, 0.63-0.98) relative to nonusers. Increased duration of ASA use (<1 year, 1-4 years, and ≥5 years) was associated with an 11% lower risk of melanoma for each categorical increase (Ptrend = .01), and women with ≥5 years of use had a 30% lower melanoma risk (hazard ratio, 0.70; 95% confidence interval, 0.55-0.94). In contrast, use of non-ASA NSAIDs and acetaminophen were not associated with melanoma risk. CONCLUSIONS: Postmenopausal women who used ASA had a significantly lower risk of melanoma, and longer duration of ASA use was associated with greater protection. Although this study was limited by the observational design and self-report of NSAID use, the findings suggest that ASA may have a chemopreventive effect against the development of melanoma and warrant further clinical investigation. Cancer 2012. © 2012 American Cancer Society.
    Cancer 03/2013; · 5.20 Impact Factor
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    ABSTRACT: Melanoma is a relatively immunogenic tumor, in which infiltration of melanoma cells by T lymphocytes is associated with a better clinical prognosis. We hypothesized that radiation-induced cell death may provide additional stimulation of an anti-tumor immune response in the setting of anti-CTLA-4 treatment. In a pilot melanoma patient, we prospectively tested this hypothesis. We treated the patient with two cycles of ipilimumab, followed by stereotactic ablative radiotherapy to two of seven hepatic metastases, and two additional cycles of ipilimumab. Subsequent positron emission tomography-computed tomography scan indicated that all metastases, including unirradiated liver lesions and an unirradiated axillary lesion, had completely resolved, consistent with a complete response by RECIST. The use of radiotherapy in combination with targeted immunotherapy as a noninvasive in vivo tumor vaccine strategy appears to be a promising method of enhancing the induction of systemic immune responses and anti-tumor effect.
    Translational oncology 12/2012; 5(6):404-7. · 3.40 Impact Factor

Publication Stats

2k Citations
395.58 Total Impact Points

Institutions

  • 1998–2014
    • VA Palo Alto Health Care System
      Palo Alto, California, United States
  • 1996–2014
    • Stanford Medicine
      • • Department of Dermatology
      • • Department of Pathology
      Stanford, California, United States
  • 1993–2014
    • Stanford University
      • Department of Dermatology
      Palo Alto, California, United States
  • 2012
    • Harvard University
      • Department of Society, Human Development, and Health
      Cambridge, MA, United States
  • 2011
    • Cancer Prevention Institute of California
      Fremont, California, United States
  • 2009
    • Northern California Arthritis Center
      Walnut Creek, California, United States
    • University of Southern California
      • Department of Preventive Medicine
      Los Angeles, CA, United States
    • Boston University
      • Department of Dermatology
      Boston, MA, United States
  • 2008
    • Comprehensive Cancer Centers of Nevada
      Las Vegas, Nevada, United States
    • University of California, Los Angeles
      Los Angeles, California, United States
  • 2006
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2003
    • University of Louisville
      • Division of Surgical Oncology
      Louisville, KY, United States
  • 1994
    • Lucile Packard Children’s Hospital at Stanford
      Palo Alto, California, United States