Susan M Swetter

Stanford University, Palo Alto, California, United States

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Publications (101)475.57 Total impact

  • Alan C Geller, Susan M Swetter, Martin A Weinstock
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    ABSTRACT: Thin fatal melanomas are a relatively new clinical and public health concern, representing an estimated 20% of melanoma deaths. Understanding this phenomenon will require a multi-pronged approach, including in-depth investigation of its behavioral and biological underpinnings. As we proceed with relevant studies, the benefits in lives saved will grow via early detection.
    Journal of Investigative Dermatology 04/2015; 135(4):947-9. DOI:10.1038/jid.2014.534 · 6.37 Impact Factor
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    ABSTRACT: Surgical resection of lentigo maligna (LM) is complicated by noncontiguous, subclinical extension and actinic melanocytic hyperplasia in sun-damaged skin of older individuals. We sought to determine the long-term effectiveness of imiquimod as primary or adjuvant therapy for LM. Patients were retrospectively identified from January 1, 2003, to December 31, 2013, with LM, early/evolving LM, and LM melanoma who had used topical imiquimod 5% cream for either primary therapy after diagnostic biopsy, or adjuvant therapy after narrow-margin surgical resection or complete clinical but not histologic resection of LM. Follow-up occurred through December 31, 2014. In all, 63 cases were identified in 61 patients, mean (SD) age 71.1 (12.4) years; 58 were analyzed for local recurrence. Imiquimod was used as primary therapy in 22 of 63 (34.9%) and adjuvant therapy in 41 of 63 (65.1%) for mean duration of 11.7 (range 2-60) weeks. Fifty cases (86.2%) demonstrated clinical clearance at mean (SD) follow-up of 42.1 (27.4) months: 72.7% primary and 94.4% adjuvant at 39.7 (23.9) and 43.1 (28.9) months, respectively. Retrospective cohort study and lack of standardized imiquimod application are limitations. Imiquimod cream appears to be a viable option for primary or adjuvant treatment of LM in older patients who are poor surgical candidates. Published by Elsevier Inc.
    Journal of the American Academy of Dermatology 03/2015; DOI:10.1016/j.jaad.2015.02.008 · 5.00 Impact Factor
  • S M Swetter
    British Journal of Dermatology 03/2015; 172(3):559-60. DOI:10.1111/bjd.13655 · 4.10 Impact Factor
  • Susan M Swetter, Alan C Geller
    Nature 11/2014; 515(7527):S117. DOI:10.1038/515S117a · 42.35 Impact Factor
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    ABSTRACT: The management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence. To outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how positive margins arise, (2) whether incompletely excised DN evolve into melanoma, (3) current data on the outcomes of DN with positive histologic margins, (4) consensus recommendations, and (5) a proposal for future studies, including a large-scale study to help guide the management of DN with positive margins. The literature, including recent studies examining management and outcomes of DN with positive margins between 2009 to 2014, was reviewed. A consensus statement by the PLS of the MPWG following review of the literature, group discussions, and a structured Delphi method consensus. This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.
    JAMA Dermatology 11/2014; 151(2). DOI:10.1001/jamadermatol.2014.2694 · 4.30 Impact Factor
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    ABSTRACT: Measurement of tumor volume may be a helpful adjunct to established prognostic factors in cutaneous melanoma, including Breslow depth, presence or absence of ulceration, mitotic index, lymphovascular invasion, and microsatellites. This report expands on the theory that a tumor volume cutoff point of 250 mm³ as measured by surface area of the lesion (ie, longest vertical and horizontal measurements either based on clinical or gross pathological assessment) multiplied by the Breslow depth could serve as a potentially relevant predictor of sentinel lymph node (SLN) metastasis in both thin and thick invasive cutaneous melanomas, which prompted investigation of a larger sample size using the pathology database at our institution.
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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. DOI:10.1016/j.jaad.2014.05.046 · 5.00 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. DOI:10.1016/j.jaad.2014.05.045 · 5.00 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; DOI:10.1016/j.ypmed.2014.08.024 · 2.93 Impact Factor
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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; DOI:10.1001/jamadermatol.2014.838 · 4.30 Impact Factor
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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; 31(5). DOI:10.1111/pde.12382 · 1.52 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; 30(1). DOI:10.1007/s13187-014-0672-4 · 1.05 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; DOI:10.1007/s00520-014-2286-0 · 2.50 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. · 4.24 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.
    04/2014; DOI:10.1001/jamadermatol.2013.7366
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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; 171(4). DOI:10.1111/bjd.13068 · 4.10 Impact Factor
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    Journal of the American Academy of Dermatology 02/2014; 70(2):e47-8. DOI:10.1016/j.jaad.2013.10.025 · 5.00 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). DOI:10.1586/edm.12.12
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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 11/2013; 119(22). DOI:10.1002/cncr.28289 · 4.90 Impact Factor
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    ABSTRACT: Background Enumerating actinic keratoses (AKs) is highly variable but important to standardize as new therapies are emerging. Objectives To assess the reliability of four different methods used to quantify AKs and to investigate whether a consensus meeting affects the reliability. Methods This was a single-blinded study of 12 experienced dermatologist raters counting AKs on the face and ears of nine subjects before and after a consensus meeting. Raters were recruited from investigators of a multicentre Veterans Affairs cooperative study. The intraclass correlation coefficient (ICC) among raters for pre- and post-consensus evaluations was the primary outcome measure. Results Of the four assessment methods, the total count' method had the greatest ICC for both pre- (018, P=004) and post-consensus (066, P=<00001) assessments. Total count was also the only pre-consensus ICC for which the null hypothesis of no association among assessments was rejected. Conclusions Total AK count appears to be the most reliable measure of quantifying AKs on the face and ears. Educational consensus discussion prior to assessment improves reliability of this measure.
    British Journal of Dermatology 08/2013; 169(6). DOI:10.1111/bjd.12591 · 4.10 Impact Factor

Publication Stats

3k Citations
475.57 Total Impact Points


  • 1997–2015
    • Stanford University
      • Department of Dermatology
      Palo Alto, California, United States
  • 2002–2014
    • VA Palo Alto Health Care System
      Palo Alto, California, United States
  • 1996–2012
    • Stanford Medicine
      • • Department of Dermatology
      • • Department of Pathology
      Stanford, California, United States
  • 2005–2009
    • Boston University
      • Department of Dermatology
      Boston, MA, United States
  • 2008
    • University of California, Los Angeles
      Los Angeles, California, United States
    • Comprehensive Cancer Centers of Nevada
      Las Vegas, Nevada, United States
  • 2006
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States