Susan M Swetter

Stanford University, Stanford, California, United States

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Publications (116)489.3 Total impact


  • No preview · Article · Jan 2016 · Journal of the American Academy of Dermatology
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    ABSTRACT: Detection and removal of melanoma, before it has metastasized, dramatically improves prognosis and survival. The purpose of this chapter is to (1) summarize current methods of melanoma detection and (2) review state-of-the-art detection methods and technologies that have the potential to reduce melanoma mortality. Current strategies for the detection of melanoma range from population-based educational campaigns and screening to the use of algorithm-driven imaging technologies and performance of assays that identify markers of transformation.This chapter will begin by describing state-of-the-art methods for educating and increasing awareness of at-risk individuals and for performing comprehensive screening examinations. Standard and advanced photographic methods designed to improve reliability and reproducibility of the clinical examination will also be reviewed. Devices that magnify and/or enhance malignant features of individual melanocytic lesions (and algorithms that are available to interpret the results obtained from these devices) will be compared and contrasted. In vivo confocal microscopy and other cellular-level in vivo technologies will be compared to traditional tissue biopsy, and the role of a noninvasive “optical biopsy” in the clinical setting will be discussed. Finally, cellular and molecular methods that have been applied to the diagnosis of melanoma, such as comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), will be discussed.
    No preview · Chapter · Jan 2016
  • S.M. Hiniker · S.A. Reddy · H.T. Maecker · S.M. Swetter · L. Shura · S.J. Knox

    No preview · Article · Nov 2015 · International journal of radiation oncology, biology, physics
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    ABSTRACT: The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
    No preview · Article · Aug 2015 · Journal of Investigative Dermatology
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    ABSTRACT: Primary cilia are ubiquitously present cell surface organelles with essential functions in cellular proliferation, differentiation, and development. We have previously demonstrated that cilia in melanoma in situ, invasive melanoma, and metastatic melanoma are nearly completely lost, whereas benign nevi are ciliated (1). Dysplastic nevi (DN) have a wide range of histopathologic features from mild (low-grade) to severe (high-grade) cytologic atypia and represent a key clinical and histopathologic marker for melanomagenesis (2). We sought to identify whether cilia are retained in these melanocytic lesions and whether increasing degree of dysplasia correlates with loss of ciliation. We measured the percentage of ciliated melanocytes (ciliation index) in DN with mild (n = 9) and severe dysplasia (n = 10). We identified the primary cilium and basal bodies by immunofluorescence staining of sections with acetylated alpha-Tubulin and gamma-Tubulin, respectively. Our results demonstrated a significant decrease in the ciliation index from mildly dysplastic (55%) to severely dysplastic nevi (14%) (p = 0.005). These data support the hypothesis that primary cilium loss may play a role in the underlying biology of severely DN. The ciliation index is novel quantitative tool that may increase the reproducibility in grading severity of dysplasia for diagnostic and clinical management of melanocytic neoplasms. This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Cutaneous Pathology
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    ABSTRACT: Topical fluorouracil was demonstrated to be effective in reducing the number of actinic keratoses (AKs) for up to 6 months, but no randomized trials studied its long-term efficacy. To evaluate the long-term efficacy of a single course of fluorouracil cream, 5%, for AK treatment. The Veterans Affairs Keratinocyte Carcinoma Chemoprevention (VAKCC) trial was a randomized, double-blinded, placebo-controlled trial with patients from dermatology clinics at 12 VA medical centers recruited from 2009 to 2011 and followed up until 2013. Our study population comprised 932 veterans with 2 or more keratinocyte carcinomas in the 5 years prior to enrollment. The mean follow-up duration was 2.6 years in both treatment and control groups. Participants applied either topical fluorouracil cream, 5% (n = 468), or vehicle control cream (n = 464) to the face and ears twice daily for up to 4 weeks. This study reports on AK counts and treatments, which were secondary outcomes of the VAKCC trial. Actinic keratoses on the face and ears were counted by study dermatologists at enrollment and at study visits every 6 months. The number of spot treatments for AKs on the face and ears at semiannual study visits and in between study visits was recorded. The number of AKs on the face and ears per participant was not different between the fluorouracil and control groups at randomization (11.1 vs 10.6, P > .10). After randomization, the fluorouracil group had fewer AKs compared with the control group at 6 months (3.0 vs 8.1, P < .001) and for the overall study duration (P < .001). The fluorouracil group also had higher complete AK clearance rates (38% vs 17% at 6 months) and fewer spot treatments at 6-month intervals, at study visits, and in between study visits during the trial (P < .01 for all). The fluorouracil group took longer to require the first spot AK treatment (6.2 months) compared with the control group (6.0 months) (hazard ratio, 0.69; 95% CI, 0.60-0.79). The number of hypertrophic AKs was not different between the 2 groups overall (P = .60), although there were fewer hypertrophic AKs in the fluorouracil group at 6 months (0.23 vs 0.41) (P = .05). Our results indicate that a single course of fluorouracil cream, 5%, effectively reduces AK counts and the need for spot treatments for longer than 2 years. clinicaltrials.gov Identifier:NCT00847912.
    Full-text · Article · May 2015
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    ABSTRACT: Background Aberrant lymphatic drainage is believed to contribute to the high recurrence rate of head and neck melanomas. This study aimed to identify the clinical significance of unexpected lymphatic drainage patterns. Methods A single institution retrospective analysis was performed of middle-aged and older males (mean age 66.2 years, range 41-87 years) who underwent successful lymphoscintigraphy with sentinel node (SLN) biopsy from 1997 through 2012. Node status, distribution, and recurrence were assessed comparing patients with expected and unexpected drainage patterns. Results Sixty-six patients were identified with 55.8 months median follow-up (range 5.6-206.1 months). Unexpected SLN drainage was associated with multiple basin drainage (p < 0.01) and greater recurrence after negative SLN biopsy (p = 0.03). Both groups had similar anatomic distribution, SLN sampling, histopathologic characteristics, follow-up, and survival. Conclusion Lymphatic drainage differing from expected patterns is associated with greater recurrence after negative SLN biopsy in middle-aged and older males. This article is protected by copyright. All rights reserved. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Apr 2015 · Head & Neck
  • 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.
    No preview · Article · Apr 2015 · Journal of Investigative Dermatology
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    Susan M Swetter · Frank W Chen · David D Kim · Barbara M Egbert
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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.
    Preview · Article · Mar 2015 · Journal of the American Academy of Dermatology
  • S M Swetter

