Robert J. Friedman, M.D.

The evolution of melanoma diagnosis: 25 years beyond the ABCDs
Rigel, Darrell S; Russak, Julie; Friedman, Robert
2010 Sep-Oct;60(5):301-316, CA: a cancer journal for clinicians
Early detection of malignant melanoma remains the key factor in lowering mortality from this cancer. Recognizing the importance of this issue 25 years ago, our group at New York University published in CA: A Cancer Journal for Clinicians the mnemonic 'ABCD' to facilitate the early diagnosis of melanoma. Studies have demonstrated the usefulness of this paradigm in enhancing early melanoma diagnosis as a part of clinical examinations, mass screenings, and public education programs. Approaches to melanoma diagnosis have dynamically evolved during the ensuing quarter century. In the 1990s, dermoscopy enabled the recognition of new subsurface features to differentiate between malignant and benign pigmented lesions. During the last decade, new computer-based technologies have improved diagnostic sensitivity and specificity and may result in optimizing lesion selection for biopsy and pathology review. Despite all of the advances in melanoma diagnosis, timely recognition, detection, and rapid treatment of melanoma remain critical. Although pathologic examination remains the gold standard for diagnosis, this cancer has the potential to be diagnosed through noninvasive approaches because of its cutaneous location. From the development of the ABCDs through current attempts that use complex computer algorithms and genetic markers, a clinician's ability to detect melanoma in its earliest form has been augmented. However, a 'good clinical eye' is still fundamental to selecting the lesions for evaluation among the sea of those that are prevalent. As current approaches are refined and new techniques are developed, the improved ability to diagnose this cancer will hopefully enhance reaching the goal of reducing melanoma mortality
— id: 113741, year: 2010, vol: 60, page: 301, stat: Journal Article,

Genomic and functional adaptation in surface ocean planktonic prokaryotes
Yooseph, Shibu; Nealson, Kenneth H; Rusch, Douglas B; McCrow, John P; Dupont, Christopher L; Kim, Maria; Johnson, Justin; Montgomery, Robert; Ferriera, Steve; Beeson, Karen; Williamson, Shannon J; Tovchigrechko, Andrey; Allen, Andrew E; Zeigler, Lisa A; Sutton, Granger; Eisenstadt, Eric; Rogers, Yu-Hui; Friedman, Robert; Frazier, Marvin; Venter, J Craig
2010 Nov 4;468(7320):60-66, Nature
The understanding of marine microbial ecology and metabolism has been hampered by the paucity of sequenced reference genomes. To this end, we report the sequencing of 137 diverse marine isolates collected from around the world. We analysed these sequences, along with previously published marine prokaryotic genomes, in the context of marine metagenomic data, to gain insights into the ecology of the surface ocean prokaryotic picoplankton (0.1-3.0 mum size range). The results suggest that the sequenced genomes define two microbial groups: one composed of only a few taxa that are nearly always abundant in picoplanktonic communities, and the other consisting of many microbial taxa that are rarely abundant. The genomic content of the second group suggests that these microbes are capable of slow growth and survival in energy-limited environments, and rapid growth in energy-rich environments. By contrast, the abundant and cosmopolitan picoplanktonic prokaryotes for which there is genomic representation have smaller genomes, are probably capable of only slow growth and seem to be relatively unable to sense or rapidly acclimate to energy-rich conditions. Their genomic features also lead us to propose that one method used to avoid predation by viruses and/or bacterivores is by means of slow growth and the maintenance of low biomass
— id: 148834, year: 2010, vol: 468, page: 60, stat: Journal Article,

The "dysplastic" nevus
Friedman, Robert J; Farber, Michele J; Warycha, Melanie A; Papathasis, Nicole; Miller, Michael K; Heilman, Edward R
2009 Jan-Feb;27(1):103-115, Clinics in dermatology
Dysplastic nevi have become an increasing focus clinically, with evidence that they are associated with a higher risk of developing melanoma. However, there still is contention regarding the significance of dysplastic nevi. This contribution provides an overview of the history, epidemiology, genetics, clinical and histologic features, and procedures for clinical management of dysplastic nevi. Since dysplastic nevi were described originally in 1978, a great deal of research has examined the epidemiology of these lesions and the genetic factors related to the development of dysplastic nevi. However, there is disagreement regarding the clinical management of dysplastic nevi and the histologic definition of dysplastic nevi. Current recommendations include preventative measures, such as sun protection and careful surveillance and biopsies of suspicious lesions as needed. The advent of new technologies, such as computer-vision systems, have the potential to significantly change treatment of dysplastic nevi in the future
— id: 97859, year: 2009, vol: 27, page: 103, stat: Journal Article,

Utility of lesion diameter in the clinical diagnosis of cutaneous melanoma
Abbasi, Naheed R; Yancovitz, Molly; Gutkowicz-Krusin, Dina; Panageas, Katherine S; Mihm, Martin C; Googe, Paul; King, Roy; Prieto, Victor; Osman, Iman; Friedman, Robert J; Rigel, Darrell S; Kopf, Alfred W; Polsky, David
2008 Apr;144(4):469-474, Archives of dermatology
OBJECTIVE: To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma. DESIGN: Cohort study. SETTING: Dermatology hospital-based clinics and community practice offices. Patients A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma. MAIN OUTCOME MEASURE: The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system. RESULTS: Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter. Conclusion The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy
— id: 78338, year: 2008, vol: 144, page: 469, stat: Journal Article,

The diagnostic performance of expert dermoscopists vs a computer-vision system on small-diameter melanomas
Friedman, Robert J; Gutkowicz-Krusin, Dina; Farber, Michele J; Warycha, Melanie; Schneider-Kels, Lori; Papastathis, Nicole; Mihm, Martin C Jr; Googe, Paul; King, Roy; Prieto, Victor G; Kopf, Alfred W; Polsky, David; Rabinovitz, Harold; Oliviero, Margaret; Cognetta, Armand; Rigel, Darrell S; Marghoob, Ashfaq; Rivers, Jason; Johr, Robert; Grant-Kels, Jane M; Tsao, Hensin
2008 Apr;144(4):476-482, Archives of dermatology
OBJECTIVE: To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter </= 6 mm) compared with an automatic multispectral computer-vision system. DESIGN: Blinded comparison study. SETTING: Dermatologic hospital-based clinics and private practice offices. Patients From a computerized skin imaging database of 990 small (</= 6-mm) pigmented skin lesions, all 49 melanomas from 49 patients were included in this study. Fifty randomly selected nonmelanomas from 46 patients served as a control. MAIN OUTCOME MEASURES: Ten dermoscopists independently examined dermoscopic images of 99 pigmented skin lesions and decided whether they identified the lesions as melanoma and whether they would recommend biopsy to rule out melanoma. Diagnostic and biopsy sensitivity and specificity were computed and then compared with the results of the computer-vision system. RESULTS: Dermoscopists were able to correctly identify small melanomas with an average diagnostic sensitivity of 39% and a specificity of 82% and recommended small melanomas for biopsy with a sensitivity of 71% and specificity of 49%, with only fair interobserver agreement (kappa = 0.31 for diagnosis and 0.34 for biopsy). In comparison, in recommending biopsy to rule out melanoma, the computer-vision system achieved 98% sensitivity and 44% specificity. CONCLUSIONS: Differentiation of small melanomas from small benign pigmented lesions challenges even expert physicians. Computer-vision systems can facilitate early detection of small melanomas and may limit the number of biopsies to rule out melanoma performed on benign lesions
— id: 78337, year: 2008, vol: 144, page: 476, stat: Journal Article,

The Sorcerer II Global Ocean Sampling expedition: expanding the universe of protein families
Yooseph, Shibu; Sutton, Granger; Rusch, Douglas B; Halpern, Aaron L; Williamson, Shannon J; Remington, Karin; Eisen, Jonathan A; Heidelberg, Karla B; Manning, Gerard; Li, Weizhong; Jaroszewski, Lukasz; Cieplak, Piotr; Miller, Christopher S; Li, Huiying; Mashiyama, Susan T; Joachimiak, Marcin P; van Belle, Christopher; Chandonia, John-Marc; Soergel, David A; Zhai, Yufeng; Natarajan, Kannan; Lee, Shaun; Raphael, Benjamin J; Bafna, Vineet; Friedman, Robert; Brenner, Steven E; Godzik, Adam; Eisenberg, David; Dixon, Jack E; Taylor, Susan S; Strausberg, Robert L; Frazier, Marvin; Venter, J Craig
2007 Mar;5(3):e16-e16, PLoS biology
Metagenomics projects based on shotgun sequencing of populations of micro-organisms yield insight into protein families. We used sequence similarity clustering to explore proteins with a comprehensive dataset consisting of sequences from available databases together with 6.12 million proteins predicted from an assembly of 7.7 million Global Ocean Sampling (GOS) sequences. The GOS dataset covers nearly all known prokaryotic protein families. A total of 3,995 medium- and large-sized clusters consisting of only GOS sequences are identified, out of which 1,700 have no detectable homology to known families. The GOS-only clusters contain a higher than expected proportion of sequences of viral origin, thus reflecting a poor sampling of viral diversity until now. Protein domain distributions in the GOS dataset and current protein databases show distinct biases. Several protein domains that were previously categorized as kingdom specific are shown to have GOS examples in other kingdoms. About 6,000 sequences (ORFans) from the literature that heretofore lacked similarity to known proteins have matches in the GOS data. The GOS dataset is also used to improve remote homology detection. Overall, besides nearly doubling the number of current proteins, the predicted GOS proteins also add a great deal of diversity to known protein families and shed light on their evolution. These observations are illustrated using several protein families, including phosphatases, proteases, ultraviolet-irradiation DNA damage repair enzymes, glutamine synthetase, and RuBisCO. The diversity added by GOS data has implications for choosing targets for experimental structure characterization as part of structural genomics efforts. Our analysis indicates that new families are being discovered at a rate that is linear or almost linear with the addition of new sequences, implying that we are still far from discovering all protein families in nature
— id: 148836, year: 2007, vol: 5, page: e16, stat: Journal Article,

In consideration of the E in the melanoma ABCDE mnemonic - Reply
Rigel, DS; Friedman, RJ; Kopf, AW; Polsky, D
2006 APR ;142(4):529-530, Archives of dermatology
— id: 63813, year: 2006, vol: 142, page: 529, stat: Journal Article,

