Darrell S Rigel, M.D.

The frequency of self-skin examination and full body skin examination in dermatologists
Saitta, Peter; Cohen, David E; Rigel, Darrell; Grekin, Steven K; Brancaccio, Ronald
2011 Jun;4(6):20-24, Journal of Clinical & Aesthetic Dermatology
Purpose: Mortalities due to skin cancer are escalating, but early detection via skin examinations can be beneficial. To date, dermatologists have not been isolated as a high-risk population for developing skin cancer, although some evidence suggests that they are a high-risk group. Therefore, the specific aims of this study were to measure the frequency at which dermatologists perform self-skin examination and receive full-body skin examination. Patients and methods: A sample of 476 respondents provided data for this cross-sectional, nine-item survey, which was e-mailed to all registered members in the American Society for Dermatologic Surgery. The initial invitation was sent in the summer of 2007, with reminders sent at four and eight weeks. E-mails contained a unique identifier, and each member could only respond once to the survey sent to that particular e-mail address. Results: 71.7 percent of the respondents reported that they routinely gave themselves a self-skin examination, 25.4 percent reported a monthly exam, 24.5 percent every six months, 17.2 percent once per year, and 4.6 percent every five years. Performing a self-skin examination was not related to age, gender, or history of skin malignancy. Seventy-six percent of all respondents never had a full-body skin examination conducted by another dermatologist, which persisted when analyzed by age (p = 0.0490) and gender (p = 0.0184). Conclusion: Dermatologists are more likely to perform self-skin examination rather than visit another dermatologist for a full-body skin examination
— id: 137963, year: 2011, vol: 4, page: 20, stat: Journal Article,

Comparing diagnostic sensitivity and specificity for pigmented lesions in clinical dermatologists versus a multispectral digital dermascopy system
Yoo, Jane; Rigel, Darrell
2011 FEB ;64(2):AB122-AB122, Journal of the American Academy of Dermatology
— id: 126449, year: 2011, vol: 64, page: AB122, stat: Journal Article,

Efficacy and substantivity evaluation of a sunscreen formulation for people conducting sporting activities in a high UV intensity locale
Rigel, D; Ouyang, H; Appa, Y
2010 MAR ;62(3):AB56-AB56, Journal of the American Academy of Dermatology
— id: 110142, year: 2010, vol: 62, page: AB56, stat: Journal Article,

Epidemiology of melanoma
Rigel, Darrell S
2010 Dec;29(4):204-209, Seminars in cutaneous medicine & surgery
Malignant melanoma represents a significant and growing public health burden in the US and worldwide. It is estimated that 68, 130 cases of invasive malignant melanoma and at least 48,000 cases of melanoma in-situ will be diagnosed in the US this year. Melanoma is also one of the few remaining cancers with increasing US incidence. In the 1930s, the lifetime risk of an American developing invasive malignant melanoma was 1 in 1,500. Currently, that risk is 1 in 59. Deaths from malignant melanoma are also increasing. The mortality rate from malignant melanoma has risen about 2% annually since 1960. This year, it is estimated that 8,700 Americans will die from this cancer. The identification of individuals at high risk for malignant melanoma is important for the development of focused and efficient prevention efforts. Acute sun exposure resulting in sunburn remains a significant risk factor for the development of melanoma, but numerous other potential risk factors have been cited. Included among these are atypical mole syndrome/dysplastic nevus syndrome, blistering sunburns, immunosuppression, prior therapy with psoralen with ultraviolet A light (UVA) light, UV exposure at tanning salons, elevated socioeconomic status, and history of melanoma in a first-degree relative. With a better understanding of the reasons for the increasing rate of this cancer, and with enhanced early detection approaches, we may be able to decrease the incidence and mortality of malignant melanoma
— id: 133850, year: 2010, vol: 29, page: 204, stat: Journal Article,

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,

A comparison of sunburn protection of high-sun protection factor (SPF) sunscreens: SPF 85 sunscreen is significantly more protective than SPF 50
Russak, Julie E; Chen, Theresa; Appa, Yohini; Rigel, Darrell S
2010 Feb;62(2):348-349, Journal of the American Academy of Dermatology
— id: 107746, year: 2010, vol: 62, page: 348, stat: Journal Article,

Tanning bed hygiene: microbes found on tanning beds present a potential health risk
Russak, Julie E; Rigel, Darrell S
2010 Jan;62(1):155-157, Journal of the American Academy of Dermatology
— id: 107747, year: 2010, vol: 62, page: 155, stat: Journal Article,