    No preview · Article · Mar 2015 · British Journal of Dermatology
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    ABSTRACT: Background and Objectives Sentinel lymph node (SLN) biopsy has become the standard method of determining regional lymph node involvement in cutaneous melanoma. Although traditionally performed via injection of radioisotope tracers and blue dyes, fluorescent lymphangiography with indocyanine green (ICG) is an attractive alternative.Methods Fifty two consecutive patients with cutaneous melanoma of the trunk or extremities underwent SLNB. Preoperative lymphoscintigraphy was performed with technetium-99m sulfur colloid (TSC). Peritumoral intradermal injection of isosulfan blue (ISB) and ICG was then performed. Successful identification of a sentinel lymph node via each modality was then assessed.ResultsA total of 77 lymph nodes were identified from the 52 patients (range 1–3). The majority of melanomas were extremity-based, superficial spreading type, and had SLN localized to the axilla. There were no complications related to IcG administration. Rates of SLN detection were 96.2% for TSC, 59.6% for ISB, and 88.5% for IcG (P < 0.05 for ICG vs ISB). On univariate logistic regression analysis, no factors were found to be associated with failure of ICG.Conclusions Fluorescent lymphangiography using ICG is an effective method of SLN identification in patients with cutaneous melanoma of the trunk and extremities. When ICG and TSC are used in combination, ISB offers no additional advantage and may be safely omitted. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Dec 2014 · Journal of Surgical Oncology
  • Susan M. Swetter · Alan C. Geller

    No preview · Article · Nov 2014 · Nature
  • Susan M Swetter · Alan C Geller

    No preview · Article · Nov 2014 · Nature
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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.
    No preview · Article · Nov 2014 · JAMA Dermatology
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    Preview · Article · Nov 2014
  • Robert G Walton · Jinah Kim · Cruz Velasco · Susan M Swetter
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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.
    No preview · Article · Nov 2014 · Cutis; cutaneous medicine for the practitioner
  • Jonathan E Mayer · Susan M Swetter · Teresa Fu · Alan C Geller
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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.
    No preview · Article · Oct 2014 · Journal of the American Academy of Dermatology
  • Jonathan E Mayer · Susan M Swetter · Teresa Fu · Alan C Geller
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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.
    No preview · Article · Oct 2014 · Journal of the American Academy of Dermatology
  • Frank W Chen · Diane Tseng · Sunil Reddy · Adil I Daud · Susan M Swetter
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    ABSTRACT: Importance 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.Observations A woman in her 20s with a history of metastatic melanoma developed EMN while receiving therapy with vemurafenib, a selective BRAF inhibitor. After disease progression, the patient was placed on a clinical trial that combined vemurafenib with a MEK inhibitor, cobimetinib. Within months, we noted clinical involution of many of her EMN. In addition, numerous preexisting nevi were noted to fade in color on the dual regimen. Over a year after initiating this combination therapy, most of the patient’s EMN were no longer clinically evident.Conclusions and Relevance Our case report describing the involution of EMN supports data from previous clinical trials indicating that combination BRAF and MEK inhibition may reduce cutaneous proliferative effects that arise on BRAF inhibitor monotherapy. Further studies are necessary to characterize the biological mechanisms underlying this phenomenon.
    No preview · Article · Aug 2014 · JAMA Dermatology
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    ABSTRACT: Objective: 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 and 1998. Methods: Logistic regression models were used to assess odds of NMSC after adjusting for skin type, sun exposure history and indication for NSAID use. Results: There were 7652 incident cases of NMSC (median follow-up: 6.9years). There was no association between regular NSAID-use and NMSC risk relative to no/low-users. However, in a subgroup analysis of 5325 women with a history of skin cancer (incident NMSC: 1897), odds of NMSC were lower among regular NSAID users whether <5years (OR 0.82, 95% CI: 0.70-0.95) or ≥5years (OR 0.82, 95% CI: 0.69-0.98) of use compared to no/low-users. Inconsistent NSAID use and acetaminophen use were not associated with NMSC risk. Conclusion: Overall, NSAID use was not associated with NMSC risk. However, in women with a history of skin cancer, regular NSAID use was associated with 18% lower odds of NMSC. Future studies on potential chemopreventative effects of NSAIDs should focus on subjects with prior history of NMSC.
    No preview · Article · Aug 2014 · Preventive Medicine

Publication Stats

3k Citations
489.30 Total Impact Points

Institutions

  • 1993-2016
    • Stanford University
      • • Department of Dermatology
      • • Department of Medicine
      • • Department of Surgery
      • • Department of Pathology
      Stanford, California, United States
  • 2015
    • Moncrief Cancer Institute
      Fort Worth, Texas, United States
  • 2002-2012
    • 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
  • 2008
    • University of California, Los Angeles
      Los Angeles, California, United States
  • 2006
    • Boston University
      Boston, Massachusetts, United States