ABCDE--an evolving concept in the early detection of melanoma
Rigel, Darrell S; Friedman, Robert J; Kopf, Alfred W; Polsky, David
2005 Aug;141(8):1032-1034, Archives of dermatology
— id: 65204, year: 2005, vol: 141, page: 1032, stat: Journal Article,

Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria
Abbasi, Naheed R; Shaw, Helen M; Rigel, Darrell S; Friedman, Robert J; McCarthy, William H; Osman, Iman; Kopf, Alfred W; Polsky, David
2004 Dec 8;292(22):2771-2776, JAMA
CONTEXT: The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (< or =6 mm) melanomas. EVIDENCE ACQUISITION: Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information. EVIDENCE SYNTHESIS: Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color. CONCLUSIONS: The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include 'evolving'). No change to the existing diameter criterion is required at this time
— id: 47818, year: 2004, vol: 292, page: 2771, stat: Journal Article,

Cancer of the skin
Rigel, Darrell S; Friedman, Robert; Dzubow, Leonard M; Reintgen, Douglas S; Bystryn, Jean-Claude; Marks, Robin
New York : Saunders, 2004,
— id: 800, year: 2004, vol: , page: , stat: ,

The pathology of malignant melanoma
Friedman, RJ; Heilman, ER
2002 Oct;20(4):659-65?, Dermatologic clinics
This article discusses that much of what has been taught over the years concerning the Pathology of melanoma clearly may have little validity. Melanoma is viewed simply as a malignant neoplasm comprised initially of a proliferation of atypical melanocytes within the surface epithelium (epidermis). It has many features in common, regardless of anatomic site. It spreads within the epidermis first for months, possibly years or even for decades. At this stage (in situ) it is wholly curable if completely surgically excised. What determines how long a given melanoma remains in situ is not clear. Once a given neoplasm penetrates into the subjacent dermis, there are whole ranges of ill-defined events that act on its ability to continue to grow and develop the competence for metastasis
— id: 32446, year: 2002, vol: 20, page: 659, stat: Journal Article,

The ABCDs of moles and melanomas
Friedman RJ; Rigel DS; Kopf AW
Cancer management: a multidisciplinary approach: medical, surgical & radiation oncology Huntington NY : PRR, 1999,
— id: 3877, year: 1999, vol: , page: 337, stat: Chapter,

Melanoma incidence: if it quacks like a duck..
Rigel DS; Friedman RJ; Kopf AW; Robinson JK; Amonette RA
1997 May;133(5):656-659, Archives of dermatology
— id: 16825, year: 1997, vol: 133, page: 656, stat: Journal Article,

Trabeculectomy at the inferior limbus
Caronia, R M; Liebmann, J M; Friedman, R; Cohen, H; Ritch, R
1996 Apr;114(4):387-391, Archives of ophthalmology
OBJECTIVE: To evaluate intraocular pressure (IOP) control and surgical complications following trabeculectomy with 5-fluorouracil (5-FU) or mitomycin at the inferior limbus. METHODS: The charts of all patients undergoing trabeculectomy at the inferior limbus from July 1984 to March 1993 were reviewed. Surgical success was defined as IOP greater than 4 mm Hg and less than 22 mm Hg and at least a 20% reduction from preoperative IOP. PATIENTS: All 101 eyes of 101 patients had undergone prior intraocular surgery at the superior limbus. Mean patient age was 57.5 +/- 2.0 (+/-SE) years; mean follow-up was 23.4+/-2.3 months; mean preoperative IOP was 32.8+/-0.9 mm Hg; and mean number of preoperative antiglaucoma medications was 2.8+/-0.1. RESULTS: Ninety-four eyes (93.1%) received postoperative 5-FU (mean total dose, 36.3+/-1.7 mg) and seven eyes (6.9%) received intraoperative mitomycin (0.5 mg/mL). Cumulative success for all eyes at 2 and 5 years was 56% and 38%, respectively. Intraocular pressure control without medications was achieved in 39% and 15% of eyes at 2 and 5 years, respectively. Complications included 5-FU epitheliopathy (34.0% of eyes receiving 5-FU), early wound leak (26.7%), choroidal effusion (25.7%), late bleb leak (12.9%), and late bleb-related endophthalmitis (11.9%). CONCLUSION: Although trabeculectomy at the inferior limbus offers the opportunity for surgical success in eyes at high risk of failure, this procedure carries an increased risk for late complications and should be reserved for cases in which the therapeutic options are extremely limited
— id: 148383, year: 1996, vol: 114, page: 387, stat: Journal Article,

Lifetime risk for development of skin cancer in the U.S. population: current estimate is now 1 in 5
Rigel DS; Friedman RJ; Kopf AW
1996 Dec;35(6):1012-1013, Journal of the American Academy of Dermatology
— id: 16826, year: 1996, vol: 35, page: 1012, stat: Journal Article,

The incidence of malignant melanoma in the United States: issues as we approach the 21st century
Rigel DS; Friedman RJ; Kopf AW
1996 May;34(5 Pt 1):839-847, Journal of the American Academy of Dermatology
The risk of malignant melanoma developing in an American in the United States has now reached 1 in 87 (up more than 1800% since the 1930s). This rising incidence of malignant melanoma is, in fact, real because (1) it is not due to increased surveillance; (2) it is not due to better cancer-counting methods in general; (3) it is not due to changes in histologic diagnostic criteria; (4) it is being noted worldwide; and (5) most importantly, despite rising survival percentages, the mortality rate from malignant melanoma also continues to rise. On the basis of these trends, incidence rates for malignant melanoma will continue to rise for at least the next 10 to 20 years, although the demographics of those affected may change. Effective programs to improve public and professional education must be developed to enhance early clinical detection and behavioral changes. An establishment of a National Melanoma Registry is needed to more effectively assess the magnitude and impact of future incidence and the success of prevention program efforts into the next century
— id: 7040, year: 1996, vol: 34, page: 839, stat: Journal Article,

The ABCDs of melanoma: why change?
Marghoob AA; Slade J; Kopf AW; Rigel DS; Friedman RJ; Perelman RO
1995 Apr;32(4):682-684, Journal of the American Academy of Dermatology
— id: 16828, year: 1995, vol: 32, page: 682, stat: Journal Article,

Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. I. Survey of biopsy practices of pigmented lesions suspected as melanoma
Salopek TG; Slade J; Marghoob AA; Rigel DS; Kopf AW; Bart RS; Friedman RJ
1995 Sep;33(3):441-450, Journal of the American Academy of Dermatology
BACKGROUND: The incidence of malignant melanoma (MM) has rapidly increased during the past five decades. Relatively little information is available on whether the role of the dermatologist has increased concomitantly in the surgical management of this cancer. OBJECTIVE: Our purpose was to learn how members of the American Academy of Dermatology (AAD) treat patients with lesions highly suspected as being MM and how the management of these patients may have changed over the past decade. This, the first of a two-part series, concerns biopsies. METHODS: The data for the study were collected by means of a questionnaire that was sent to all members of the AAD practicing in the United States (N = 7412). RESULTS: A total of 2991 valid questionnaires were returned, a response rate of 40%. The majority of respondents (89% in 1982; 90% in 1992) stated that they performed the biopsies of pigmented lesions suspected of being MMs. Excisional biopsy was the preferred technique (58% in 1982; 68% in 1992). The type of biopsy and who performed the initial biopsy of a suspected MM were associated with the following factors: (1) the number of years in practice, (2) the type of practice, and (3) whether the dermatologist subsequently performed the definitive surgery for the MM. Regional variations in biopsy practices were also noted. CONCLUSION: Most AAD dermatologists who responded to the questionnaire perform the biopsies of lesions highly suspected of being MM. During the last decade an increasing proportion of dermatologists are performing excisional biopsies rather than other types of biopsies for such lesions
— id: 12736, year: 1995, vol: 33, page: 441, stat: Journal Article,

Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. II. Definitive surgery for malignant melanoma
Salopek TG; Slade JM; Marghoob AA; Rigel DS; Kopf AW; Bart RS; Friedman RJ
1995 Sep;33(3):451-461, Journal of the American Academy of Dermatology
BACKGROUND: During the past few decades there has been increasing interest and training in dermatologic surgery. OBJECTIVE: Our purpose was to determine to what extent members of the American Academy of Dermatology (AAD) are involved in the surgical management of patients with malignant melanomas (MMs), comparing 1982 with 1992. METHODS: Members of the AAD practicing in the United States (N = 7412) were sent a questionnaire that surveyed their role in the definitive treatment of patients with MMs and the surgical margins of normal-appearing skin that they used or recommended for melanomas of various thicknesses. RESULTS: Sixty-four percent of the respondents stated that they performed the definitive surgery for in situ melanoma in 1992, a 14% increase from 1982. Although a significantly greater percentage of dermatologists were performing the definitive surgery for invasive melanoma in 1992 (28%) compared with 1982 (14%), the majority continued to refer their patients to surgical colleagues for definitive treatment. There has been a narrowing of surgical margins recommended or used for melanomas of all thicknesses. In addition, regional differences of the role of the dermatologist in surgical management of patients with MM were observed. CONCLUSION: An increasing proportion of dermatologists are involved in the surgical management of patients with MMs. Most dermatologists appear to be in accord with the guidelines for surgical margins currently recommended in the literature
— id: 12735, year: 1995, vol: 33, page: 451, stat: Journal Article,

Risk of cutaneous malignant melanoma in patients with 'classic' atypical-mole syndrome. A case-control study
Marghoob AA; Kopf AW; Rigel DS; Bart RS; Friedman RJ; Yadav S; Abadir M; Sanfilippo L; Silverman MK; Vossaert KA
1994 Aug;130(8):993-998, Archives of dermatology
BACKGROUND AND DESIGN: There is an increased risk of developing cutaneous malignant melanomas (MMs) in patients with classic atypical-mole syndrome (AMS). This study compares the incidence of newly diagnosed MMs in patients with classic AMS (cases) with the incidence of newly diagnosed MMs developing in a population without classic AMS (control patients). The charts of 287 white patients with AMS and 831 white patients without AMS were reviewed for the occurrence of newly diagnosed invasive MMs during follow-up. Both cases and control patients were followed up regularly by total-body cutaneous examinations. The cumulative 10-year risk for developing newly diagnosed invasive MMs was calculated (life-table method) for each cohort. RESULTS: Of the 287 AMS cases, 10 developed a newly diagnosed invasive MM, resulting in a 10-year cumulative risk of 10.7%. Of the 831 control patients, two developed a newly diagnosed invasive MM, resulting in a 10-year cumulative risk of 0.62%. CONCLUSION: Patients with classic AMS, regardless of the presence of a personal and/or family history of MM, are at significantly increased risk of developing invasive MMs compared with control patients
— id: 8191, year: 1994, vol: 130, page: 993, stat: Journal Article,