Imiquimod 2.5% and 3.75% for the treatment of actinic keratoses: Results of two placebo-controlled studies of daily application to the face and balding scalp for two 2-week cycles
Swanson, Neil; Abramovits, William; Berman, Brian; Kulp, James; Rigel, Darrell S; Levy, Sharon
2010 Apr;62(4):582-590, Journal of the American Academy of Dermatology
BACKGROUND: The approved imiquimod 5% cream regimen for treating actinic keratoses requires a long treatment time and is limited to a small area of skin. OBJECTIVE: We sought to evaluate imiquimod 2.5% and 3.75% for short-course treatment of the full face or balding scalp. METHODS: In two identical studies, adults with 5 to 20 lesions were randomized to placebo, imiquimod 2.5%, or imiquimod 3.75% (1:1:1). Up to two packets (250 mg each) were applied per dose once daily for two 2-week treatment cycles, with a 2-week, no-treatment interval between cycles. Efficacy was assessed at 8 weeks posttreatment. RESULTS: A total of 479 patients were randomized to placebo, or imiquimod 2.5% or 3.75%. Complete and partial clearance (>/=75% lesion reduction) rates were 6.3% and 22.6% for placebo, 30.6% and 48.1% for imiquimod 2.5%, and 35.6% and 59.4% for imiquimod 3.75%, respectively (P < .001 vs placebo, each; P = .047, 3.75% vs 2.5% for partial clearance). Median reductions from baseline in lesion counts were 25.0% for placebo, 71.8% for imiquimod 2.5%, and 81.8% for imiquimod 3.75% (P < .001, each active vs placebo; P = .048 3.75% vs 2.5%). There were few treatment-related discontinuations. Patient rest period rates were 0% for placebo, 6.9% for imiquimod 2.5%, and 10.6% for imiquimod 3.75%. LIMITATIONS: Local pharmacologic effects of imiquimod, including erythema, may have limited concealment of treatment assignment in some patients. CONCLUSIONS: Both imiquimod 2.5% and 3.75% creams were more effective than placebo and were well tolerated when administered daily as a 2-week on/off/on regimen to treat actinic keratoses
— id: 107745, year: 2010, vol: 62, page: 582, stat: Journal Article,

Selection criteria for genetic assessment of patients with familial melanoma
Leachman, Sancy A; Carucci, John; Kohlmann, Wendy; Banks, Kimberly C; Asgari, Maryam M; Bergman, Wilma; Bianchi-Scarra, Giovanna; Brentnall, Teresa; Bressac-de Paillerets, Brigitte; Bruno, William; Curiel-Lewandrowski, Clara; de Snoo, Femke A; Debniak, Tadeusz; Demierre, Marie-France; Elder, David; Goldstein, Alisa M; Grant-Kels, Jane; Halpern, Allan C; Ingvar, Christian; Kefford, Richard F; Lang, Julie; MacKie, Rona M; Mann, Graham J; Mueller, Kurt; Newton-Bishop, Julia; Olsson, Hakan; Petersen, Gloria M; Puig, Susana; Rigel, Darrell; Swetter, Susan M; Tucker, Margaret A; Yakobson, Emanuel; Zitelli, John A; Tsao, Hensin
2009 Oct;61(4):677.e1-677.14, Journal of the American Academy of Dermatology
Approximately 5% to 10% of melanoma may be hereditary in nature, and about 2% of melanoma can be specifically attributed to pathogenic germline mutations in cyclin-dependent kinase inhibitor 2A (CDKN2A). To appropriately identify the small proportion of patients who benefit most from referral to a genetics specialist for consideration of genetic testing for CDKN2A, we have reviewed available published studies of CDKN2A mutation analysis in cohorts with invasive, cutaneous melanoma and found variability in the rate of CDKN2A mutations based on geography, ethnicity, and the type of study and eligibility criteria used. Except in regions of high melanoma incidence, such as Australia, we found higher rates of CDKN2A positivity in individuals with 3 or more primary invasive melanomas and/or families with at least one invasive melanoma and two or more other diagnoses of invasive melanoma and/or pancreatic cancer among first- or second-degree relatives on the same side of the family. The work summarized in this review should help identify individuals who are appropriate candidates for referral for genetic consultation and possible testing
— id: 114948, year: 2009, vol: 61, page: 677.e1, stat: Journal Article,

Long-term follow up of diclofenac sodium 3% in 2.5% hyaluronic acid gel for actinic keratosis: One-year evaluation
Nelson C.; Rigel D.
2009 ;2(7):-, Journal of Clinical & Aesthetic Dermatology
Objective: To evaluate the long-term effects of treatment with diclofenac sodium 3% in 2.5% hyaluronic acid gel on clinically diagnosed actinic keratosis lesions in well-defined skin areas. Design: A one-year extension of a Phase 4, single-arm, multicenter, open-label study was conducted. Patients in the original study received diclofenac sodium 3% gel twice daily for 90 days. The extension study consisted of a single evaluation approximately one year post-treatment. Setting: Five US centers. Participants: Patients who had completed the initial treatment phase with no further treatment for actinic keratosis in the designated treatment blocks. Measurements: The primary endpoint was the proportion of patients achieving 75-percent clearance of actinic keratosis lesions at one-year follow up based on percent change from baseline in target lesion number score or cumulative lesion number score. Secondary endpoints were the proportion of patients achieving 100-percent actinic keratosis lesion clearance and change in investigator's global improvement index scores. Results: Eighty-one percent of patients reported no additional treatment for actinic keratosis lesions for one year after completing treatment with diclofenac sodium 3% gel. The proportion of patients with 75-percent clearance after one year was 91 percent (95% CI, 84-99%) for target lesions and 70 percent (95% CI, 57-83%) for cumulative lesions. The proportion of patients with 100-percent clearance at one year was 79 percent (95% CI, 67-90%) for target lesions and 30 percent (95% CI, 17-43%) for cumulative lesions. Investigator's global improvement index severity scores showed that the majority (96%) of patients improved from baseline after one year. Conclusion: The efficacy of a single, 90-day course of diclofenac sodium 3% gel persisted in the majority of patients at one year. 2010 The Journal of Clinical and Aesthetic Dermatology
— id: 111402, year: 2009, vol: 2, page: , stat: Journal Article,