Risk of malignant melanoma for patients with "classic" atypical-mole syndrome
Marghoob AA; Kopf AW; Rigel DS; Bart RS; Friedman RJ; Yadav S; Abadir M; Sanfilippo L; Silverman MK; Vossaert KA
1994 ;12:1-2, Melanoma letter
— id: 62437, year: 1994, vol: 12, page: 1, stat: Journal Article,

Lack of selective attendance of participants at skin cancer/melanoma screening clinics
Rigel DS; Friedman RJ
1994 Jul;31(1):131-131, Journal of the American Academy of Dermatology
— id: 16829, year: 1994, vol: 31, page: 131, stat: Journal Article,

Multiparametric image cytometry of nevi and melanomas
Fleming, M G; Friedman, R J
1993 Apr;15(2):106-113, American journal of dermatopathology
Multiparametric image cytometry was applied to 10 examples each of malignant melanoma and common, Spitz, and dysplastic nevus. DNA index, area, and 21 parameters describing chromatin texture were measured for 50 nuclei in each lesion. Linear discriminant analysis was used to derive discriminant functions based on the measured parameters. The analysis demonstrated that chromatin texture provides more diagnostic information than either DNA index or nuclear area. The discriminant functions allowed 68% of nuclei to be accurately classified among the four groups, and allowed 37 of the 40 lesions to be accurately classified as nevus or melanoma
— id: 141505, year: 1993, vol: 15, page: 106, stat: Journal Article,

The rationale of the ABCDs of early melanoma
Rigel DS; Friedman RJ
1993 Dec;29(6):1060-1061, Journal of the American Academy of Dermatology
— id: 16830, year: 1993, vol: 29, page: 1060, stat: Journal Article,

Lesion thickness and prognosis in melanoma: horses are not zebras. A response to Green and Ackerman
Rigel DS; Kopf AW; Friedman RJ
1993 Oct;15(5):474-476, American journal of dermatopathology
— id: 6496, year: 1993, vol: 15, page: 474, stat: Journal Article,

Drug treatment in depression
Friedman, R; Kocsis, J H; Chen, J S; Mann, J J
1992 Jan;43(1):83-84, Hospital & community psychiatry
— id: 148529, year: 1992, vol: 43, page: 83, stat: Journal Article,

Influence of gender on survival in patients with stage I malignant melanoma
Vossaert KA; Silverman MK; Kopf AW; Bart RS; Rigel DS; Friedman RJ; Levenstein M
1992 Mar;26(3 Pt 2):429-440, Journal of the American Academy of Dermatology
BACKGROUND: Women with stage I malignant melanoma (MM) have a survival advantage over men as judged by univariate analysis. However, on multivariate analysis, gender was found to be an independent predictor of survival in only 8 of 14 published studies. OBJECTIVE: This study attempts to explain the disparate findings for gender as a prognostic factor in different multivariate analyses. METHODS: Univariate and multivariate analyses were performed on 832 patients with stage I MM in the New York University Melanoma Cooperative Group (NYU-MCG) data base. The results were compared with those of 14 similar studies. RESULTS: In the NYU-MCG data base, gender, age of the patient, and number of mitoses per square millimeter were not independent factors on multivariate analysis, whereas thickness, anatomic site, and presence of ulceration were. The statistically significant difference in survival by gender on univariate analysis, in the NYU-MCG data base, could be explained by the differences in thickness and anatomic site of the MMs in the sexes. Comparison of these results with the reviewed reports from the literature consistently shows thickness and ulceration to be independent prognosticators of survival. Likewise, most authors agree that age is not an independent predictor. However, there is no consensus with respect to gender and site, each of which was found to be an independent predictor of survival in only about half the studies reviewed. CONCLUSION: The disparate findings for gender in different multivariate analyses are explained by a gender-related difference in anatomic distribution of MM. Gender and site appear to have a similar influence in multivariate analysis and thus either one or the other is a dominant factor in different multivariate analyses
— id: 13671, year: 1992, vol: 26, page: 429, stat: Journal Article,

Distinguishing benign and malignant melanocytic lesions with the AgNOR method
Friedman RJ; Grin CM; Heilman E; Weiser J; Gottlieb GJ; Waldo E; Rigel DS; Kopf AW
1991 Oct;9(4):689-693, Dermatologic clinics
A silver staining technique has recently been devised to aid in the differentiation between benign and malignant melanocytic lesions. This study showed a statistically significant difference between the staining of silver-nucleolar organizer regions (AgNORs) in melanocytic nevi and that of AgNORs in malignant melanomas
— id: 13872, year: 1991, vol: 9, page: 689, stat: Journal Article,

Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation
Friedman RJ; Rigel DS; Kopf AW; Grin CM; Heilman E; Bart RS; Kamino H; Harris MN; Roses DF; Postel AH; et al
1991 Oct;9(4):643-648, Dermatologic clinics
There are many clinical and histologic factors that are known to be valuable in predicting survival rates for patients with cutaneous malignant melanomas. Breslow thickness is considered to be the most reliable prognostic factor; however, thickness is a unidimensional measurement. A more accurate mensuration to predict biologic behavior might be one that takes into account the three-dimensional volume of the neoplasm. In a study of 35 primary malignant melanomas, the volumes of the dermal components of the tumors were calculated. Those patients with tumor volumes of 200 mm3 or less had a 91.4% 5-year disease-free survival rate, compared with survival rate of only 16.7% for those patients whose lesions had tumor volumes exceeding 200 mm3. On multivariate analysis, tumor volume exceeded thickness as a prognostic indicator. Thus, measurement of tumor volume proved to be of greater significance than thickness in predicting the outcome for patients with malignant melanomas
— id: 13874, year: 1991, vol: 9, page: 643, stat: Journal Article,

Malignant melanoma in the 1990s: the continued importance of early detection and the role of physician examination and self-examination of the skin
Friedman RJ; Rigel DS; Silverman MK; Kopf AW; Vossaert KA
1991 Jul-Aug;41(4):201-226, CA: a cancer journal for clinicians
Despite the exciting new techniques being developed to help diagnose early malignant melanoma, the current standard of care remains periodic examination of the skin. The combination of routine physician examination coupled with self-examination of the skin provides an opportunity for the identification of early malignant melanoma. Removal of such thin lesions can significantly reduce the ever-increasing mortality rate from this potentially serious form of cutaneous cancer
— id: 13970, year: 1991, vol: 41, page: 201, stat: Journal Article,

Cancer of the skin
Friedman, Robert J.; Rigel, Darrell S.; Kopf, Alfred W.; Harris, Matthew N.; Baker, Daniel C
Philadelphia : Saunders, 1991,
— id: 244, year: 1991, vol: , page: , stat: ,

Factors influencing survival in melanoma
Rigel DS; Friedman RJ; Kopf AW; Silverman MK
1991 Oct;9(4):631-642, Dermatologic clinics
Multiple factors appear to influence survival of patients with MM. As computer and mathematic analysis techniques advance, the specific effects of these variables, in terms of their impact on survival rates, will be delineated better
— id: 13875, year: 1991, vol: 9, page: 631, stat: Journal Article,

The histopathology of dysplastic nevi. Continued controversy
Roth, M E; Grant-Kels, J M; Ackerman, A B; Elder, D E; Friedman, R J; Heilman, E R; Maize, J C; Sagebiel, R W
1991 Feb;13(1):38-51, American journal of dermatopathology
The histopathologic criteria used in the diagnosis of dysplastic nevi have been a source of controversy, as has the clinical significance of these lesions. Several dermatopathologists noted for their work on dysplastic nevi were asked to contribute responses to questions regarding the architectural and cytological criteria used to classify a melanocytic nevus as dysplastic, the terminology used to describe these lesions, and the role of dysplastic nevi as precursors of melanoma. Although no consensus has been reached regarding the cytologic features required for diagnosis of dysplastic nevi, there is substantial agreement regarding the architectural features of these lesions
— id: 89167, year: 1991, vol: 13, page: 38, stat: Journal Article,

Prospective follow-up for malignant melanoma in patients with atypical-mole (dysplastic-nevus) syndrome
Tiersten AD; Grin CM; Kopf AW; Gottlieb GJ; Bart RS; Rigel DS; Friedman RJ; Levenstein MJ
1991 Jan;17(1):44-48, Journal of dermatologic surgery & oncology
A total of 357 white patients who had melanocytic nevi that fulfilled the clinical criteria for the 'classic' atypical-mole (dysplastic-nevus) syndrome (100 or more melanocytic nevi; one or more melanocytic nevi 8 mm or larger in diameter; and, one or more melanocytic nevi with atypical features) were followed for the development of cutaneous malignant melanomas. Seventeen patients (4.8%) developed malignant melanomas during an average follow-up period of 49 months. One patient developed two malignant melanomas. Eight of the malignant melanomas detected were in situ and ten were invasive melanomas (less than 0.86 mm in Breslow thickness), implying an excellent prognosis. The number of malignant melanomas detected in these patients exceeded significantly the number expected to occur in age- and sex-matched white controls. All groups were shown to have an increased risk for the development of malignant melanomas. Total-body photographs were helpful in detecting changes in size, shape, and color that led to the diagnosis of malignant melanoma. These data support the concept that patients with this readily regionalized clinical presentation of classic atypical-mole syndrome are at an increased risk for malignant melanomas and, therefore, should be examined regularly
— id: 8192, year: 1991, vol: 17, page: 44, stat: Journal Article,

Computer applications in the diagnosis and prognosis of malignant melanoma
White R; Rigel DS; Friedman RJ
1991 Oct;9(4):695-702, Dermatologic clinics
Recent advances in computer technology have begun to make computers a more effective tool in the diagnosis and evaluation of malignant melanoma. Preliminary computer-aided diagnosis programs have been developed. Histologic evaluation applications in both diagnosis and prognosis are also evolving. Further advances in computers may make them an integral part of the diagnosis and prognosis of melanoma in the future
— id: 13871, year: 1991, vol: 9, page: 695, stat: Journal Article,

Atypical mole syndrome
Kopf AW; Friedman RJ; Rigel DS
1990 Jan;22(1):117-118, Journal of the American Academy of Dermatology
— id: 16832, year: 1990, vol: 22, page: 117, stat: Journal Article,

Statistical issues in the identification of risk factors for suicidal behavior: the application of survival analysis
Leon, A C; Friedman, R A; Sweeney, J A; Brown, R P; Mann, J J
1990 Jan;31(1):99-108, Psychiatry research
Studies of suicide risk factors generally examine suicidal behavior as a dichotomous outcome. Survival analytic techniques are discussed in which the time until a suicide attempt from a specific point, such as prior attempt or onset of illness, is also examined. These procedures can incorporate information on those lost to followup or 'censored.' One survival analytic technique, Cox's proportional hazards model, is a particularly informative statistical technique for the study of suicidal risk factors because several covariates can be incorporated. Illustrative analyses estimate the significance of different risk factors, and demonstrate that there is a 32% increase in the relative risk of a suicide attempt associated with each prior attempt
— id: 148410, year: 1990, vol: 31, page: 99, stat: Journal Article,

Another view of melanoma and dysplastic nevi
Rigel DS; Kopf AW; Friedman RJ
1990 ;10:31-32, Primary care & cancer
— id: 62439, year: 1990, vol: 10, page: 31, stat: Journal Article,

The article reviewed on diagnosis and management of dysplastic nevus syndrome and early melanoma
Rigel DS; Kopf AW; Friedman RJ
1990 ;4:82-82, Oncology
— id: 62481, year: 1990, vol: 4, page: 82, stat: Journal Article,

Clinical characteristics of malignant melanomas developing in persons with dysplastic nevi
Rivers JK; Kopf AW; Vinokur AF; Rigel DS; Friedman RJ; Heilman ER; Levenstein M
1990 Mar 1;65(5):1232-1236, Cancer
A total of 452 patients with dysplastic nevi (DN) were followed prospectively by repetitive, complete cutaneous examinations in order to determine the clinical features of early malignant melanomas (MM) arising in them. Sixteen patients (3.5%) developed 18 newly diagnosed MM during an average follow-up period of 27 months. Twelve of the 18 MM were in situ and all of the primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. The principal clinical clue to the diagnosis of MM was change in a preexisting pigmented lesion. Total-body photographs were very useful in helping to identify the early MM in these patients
— id: 16831, year: 1990, vol: 65, page: 1232, stat: Journal Article,

Increased survival rate may be due to public education
Rigel DS; Kopf AW; Friedman RJ
1989 ;7:15-15, Skin Cancer Foundation journal
— id: 62417, year: 1989, vol: 7, page: 15, stat: Journal Article,

Dysplastic nevi. Markers for increased risk for melanoma
Rigel DS; Rivers JK; Kopf AW; Friedman RJ; Vinokur AF; Heilman ER; Levenstein M
1989 Jan 15;63(2):386-389, Cancer
A total of 452 white patients, classified into four dysplastic nevi groups, were followed prospectively by repetitive, complete cutaneous examinations using total-body photographs taken on entry into the study. Sixteen patients (3.5%) developed 18 newly diagnosed malignant melanomas (MM) during an average follow-up period of 27 months. Twelve of the 18 MM were in situ, and all of the six primary invasive MM diagnosed prospectively in this follow-up were less than 0.89 mm in Breslow thickness, implying an excellent prognosis. Compared with reference populations, the number of MM detected significantly exceeded the number estimated to occur in the comparable age-matched control groups. These data support the concept of repetitive follow-ups of all groups of patients with dysplastic nevi
— id: 8193, year: 1989, vol: 63, page: 386, stat: Journal Article,

Risk factors for the development of malignant melanoma--I: Review of case-control studies
Evans RD; Kopf AW; Lew RA; Rigel DS; Bart RS; Friedman RJ; Rivers JK
1988 Apr;14(4):393-408, Journal of dermatologic surgery & oncology
Data concerning risk factors for the development of cutaneous malignant melanoma (MM) were abstracted from published case-control studies. Relative risks (more appropriately 'odds ratios') and 95% confidence intervals were quoted or calculated for each risk factor in each study. Those risk factors that were reported to be significant in over half of the studies include: phenotypic factors (blue eyes, blond or red hair, light complexion, freckles, sun sensitivity, and inability to tan); personal history of non-melanoma cutaneous cancer or precancer; higher socioeconomic status; increased numbers of nevocytic nevi; and bursts of sun exposure. Further study is needed on family history and personal history of MM; these were not found to be significant risk factors in over half the reviewed case-control studies. This review leaves out other undoubtedly important risk factors such as dysplastic nervus syndrome and race, which need investigation by the case-control method. Determination of risk factors allows the identification of that subset of the population most at risk for the development of MM. Given the continued increase in the incidence of MM, these data can help to focus preventive measures on the more susceptible subgroups of the population
— id: 16833, year: 1988, vol: 14, page: 393, stat: Journal Article,

Scleral depression to facilitate endophotocoagulation
Fisher YL; Friedman R
1988 Jun;106(6):721-721, Archives of ophthalmology
— id: 32591, year: 1988, vol: 106, page: 721, stat: Journal Article,

The relationship between melanocytic nevi and malignant melanoma
Friedman RJ; Rigel DS; Heilman ER
1988 Apr;6(2):249-256, Dermatologic clinics
In conclusion, although there are data, some quite convincingly implicating dysplastic nevi and congenital nevi (particularly 'giant') as 'precursors' of malignant melanomas, our ability to predict the magnitude of these associations is lacking. Thus, until additional basic and clinical research data are forthcoming, any recommendation to prophylactically remove all congenital nevi or all dysplastic nevi in order to decrease the incidence of malignant melanoma is premature. In regard to congenital nevi, evidence exists that giant (larger than 20 cm in diameter) congenital nevi may have a significant risk factor so as to warrant, when feasible, prophylactic excision of such lesions. In our opinion, no uniform recommendation can be made at this time for the management of small and medium-sized congenital nevi. Patients with familial dysplastic nevus syndrome should be followed carefully and educated concerning the early detection of malignant melanoma. Patients with sporadic dysplastic nevus syndrome deserve further study to enable us to accurately determine their risk of developing malignant melanoma
— id: 11123, year: 1988, vol: 6, page: 249, stat: Journal Article,

Skin types in dysplastic nevus syndrome
Kopf AW; Goldman RJ; Rivers JK; Levenstein M; Rigel DS; Friedman RJ; Bart RS
1988 Aug;14(8):827-831, Journal of dermatologic surgery & oncology
In order to determine if individuals with dysplastic nevi (DN) are relatively more sun-sensitive than controls who do not have DN, the sun-reactivity skin types (based on the Harvard classification) were determined in these two groups. Compared with controls, sun-sensitive types were significantly overrepresented in the DN group. This is consistent with the hypothesis that the fundamental defect in the dysplastic nevus syndrome is the genetically unstable melanocyte, which is susceptible to neoplastic transformation induced by sunlight
— id: 10998, year: 1988, vol: 14, page: 827, stat: Journal Article,

PHOTOGRAPHS ARE USEFUL FOR DETECTION OF MALIGNANT MELANOMAS IN PATIENTS WHO HAVE DYSPLASTIC NEVI
Kopf, AW; Rivers, JK; Slue, W; Rigel, DS; Friedman, RJ
1988 Dec;19(6):1132-1134, Journal of the American Academy of Dermatology
— id: 31430, year: 1988, vol: 19, page: 1132, stat: Journal Article,

Risk gradient for malignant melanoma in individuals with dysplastic naevi
Rigel DS; Rivers JK; Friedman RJ; Kopf AW
1988 Feb 13;1(8581):352-353, Lancet
— id: 8384, year: 1988, vol: 1, page: 352, stat: Journal Article,

Symposium on age-related macular degeneration
Yannuzzi, L A; Friedman, R; Fine, S L; Gass, J D; Gitter, K A; Orth, D H; Singerman, L J
1988 Dec;64(9):955-1013, Bulletin of the New York Academy of Medicine
— id: 103488, year: 1988, vol: 64, page: 955, stat: Journal Article,

Prognostic significance of hypopigmentation in malignant melanoma
Bystryn JC; Rigel D; Friedman RJ; Kopf A
1987 Aug;123(8):1053-1055, Archives of dermatology
It has been suggested that the presence of cutaneous hypopigmentation favorably influences the prognosis of patients with malignant melanoma (MM). To examine this possibility, we have compared the actual with the predicted survival of 46 patients with MM and hypopigmentation who were among 1130 patients with MM entered in a long-term prospective study of MM at the New York University Medical Center. The actual average five-year survival rate of the patients with MM and hypopigmentation (86.3%) was significantly better than predicted (74.8%) on the basis of the risk factors present in each patient at the time of entry into the study. The findings suggest that hypopigmentation is a factor that beneficially influences the prognosis of MM, and that the mechanisms that inhibit or destroy normal melanocytes in patients with MM may also slow the growth of this cancer
— id: 16246, year: 1987, vol: 123, page: 1053, stat: Journal Article,

Ophthalmologic oncology: conjunctival malignant melanoma in association with sporadic dysplastic nevus syndrome
Friedman RJ; Rodriguez-Sains R; Jakobiec F
1987 Jan;13(1):31-34, Journal of dermatologic surgery & oncology
— id: 65129, year: 1987, vol: 13, page: 31, stat: Journal Article,

MUCOUS-MEMBRANES IN CUTANEOUS DISEASE
Friedman, RJ
1987 Apr-Jun;5(2):157-163, Clinics in dermatology
— id: 31317, year: 1987, vol: 5, page: 157, stat: Journal Article,

Prognostic index for malignant melanoma
Kopf AW; Gross DF; Rogers GS; Rigel DS; Hellman LJ; Levenstein M; Welkovich B; Friedman RJ; Roses DF; Bart RS; et al.
1987 Mar 15;59(6):1236-1241, Cancer
This report verifies the ability of a Prognostic Index (PI) to accurately predict 5-year survival rates for 879 Stage I cutaneous malignant melanoma (MM) patients seen at New York University Medical Center. The PI used in this study was first reported from Munich, West Germany, and is calculated from standard histologic sections by multiplying the MM thickness in millimeters (Breslow method) by the number of MM mitoses per square millimeter. A PI value of less than 19 versus greater than or equal to 19 was found to be a significant and independent prognostic variable for Stage I MM when compared with seven other predictive variables (including Breslow thickness). These PI intervals identified a subgroup of patients with MM of intermediate thicknesses (1.50-3.49 mm) whose significantly worse survival would not have been anticipated if prognosis were determined by Breslow thickness alone. For example, patients with MM 1.50 to 2.49 mm thick have a 5-year survival rate of 84.1% determined by Breslow thickness alone; however, among these patients exists a subgroup with PI greater than or equal to 19 whose survival rate is only 57.6%. This study verifies the additive usefulness of the PI in predicting survival rates of patients with Stage I cutaneous MM
— id: 16835, year: 1987, vol: 59, page: 1236, stat: Journal Article,

Thickness of malignant melanoma: global analysis of related factors
Kopf AW; Welkovich B; Frankel RE; Stoppelmann EJ; Bart RS; Rogers GS; Rigel DS; Friedman RJ; Levenstein MJ; Gumport SL; et al.
1987 Apr;13(4):345-90, 401, Journal of dermatologic surgery & oncology
— id: 16834, year: 1987, vol: 13, page: 345, stat: Journal Article,

The rate of malignant melanoma in the United States: are we making an impact?
Rigel DS; Kopf AW; Friedman RJ
1987 Dec;17(6):1050-1053, Journal of the American Academy of Dermatology
— id: 11302, year: 1987, vol: 17, page: 1050, stat: Journal Article,

VITILIGO-LIKE HYPOPIGMENTATION INFLUENCES FAVORABLY THE PROGNOSIS OF MELANOMA
Bystryn, JC; Rigel, D; Friedman, RJ; Kopf, A
1986 Sep;87(3):434-434, Journal of investigative dermatology
— id: 31016, year: 1986, vol: 87, page: 434, stat: Journal Article,

THE USE OF THE COMPUTER IN THE DERMATOPATHOLOGY LABORATORY
FRIEDMAN, RJ; GRANT, K; HEILMAN, ER
1986 OCT ;4(4):651-656, Dermatologic clinics
— id: 41279, year: 1986, vol: 4, page: 651, stat: Journal Article,

Self-examination of the skin: the patient's role in early detection
Kopf AW; Friedman RJ; Rigel DS
1986 ;4:25-29, Skin Cancer Foundation journal
— id: 62412, year: 1986, vol: 4, page: 25, stat: Journal Article,

Relationship of lumbosacral nevocytic nevi to sun exposure in dysplastic nevus syndrome
Kopf AW; Gold RS; Rogers GS; Hennessey NP; Friedman RJ; Rigel DS; Levenstein M
1986 Sep;122(9):1003-1006, Archives of dermatology
In 104 consecutive Caucasian patients who had histologically proved dysplastic nevi, the number and diameter of nevocytic nevi were determined in two equally sized contiguous rectangles in the lumbosacral region. The cephalad (superior) rectangle was in a relatively sun-exposed site, whereas the caudad (inferior) rectangle was in a relatively sun-protected site. Many of the nevocytic nevi identified in these rectangles had the clinical features of dysplastic nevi. Significantly, more nevi were found in the cephalad rectangle compared with the caudad rectangle. Men greater than or equal to 40 years of age had significantly larger nevi in the cephalad rectangle compared with the caudad rectangle. These data are consistent with the hypothesis that sunlight promotes development of more and larger nevocytic nevi in individuals afflicted with dysplastic nevus syndrome
— id: 16433, year: 1986, vol: 122, page: 1003, stat: Journal Article,

Familial malignant melanoma
Kopf AW; Hellman LJ; Rogers GS; Gross DF; Rigel DS; Friedman RJ; Levenstein M; Brown J; Golomb FM; Roses DF; et al.
1986 Oct 10;256(14):1915-1919, JAMA
Characteristics associated with familial compared with nonfamilial malignant melanoma were assessed. These data were obtained from consecutive prospectively completed questionnaires on 1169 cases of cutaneous malignant melanoma. Of these, 69 patients indicated a positive family history for this cancer. Among the various clinical and histological variables compared, those that significantly correlated with the familial occurrence of malignant melanoma include younger age at first diagnosis, smaller diameter of the lesion, lower Clark level, decreased frequency of nonmelanoma skin cancer, and reduced prevalence of noncutaneous cancer. Increased awareness of malignant melanoma among family members could account for some of these observations. Identification of the familial variety of malignant melanoma has practical implications concerning early detection and prompt intervention
— id: 16837, year: 1986, vol: 256, page: 1915, stat: Journal Article,

The incredible increasing incidence of malignant melanoma in the United States
Kopf AW; Rigel DS; Friedman RJ
1986 ;4:21,93-, Skin Cancer Foundation journal
— id: 62413, year: 1986, vol: 4, page: 21,93, stat: Journal Article,

Importance of complete cutaneous examination for the detection of malignant melanoma
Rigel DS; Friedman RJ; Kopf AW; Weltman R; Prioleau PG; Safai B; Lebwohl MG; Eliezri Y; Torre DP; Binford RT; et al.
1986 May;14(5 Pt 1):857-860, Journal of the American Academy of Dermatology
With the rate of melanoma increasing 1,000% in the past 50 years, the early detection of the disease is becoming more important. Data from 2,239 persons seen at the Manhattan Melanoma/Skin Cancer Detection Screening Program were analyzed to determine if a complete cutaneous examination would significantly increase the chance of detecting melanoma. Thirteen of the fourteen melanomas detected were on anatomic sites normally covered by clothing. Patients having complete skin examinations were 6.4 times more likely to have a melanoma detected than those having partial examinations (p = 0.025). These findings reinforce the importance of complete skin examination for the early detection of malignant melanoma
— id: 16842, year: 1986, vol: 14, page: 857, stat: Journal Article,

MALIGNANT-MELANOMA - INCISIONAL VS EXCISIONAL BIOPSY AND ITS EFFECTS ON SURVIVAL
RIGEL, DS; FRIEDMAN, RJ; KOPF, AW; ROGERS, GS; LEVENSTEIN, M
1986 JUL ;12(7):760-&, Journal of dermatologic surgery & oncology
— id: 41378, year: 1986, vol: 12, page: 760, stat: Journal Article,

Hazard-rate analysis in state I malignant melanoma
Rogers GS; Kopf AW; Rigel DS; Friedman RJ; Levenstein M; Bart RS
1986 Sep;122(9):999-1002, Archives of dermatology
Hazard-rate analysis provides a unique means of assessing prognosis in patients with malignant disease. The hazard rate is the probability of a patient dying within a particular unit of time after definitive therapy. Hazard-rate analysis was performed on a series of 719 consecutive patients with clinical stage I cutaneous malignant melanoma (MM). The peak hazard rate for death from metastatic MM occurred during the 48th month of follow-up. Thereafter, the hazard rate declined and approached zero by the 120th month. When the patients were stratified by the thickness of their primary MM, thicker lesions reached their peak hazard-rate month earlier than thinner lesions. We conclude that after 120-month survival, the risk of dying from MM is virtually zero. However, since rare late deaths from MM occur, lifetime follow-up is recommended
— id: 16840, year: 1986, vol: 122, page: 999, stat: Journal Article,

Influence of anatomic location on prognosis of malignant melanoma: attempt to verify the BANS model
Rogers GS; Kopf AW; Rigel DS; Levenstein ML; Friedman RJ; Harris MN; Golomb FM; Hennessey P; Gumport SL; Roses DF; et al.
1986 Aug;15(2 Pt 1):231-237, Journal of the American Academy of Dermatology
Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies
— id: 16841, year: 1986, vol: 15, page: 231, stat: Journal Article,

The dysplastic nevus. Clinical and pathologic features
Friedman RJ; Heilman ER; Rigel DS; Kopf AW
1985 Apr;3(2):239-249, Dermatologic clinics
The dysplastic nevus has not only been considered to be a 'marker,' but also a formal 'precursor' of malignant melanoma. Therefore, these lesions are important to recognize clinically. This article presents a classification of the dysplastic nevus based upon its variable clinical presentations. It is hoped that this classification will assist the physician to recognize many of the clinical variants of this unusual melanocytic nevus and, thus, to identify patients at greater risk for the development of malignant melanoma
— id: 16850, year: 1985, vol: 3, page: 239, stat: Journal Article,

The clinical features of malignant melanoma
Friedman RJ; Rigel DS
1985 Apr;3(2):271-283, Dermatologic clinics
The clinical diagnosis of malignant melanoma requires the following: an acceptance of the concept of 'in situ' malignancy, both clinically and histologically; a high index of suspicion concerning any pigmented lesion; recalling the mnemonic 'remember your A,B,C,D's'; and a knowledge of the clinical simulators of malignant melanoma. Prevention of death from malignant melanoma is possible through early diagnosis and prompt treatment of thin lesions (less than 0.76 mm in thickness). Such lesions have an excellent prognosis. This goal can be reached by carefully designed and implemented professional and public education programs such as those that have been introduced in Australia, West Germany, and the United States. Currently, new programs are being developed jointly by the American Academy of Dermatology and the American Cancer Society that are aimed at promoting self-examination of the skin as an adjunct to a routine physician examination as an additional means of detecting malignant melanoma at a time when it is wholly curable
— id: 16848, year: 1985, vol: 3, page: 271, stat: Journal Article,

Early detection of malignant melanoma: the role of physician examination and self-examination of the skin
Friedman RJ; Rigel DS; Kopf AW
1985 May-Jun;35(3):130-151, CA: a cancer journal for clinicians
The combination of routine physician examination of the skin coupled with self-examination provides a realistic opportunity for the identification of early malignant melanomas. Removal of such thin lesions can significantly reduce the mortality rate from this potentially serious form of cutaneous cancer
— id: 16844, year: 1985, vol: 35, page: 130, stat: Journal Article,

DYSPLASTIC NEVI
Friedman, RJ
1985 ;11(8):789-790, Journal of dermatologic surgery & oncology
— id: 30856, year: 1985, vol: 11, page: 789, stat: Journal Article,

Symposium on melanoma and pigmented lesions
Friedman, Robert J.; Rigel, Darrell S
Philadelphia : Saunders, 1985,
— id: 41, year: 1985, vol: , page: , stat: ,

Congenital-nevus-like nevi, nevi spili, and cafe-au-lait spots in patients with malignant melanoma
Kopf AW; Levine LJ; Rigel DS; Friedman RJ; Levenstein M
1985 Mar;11(3):275-280, Journal of dermatologic surgery & oncology
The prevalence of congenital-nevus-like nevi (CNLN) in a group of 105 adults who had malignant melanoma (MM) was compared with that in a control group of 601 adults not afflicted by MM. Total cutaneous examinations were performed on both groups. The control group presented with complaints other than pigmented lesions. In this series, 10 (9.5%) of the group with MM had clinically diagnosed CNLN 1.5 cm or larger in diameter. These CNLN were not in contiguity with the MM sites. The 9.5% prevalence of CNLN in the group with MM was significantly higher (p less than 0.005) than the 2.5% CNLN observed in the control population. None of the patients in either group had large congenital nevocytic nevi (greater than or equal to 20 cm). In addition, in the group with MM, 5 patients (4.8%) had nevi spili (NS) and 13 (12.4%) had cafe-au-lait spots (CLS). The prevalence rates for these two types of pigmented lesions were not significantly different from those observed in the nonmelanoma control group (2.3% for NS; 13.8% for CLS). The relative risk for developing MM is 4.1 in people with CNLN compared with those without CNLN, which indicates that these nevi may be markers for individuals prone to develop malignant melanoma
— id: 16851, year: 1985, vol: 11, page: 275, stat: Journal Article,

Prevalence of congenital-nevus-like nevi, nevi spili, and cafe au lait spots
Kopf AW; Levine LJ; Rigel DS; Friedman RJ; Levenstein M
1985 Jun;121(6):766-769, Archives of dermatology
To determine the clinical prevalence of medium-sized (1.5- to 19.9-cm-diameter) congenital-nevus-like nevi (CNLN), a consecutive series of 601 patients (mostly adults) had total cutaneous examinations. In this series, 15 (2.5%) were found to have such lesions. In addition, 14 (2.3%) had nevi spili and 83 (13.8%) had cafe au lait spots. All three types of lesions were equally represented in both sexes and tended to spare the head, neck, and upper extremities. Compared with CNLN, nevi spili were found to have significantly larger diameters and lower mean age, suggesting that these are different types of lesions. Some recommend the surgical removal of all congenital nevocytic nevi because of their malignant potential. Since it is not possible to clinically distinguish congenital nevocytic nevi and CNLN and since the observed prevalence of these lesions in adults is over four times that previously reported in newborns, such a recommendation becomes less feasible
— id: 16843, year: 1985, vol: 121, page: 766, stat: Journal Article,

Relationship of nevocytic nevi to sun exposure in dysplastic nevus syndrome
Kopf AW; Lindsay AC; Rogers GS; Friedman RJ; Rigel DS; Levenstein M
1985 Apr;12(4):656-662, Journal of the American Academy of Dermatology
In eighty consecutive patients who have the dysplastic nevus syndrome, the concentration of nevocytic nevi on the relatively sun-protected lateral thoracic area was compared to the concentration on the relatively sun-exposed areas of the anterior and posterior thorax. Nevocytic nevi in an area 7 X 20 cm were counted in each location. There was a total of 177 nevi on the lateral thorax (average, 2.2 nevi/person), 361 on the anterior thorax (average, 4.5 nevi/person), and 506 on the posterior thorax (average, 6.3 nevi/person). Men showed no significant difference in the number of nevi on the anterior and posterior thoracic areas, but women had fewer nevi on the anterior than on the posterior thoracic sites. These findings are consonant with the hypothesis that sunlight induces nevocytic nevi in patients who have the dysplastic nevus syndrome
— id: 16845, year: 1985, vol: 12, page: 656, stat: Journal Article,

The management of patients with dysplastic and congenital nevi
Rigel DS; Friedman RJ
1985 Apr;3(2):251-255, Dermatologic clinics
Although both dysplastic and congenital nevi appear to have a greater-than-expected risk for evolving into malignant melanoma, the magnitude of that risk is uncertain. For this reason, the management of patients with these lesions remains controversial. The National Institutes of Health Consensus Conference guidelines are presented with specific recommendations for the management of patients
— id: 16849, year: 1985, vol: 3, page: 251, stat: Journal Article,

Surgical margins for removal of dysplastic nevi
Rigel DS; Friedman RJ; Kopf AW
1985 ;11:745-745, Journal of dermatologic surgery & oncology
— id: 62472, year: 1985, vol: 11, page: 745, stat: Journal Article,

Precursors of malignant melanoma. Problems in computing the risk of malignant melanoma arising in dysplastic and congenital nevocytic nevi
Rigel DS; Friedman RJ; Kopf AW; Rogers GS; Heilman ER
1985 Apr;3(2):361-365, Dermatologic clinics
It has recently been shown that both dysplastic and congenital nevi are precursors to malignant melanoma. These findings are based upon mathematical models that show an increased risk of the nevi evolving into melanoma over random choice. However, problems exist with these models that may invalidate their results. The recommendation to remove dysplastic and congenital nevi prophylactically based upon models such as these is premature
— id: 16846, year: 1985, vol: 3, page: 361, stat: Journal Article,

Prognosis of malignant melanoma
Rigel DS; Rogers GS; Friedman RJ
1985 Apr;3(2):309-314, Dermatologic clinics
Multiple factors appear to influence survival in patients with malignant melanoma. Although at present thickness appears to be the best individual prognostic factor, other variables such as anatomic site of the lesion, ulceration, and level consistently appear in multivariate prognostic models. These multivariate models enable the assessment of patient prognosis for the optimization of treatment as well as the evaluation of future therapeutic trials. Future study of these prognostic factors will hopefully help us to understand the pathophysiology of melanoma and, possibly, unlock the secrets of the biology of this disease
— id: 16847, year: 1985, vol: 3, page: 309, stat: Journal Article,

SYMPOSIUM ON MELANOMA AND PIGMENTED LESIONS - FOREWORD
Rigel, DS; Friedman, RJ
1985 ;3(2):195-195, Dermatologic clinics
— id: 30913, year: 1985, vol: 3, page: 195, stat: Journal Article,

Malignant melanoma in World War II veterans
Brown J; Kopf AW; Rigel DS; Friedman RJ
1984 Dec;23(10):661-663, International journal of dermatology
In a consecutive series of 1,067 patients entered into the data base of the Melanoma Cooperative Group at New York University School of Medicine between 1972 and 1980, 120 men were of draft age (18-31 years) during World War II (1941-1945). Questionnaires were sent to these 120 individuals; 89 responded. Simultaneously, a control (nonmelanoma) population of 65 men of similar age was queried. Each subject in both groups was asked whether he had served in the armed forces during World War II and, if so, what were his theaters of operation. Based on the response, 83% (74 of 89) of the melanoma group compared with 76% (49 of 65) of the control group had served in the armed forces during World War II; however, a significantly (p = 0.0002) greater percent of the melanoma patients (34%) served in the tropics than did the control subjects (6%). Further, overrepresented in the melanoma group that served in the tropics (compared with the melanoma group who served in the armed forces in nontropical theaters) were malignant melanomas that had their origin in nevocytic nevi. The findings suggest that Caucasian individuals heavily exposed to sunlight in the tropics for several years during early life may be at higher risk to the subsequent development of cutaneous malignant melanoma. In some individuals this may be a two-step phenomenon, in which the first step is the solar induction of nevocytic nevi and the second is malignant transformation within them
— id: 16853, year: 1984, vol: 23, page: 661, stat: Journal Article,

Malignant melanoma in association with lichen sclerosus on the vulva of a 14-year-old
Friedman RJ; Kopf AW; Jones WB
1984 Summer;6 Suppl:253-256, American journal of dermatopathology
— id: 49414, year: 1984, vol: 6 Suppl, page: 253, stat: Journal Article,

"Microscopic satellites" are more highly associated with regional lymph node metastases than is primary melanoma thickness
Harrist TJ; Rigel DS; Day CL; Sober AJ; Lew RA; Rhodes AR; Harris MN; Kopf AW; Friedman RJ; Golomb FM; et al.
1984 May 15;53(10):2183-2187, Cancer
A multivariate analysis was performed on 20 clinical and histologic variables from 327 Stage I prospectively studied melanoma patients who underwent elective regional lymph node dissection (ERLD). Primary tumor thickness, microscopic satellites, and the elapsed interval between diagnosis and ERLD, were selected as the combination of variables that were most highly associated with clinically occult regional lymph node metastases (P = 10(-15), model chi-square). Microscopic satellites were defined as tumor nests, greater than 0.05 mm in diameter, in the reticular dermis, panniculus, or vessels beneath the principal invasive tumor mass but separated from it by normal tissue on the section in which the Breslow measurement was taken. The probability of finding nodal metastases for melanomas less than 0.75 mm thick was 0% (0/41 patients); for those 0.76-1.50 mm, 4% (4/108); 1.51-3.0 mm, 14% (14/102); and greater than 3.0 mm, 39.5% (30/76). Primary melanomas greater than 1.50 mm thick with microscopic satellites were more often associated with nodal metastases than those of similar thickness without satellites (30/57 (53%) versus 14/121 (12%), P = 0.01). Some satellites probably represent intraspecimen metastases, while others do not. Any predictive model for occult regional lymph node metastases based on data from ERLD done less than 50 days after diagnosis may underestimate the prevalence of metastases
— id: 16855, year: 1984, vol: 53, page: 2183, stat: Journal Article,

Is the Unsuit unsuitable?
Rigel DS; Kopf AW; Greenwald DI; Levine LJ; Friedman RJ
1984 Jul 19;311(3):200-200, New England journal of medicine
— id: 16854, year: 1984, vol: 311, page: 200, stat: Journal Article,

Predictors of late deaths among patients with clinical stage I melanoma who have not had bony or visceral metastases within the first 5 years after diagnosis
Day CL; Mihm MC; Sober AJ; Harris MN; Kopf AW; Fitzpatrick TB; Lew RA; Harrist TJ; Golomb FM; Postel A; Hennessey P; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Rigel D; Friedman RJ; Mintzis MM
1983 Jun;8(6):864-868, Journal of the American Academy of Dermatology
— id: 16625, year: 1983, vol: 8, page: 864, stat: Journal Article,

Favorable prognosis for malignant melanomas associated with acquired melanocytic nevi
Friedman RJ; Rigel DS; Kopf AW; Lieblich L; Lew R; Harris MN; Roses DF; Gumport SL; Ragaz A; Waldo E; Levine J; Levenstein M; Koenig R; Bart RS; Trau H
1983 Jun;119(6):455-462, Archives of dermatology
In a clinicohistopathologic study of 557 patients with primary cutaneous malignant melanoma, there were fewer metastases and/or deaths from melanoma when histologic evidence of a coexisting acquired melanocytic nevus was found. A total of 130 patients with melanocytic nevus and 427 cases of melanoma without histologic evidence of a nevus (denovo) were studied. Clinical follow-up evaluation for evidence of metastases and/or death was obtained. Only ten of the patients (7.7%) with nevus-associated melanoma had metastases and/or death v 78 (18.3%) with de novo melanoma. When stratified by lesion thickness, the logrank test for survival revealed a statistically significant difference between the two groups. An overall favorable outcome seen in patients with malignant melanomas associated with acquired melanocytic nevi was found, therefore, to be independent of lesion thickness as well as six other variables reported to be related to the biologic behavior of malignant melanoma. Thus, the presence of nevus cells in a specimen of malignant melanoma portends a better prognosis and may have important implications in the biology of this neoplasm
— id: 16858, year: 1983, vol: 119, page: 455, stat: Journal Article,

THE DYSPLASTIC NEVUS SYNDROME - CLINICOPATHOLOGIC DIFFERENCE IN THE SPORADIC AND FAMILIAL FORMS
FRIEDMAN, RJ
1983 ;9(8):659-660, Journal of dermatologic surgery & oncology
— id: 40645, year: 1983, vol: 9, page: 659, stat: Journal Article,

Relationship of fluorescent lights to malignant melanoma: another view
Rigel DS; Friedman RJ; Levenstein MJ; Greenwald DI
1983 Oct;9(10):836-838, Journal of dermatologic surgery & oncology
In an attempt to determine whether exposure to fluorescent lights may cause an increased risk for developing melanoma, 114 patients with melanoma were compared to 228 age-matched controls. Fluorescent-light exposure, along with 10 other risk factors, was analyzed for its possible relationship to malignant melanoma. No association was found between fluorescent-light exposure and increased risk for acquiring malignant melanoma
— id: 16857, year: 1983, vol: 9, page: 836, stat: Journal Article,

Effect of anatomical location on prognosis in patients with clinical stage I melanoma
Rogers GS; Kopf AW; Rigel DS; Friedman RJ; Levine JL; Levenstein M; Bart RS; Mintzis MM
1983 Aug;119(8):644-649, Archives of dermatology
A study of the influence of the anatomical location of malignant melanoma on the prognosis of 971 patients with stage I disease disclosed specific high-, intermediate-, and low-risk sites. High-risk sites included scalp, mandibular area, midline of trunk (anterior and posterior), upper medial thighs, hands, feet (except the arches), popliteal fossae, and genitalia. The life-table-adjusted five-year disease-free survival was 54% in the high-risk locations, 79% in intermediate-risk locations, and 93% in low-risk sites. A Cox proportional hazards analysis demonstrated that the grouping of lesions by their anatomical risk location had prognostic value that was significant in a model of eight other known predictive variables (thickness, sex, age, type, level, mitotic index, ulceration, and presence of preexistent nevus). The results indicate that anatomical location of the primary melanoma is significantly associated with five-year disease-free survival
— id: 16624, year: 1983, vol: 119, page: 644, stat: Journal Article,

Local and in-transit metastases following definitive excision for primary cutaneous malignant melanoma
Roses DF; Harris MN; Rigel D; Carrey Z; Friedman R; Kopf AW
1983 Jul;198(1):65-69, Annals of surgery
A total of 672 consecutive patients with clinical stage I and stage II primary cutaneous malignant melanoma were treated by excision of 3.0 to 5.0 cm of surrounding skin down to and including the underlying fascia when the lesion exceeded 0.5 mm thickness (Breslow measurement). More conservative margins were taken in locations where such excisions would result in significant cosmetic or functional morbidity and for thinner lesions (less than 0.5 mm). Seven of 658 patients with clinical stage I disease (1.1%) and three of 14 patients with clinical stage II disease (21.4%) developed histologically verified local metastases within 5 cm of the primary excision scar or skin graft. Fifteen patients with stage I disease developed in-transit metastases (2.3%) at a site more than 5.0 cm proximal to the surgical scar or skin graft but not beyond the regional nodal group. Two patients with stage II disease who had developed local metastases also developed in-transit metastases (14.3%). No patient with a lesion less than 1.0 mm thick has had a local recurrence. Nine of the ten patients (90%) who developed local metastases and 12 of the 17 patients (70.6%) who developed in-transit metastases have also developed systemic metastases to date. Local and in-transit metastases following such definitive excision is a significant indicator of disseminated systemic metastatic melanoma
— id: 25134, year: 1983, vol: 198, page: 65, stat: Journal Article,

Regression in malignant melanoma
Trau H; Kopf AW; Rigel DS; Levine J; Rogers G; Levenstein M; Bart RS; Mintzis MM; Friedman RJ
1983 Mar;8(3):363-368, Journal of the American Academy of Dermatology
A multiple stepwise logistic regression analysis shows that histologic regression is more likely to be found in a malignant melanoma that is level III or less, more than 10 mm in diameter, associated with solar elastosis, located on an anatomic area other than the head or neck, and when there are areas of whiteness clinically. Although patients with malignant melanomas displaying signs of regression histologically have a slightly better 5-year disease-free survival, this may be attributed to a difference in tumor thickness
— id: 16626, year: 1983, vol: 8, page: 363, stat: Journal Article,

Metastases of thin melanomas
Trau H; Rigel DS; Harris MN; Kopf AW; Friedman RJ; Gumport SL; Bart RS; Grier WR
1983 Feb 1;51(3):553-556, Cancer
Although thin malignant melanomas, i.e., those less than 0.76 mm in thickness, of the skin generally do not metastasize, it has been recently reported that when histologic regression is present, such lesions may then have a greater propensity for dissemination. However, this was not apparent in this study in which only one melanoma metastasized in a consecutive series of 41 thin lesions which were step-sectioned and had evidence of regression histologically. Possible explanations for this discrepancy are the failure of other authors to include only step-sectioned specimens of the primary melanomas in their material and/or geographic differences in the biologic behavior of this malignant neoplasm
— id: 16859, year: 1983, vol: 51, page: 553, stat: Journal Article,

A multivariate analysis of prognostic factors for melanoma patients with lesions greater than or equal to 3.65 mm in thickness. The importance of revealing alternative Cox models
Day CL; Lew RA; Mihm MC; Sober AJ; Harris MN; Kopf AW; Fitzpatrick TB; Harrist TJ; Golomb FM; Postel A; Hennessey P; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Rigel D; Friedman RJ; Mintzis MM; Grier RW
1982 Jan;195(1):44-49, Annals of surgery
Fourteen prognostic factors were examined in 79 patients with clinical Stage I melanoma greater than or equal to 3.65 mm in thickness. All nine patients with melanoma of the hands or feet died of melanoma. A Cox proportional hazards (multivariate) analysis of the remaining 70 patients showed that a combination of the following four variables best predicted bony or visceral metastases: 1) a nearly absent or minimal lymphocyte response at the base of the tumor, 2) histologic type other than superficial spreading melanoma, 3) location on the trunk, and 4) positive nodes or no initial node dissection. Ulceration and/or ulceration width were not useful in predicting outcome either singly or in combination with other variables. Patients with negative lymph nodes and primary tumors of the trunk, hands, and feet did not do better than patients with positive nodes at those sites. Conversely, non of 16 patients with negative lymph nodes and extremity melanomas (excluding the hands and feet) or head and neck melanomas developed visceral or bony metastases (i.e., five-year disease-free survival rate 100%)
— id: 16628, year: 1982, vol: 195, page: 44, stat: Journal Article,

Prognostic factors for patients with clinical stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A conceptual model for tumor growth and metastasis
Day CL; Mihm MC; Lew RA; Harris MN; Kopf AW; Fitzpatrick TB; Harrist TJ; Golomb FM; Postel A; Hennessey P; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Rigel D; Friedman RJ; Mintzis MM; Sober AJ
1982 Jan;195(1):35-43, Annals of surgery
Fourteen variables were tested for their ability to predict visceral or bony metastases in 177 patients with clinical Stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A Cox multivariate analysis yielded a combination of four variables that best predicted bony or visceral metastases for these patients: 1) mitoses greater than 6/min 2 (p = 0.0007), 2) location other than the forearm of leg) p = 0.009, 3) ulceration width greater than 3 mm (p = 0.04), 4) microscopic satellites (p = 0.05). The overall prognostic model chi square was 32.40 with 4 degrees of freedom (p less than 10 (-5). Combinations of the above variables were used to separate these patients into at least two risk groups. The high risk patients had at least a 35% or greater chance of developing visceral metastases within five years, while the low risk group had greater than an 85% chance of being disease free at five years. Criteria for the high risk group were as follows: 1) mitoses greater than 6/mm 2 in at least one area of the tumor, irrespective of primary tumor location, or 2) a melanoma located at some site other than the forearm or leg and histologic evidence in the primary tumor of either ulceration greater than 3 mm wide or microscopic satellites. The low risk group was defined as follows: 1) mitoses less than or equal to 6/mm 2 and a location on the leg or forearm, or 2) mitoses less than or equal to 6/mm 2 and the absence in histologic sections of the primary tumor of both microscopic satellites and ulceration greater then 3 mm wide. The number of patients in this series who did not undergo elective regional node dissection (N = 47) was probably too small to detect any benefit from this procedure. Based on survival rates from this and other studies, it is estimated that approximately 1500 patients with clinical Stage I melanoma of intermediate thickness in each arm of a randomized clinical trial would be needed to detect an increase in survival rates from elective regional node dissection
— id: 16629, year: 1982, vol: 195, page: 35, stat: Journal Article,

Prognostic factors for melanoma patients with lesions 0.76 - 1.69 mm in thickness. An appraisal of "thin" level IV lesions
Day CL; Mihm MC; Sober AJ; Harris MN; Kopf AW; Fitzpatrick TB; Lew RA; Harrist TJ; Golomb FM; Postel A; Hennessey P; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Rigel D; Friedman RJ; Mintzis MM
1982 Jan;195(1):30-34, Annals of surgery
Fourteen variables were tested for their prognostic usefulness in 203 patients with clinical Stage I melanoma and primary tumor 0.76-169 mm thick. Only two variables, primary tumor location and level of invasion, were useful in predicting death from melanoma for these patients. Of the 12 deaths from melanoma, 11 occurred in patients with primary tumors located on the upper back, posterior arm, posterior neck, and posterior scalp (=BANS). There has been only one death from melanoma in 136 patients with melanoma located at other sites (11/67 vs 1/136, p less than 0.0001 Fisher's Exact Test). Of the 67 BANS patients, 51 had level II or level III lesions and five (10%0 died of melanoma. This compared with six deaths from melanoma in 16 patients (37.5%) with level IV BANS lesions (5/51 vs 6/16, p = 0.01 Fisher's Exact Test). The relatively high incidence of both melanoma deaths and regional node metastases for the BANS group merits consideration for testing the efficacy of elective regional node dissection for these patients
— id: 16630, year: 1982, vol: 195, page: 30, stat: Journal Article,

MUSCLE PHOSPHOGLYCERATE MUTASE DEFICIENCY
DIMAURO, S; MIRANDA, AF; OLARTE, M; FRIEDMAN, R; HAYS, AP
1982 JAN 20 ;32(6):584-591, Neurology
— id: 98621, year: 1982, vol: 32, page: 584, stat: Journal Article,

Cutaneous malignant melanomas, five-year survival
Kopf AW; Rigel DS; Friedman RJ
1982 Nov;41(11):398-398, Hawaii medical journal
— id: 16860, year: 1982, vol: 41, page: 398, stat: Journal Article,

The rising incidence and mortality rate of malignant melanoma
Kopf AW; Rigel DS; Friedman RJ
1982 Sep;8(9):760-761, Journal of dermatologic surgery & oncology
— id: 16862, year: 1982, vol: 8, page: 760, stat: Journal Article,

"Small" melanomas: relation of prognostic variables to diameter of primary superficial spreading melanomas
Kopf AW; Rodriguez-Sains RS; Rigel DS; Friedman RJ; Bart RS; Grier WR; Mintzis MM; Postel AH
1982 Sep;8(9):765-770, Journal of dermatologic surgery & oncology
In a consecutive series of 648 superficial spreading melanomas a significantly better 5-year disease-free survival rate was observed for patients whose primary tumors were 14 mm or less in diameter when compared with those 15 mm or larger in diameter. Other distinguishing features of the group of 'smaller' superficial spreading melanomas were that they occurred in younger patients; were of shorter durations; were more common in women; occurred disproportionately on the lower limbs; were less elevated; tended to be round in shape; were thinner (Breslow); penetrated less deeply (Clark levels); showed less histologic regression; and developed fewer metastases. Based on these findings it is recommended that educational programs be undertaken for the medical profession and for the public to promote early diagnosis and prompt treatment of superficial spreading melanomas when they are small in diameter and more often curable. A color atlas of 'small' melanomas is presented
— id: 16627, year: 1982, vol: 8, page: 765, stat: Journal Article,

INTERFERON IN SYSTEMIC LUPUS-ERYTHEMATOSUS
PREBLE, OT; BLACK, RJ; KLIPPEL, JH; FRIEDMAN, R; VILCEK, J
1982 ;25(4):219-231, UCLA symposia on molecular & cellular biology
— id: 40378, year: 1982, vol: 25, page: 219, stat: Journal Article,

Malignant melanoma. Prognostic significance of "microscopic satellites" in the reticular dermis and subcutaneous fat
Day CL Jr; Harrist TJ; Gorstein F; Sober AJ; Lew RA; Friedman RJ; Pasternack BS; Kopf AW; Fitzpatrick TB; Mihm MC Jr
1981 Jul;194(1):108-112, Annals of surgery
A review of the microscope slides of the primary tumors for 596 patients with clinical Stage I melanoma revealed that primary lesions displayed two distinct patterns of invasion: 1) single cell invasion with direct extension of the main body of tumor into the reticular dermis or subcutaneous fat, and 2) invasion with 'microscope satellites' (i.e. discrete tumor nests greater than 0.05 mm in diameter, that were separated from the main body of the tumor by normal reticular dermal collagen or subcutaneous fat). The five-year disease free survival rate for 95 patients with 'microscopic satellites' was 36% +/- 6%. This is in contrast to a five-year disease free survival rate of 89% +/- 2% for 501 patients without these satellites (p = 4.3 x 10(-29), generalized Wilcoxon test). 'Microscopic satellites' (present vs absent) was comparable to histologic ulceration in its additive prognostic effect of tumor thickness (Breslow).
— id: 10291, year: 1981, vol: 194, page: 108, stat: Journal Article,

HUMAN-MUSCLE PHOSPHOGLYCERATE MUTASE DEFICIENCY - NEWLY DISCOVERED METABOLIC MYOPATHY
DIMAURO, S; MIRANDA, AF; KHAN, S; GITLIN, K; FRIEDMAN, R
1981 JAN 20 ;212(4500):1277-1279, Science
— id: 98638, year: 1981, vol: 212, page: 1277, stat: Journal Article,

Factors related to thickness of melanoma. Multifactorial analysis off variables correlated with thickness of superficial spreading malignant melanoma in man
Kopf AW; Rigel D; Bart RS; Mintzis MM; Hennessey P; Harris MN; Ragaz A; Trau H; Friedman RJ; Esrig B
1981 Aug;7(8):645-650, Journal of dermatologic surgery & oncology
Computer analyses to identify correlations between thickness of primary superficial spreading malignant melanoma and eighteen variables previously reported to be related to prognosis were performed on a series of malignant melanomas. The variables that showed statistically significant (less than or equal to 0.05) direct relationships to thickness were level (Clark), elevation of lesion, age of patient, least and greatest diameters of lesion, history of bleeding, ulceration, clinical and histologic stage, anatomic location, pedunculation, and satellitosis. The variables that did not correlate with thickness were clinical diagnosis of regional lymphadenopathy, in-transit metastasis, duration of lesion, sex, history of a previous malignant melanoma, and history of a pre-existing lesion at the site of the development of melanoma. Multiple regression analysis of the factors that showed statistically significant correlation with thickness of the primary lesion revealed a subset of six dominant variables that were most predictive of thickness, namely, level, elevation, largest diameter of lesion, ulceration, histologic stage, and age of the patient
— id: 16631, year: 1981, vol: 7, page: 645, stat: Journal Article,

Correlation of thicknesses of superficial spreading malignant melanomas and ages of patients
Levine J; Kopf AW; Rigel DS; Bart RS; Hennessey P; Friedman RJ; Mintzis MM
1981 Apr;7(4):311-316, Journal of dermatologic surgery & oncology
In a prospective study of 455 consecutive patients with superficial spreading malignant melanomas entered into the data base of the Melanoma Cooperative Group of New York University Medical Center, it was found by linear-regression analysis that there is a statistically significant (p = 0.005) positive correlation between the ages of the patients and the thickness of their lesions. Although the reasons for the correlation between ages and thicknesses ae not certain, several possible explanations were considered, namely: (1) the greater prevalence of superficial spreading malignant melanomas in the aged on the lower limbs where thicker lesions were present in our patients, (2) the altered skin of the elderly, which may favor deeper penetration by these neoplasms, (3) impaired immunologic responses in the aged, (4) the delay in diagnosis of malignant melanomas in the elderly because of obsuration of them by numerous benign pigmented lesions that frequently develop with aging, and (5) lesser concern of the elderly with their physical appearances in particular and medical problems in general
— id: 16632, year: 1981, vol: 7, page: 311, stat: Journal Article,

Cigarette smoking and malignant melanoma. Prognostic implications
Rigel DS; Friedman RJ; Levine J; Kopf AW; Levenstein M
1981 Nov;7(11):889-891, Journal of dermatologic surgery & oncology
In a prospective study of 178 patients with malignant melanoma, a subset of 33 patients (18.5%) was identified to be at significantly higher risk for developing metastatic disease based on history of cigarette smoking. Patients in this high-risk group (current smokers with a greater than 15 pack-years of smoking history) had two-year disease-free survival rates of 74.2%. versus 92.3% for the remaining patients (p = 0.008). A possible explanation of this phenomenon is that chronic smoking diminishes host defense mechanisms and results in an adverse affect on the biologic behavior of established malignant melanomas
— id: 16866, year: 1981, vol: 7, page: 889, stat: Journal Article,

Predicting recurrence of basal-cell carcinomas treated by microscopically controlled excision: a recurrence index score
Rigel DS; Robins P; Friedman RJ
1981 Oct;7(10):807-810, Journal of dermatologic surgery & oncology
Despite the high cure rate achieved for basal-cell carcinomas treated with microscopically controlled excision, recurrences do occur. To determine if lesions that are likely to recur may be predicted at the time of surgery, data from 5020 patients with 7010 basal-cell carcinomas treated with Mohs' technique were reviewed. Two thousand nine hundred sixty (2960) lesions with five-year follow-up were studied (overall recurrence rate = 2.6%). Sex and age of the patients, size and location of lesions, types of previous therapy, and the number of surgical stages of microscopically controlled excision were all found to correlate significantly with recurrence rate (p less than 0.01). Multiple regression analysis was performed to determine the relative contribution of each of these variables to predictability of recurrences by a weighted scoring system. The derived model delineated the lesions into no-risk, low-, medium-, and high-risk groupings (p less than 0.000001). Lesions in the high-risk group had a recurrence rate of 10.1%, almost four times greater than the average. More aggressive microscopically controlled excisions and closer follow-up care are indicated for those lesions that can be predicted to result in a high-risk score
— id: 16867, year: 1981, vol: 7, page: 807, stat: Journal Article,

Pigmented Pilomatricoma. A clinical simulator of malignant melanoma
Spitz D; Fisher D; Friedman RJ; Kopf AW
1981 Nov;7(11):903-906, Journal of dermatologic surgery & oncology
— id: 49438, year: 1981, vol: 7, page: 903, stat: Journal Article,