Sunburn protection by sun protection factor (SPF) 85 and SPF 50 sunscreens at high altitudes
Rigel, DS; Chen, T; Appa, Y
2009 MAR ;60(3):AB155-AB155, Journal of the American Academy of Dermatology
— id: 97562, year: 2009, vol: 60, page: AB155, 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,

Diclofenac sodium 3% gel in the treatment of actinic keratoses postcryosurgery
Berlin, Joshua M; Rigel, Darrell S
2008 Jul;7(7):669-673, Journal of drugs in dermatology : JDD
BACKGROUND: Actinic keratoses are increasingly common skin lesions that are evaluated and treated by dermatologists on a daily basis. It is estimated that more than 90% of actinic keratoses in the US are treated by destructive therapies, such as cryosurgery. The purpose of this study was to evaluate the efficacy of sequential therapy of cryosurgery followed by diclofenac sodium 3% gel. METHODS: This prospective, double-arm, multicenter, open-label, phase 4 study was performed at 82 community dermatology centers in the US. A total of 714 subjects who had a clinical diagnosis of actinic keratosis with between 5 and 15 lesions contained in a target area such as the forehead, scalp, and hands were enrolled in the study. These subjects were randomized into 2 arms of the study: cryosurgery alone and cryosurgery followed by diclofenac sodium 3% gel for a period of 90 days. Lesion counts were assessed at baseline, and 45, 75, 105, and 135 days after cryosurgery. RESULTS: Of the 521 patients enrolled in the study who successfully completed all of the visits concluding on day 135, 277 were in the cryosurgery alone arm and 244 were in the cryosurgery followed by diclofenac sodium 3% gel arm. At the conclusion of the study, 46% of the subjects in the cryosurgery followed by the use of diclofenac sodium 3% gel arm achieved 100% cumulative (target plus new lesions) lesion clearance compared to 21% in the cryosurgery alone arm (P < .0001). One hundred percent target lesion clearance was achieved in 64% of the subjects in the active arm compared to 32% in the cryosurgery alone arm (P < .0001). CONCLUSIONS: With the increased prevalence of actinic keratoses, it is important to consider and evaluate emerging therapeutic options. The sequential treatment with cryosurgery followed by diclofenac sodium 3% gel for 90 days is well tolerated and can provide a therapeutic modality that may provide patients with actinic keratoses a more successful outcome than monotherapy with cryosurgery by effectively treating clinical and subclinical lesions
— id: 94444, year: 2008, vol: 7, page: 669, stat: Journal Article,

Innovations in Natural Antioxidants and Their Role in Dermatology
Ditre, C; Wu, J; Baumann, LS; Rigel, D
2008 DEC ;82(6):2-16, Cutis
The use of natural products for skin care has become more common in the past few years. Consumers are more aware of unnatural chemicals and other toxins and are searching for natural products to use on their skin. Fortunately, a large number of botanical antioxidants exist and are being marketed as either over-the-counter or prescription skin care products. Antioxidants can have profound effects on the intracellular signaling pathways involved in skin damage and thus may be protective against photodamage as well as may prevent wrinkles and inflammation. This supplement discusses the potent effect that botanical antioxidants may have in the management of a broad range of skin issues, from photoaging to inflammatory skin conditions
— id: 91497, year: 2008, vol: 82, page: 2, 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,

Evaluation of sunburn protection by a single application of an SPF 70 formulation at high altitudes under extreme sun conditions
Rigel, D; Chen, T; Appa, Y
2008 FEB ;58(2):AB113-AB113, Journal of the American Academy of Dermatology
— id: 75946, year: 2008, vol: 58, page: AB113, stat: Journal Article,

Cutaneous ultraviolet exposure and its relationship to the development of skin cancer
Rigel, Darrell S
2008 May;58(5 Suppl 2):S129-S132, Journal of the American Academy of Dermatology
Skin cancer is becoming an increasingly important public health problem. Multiple studies have now demonstrated a relationship between ultraviolet exposure and increased risk of developing skin cancer. However, the specifics of that association are somewhat different for malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. A better understanding of the mechanisms that allow cutaneous ultraviolet radiation to induce neoplasia will result in the development of better future sun-protection agents and strategies
— id: 78741, year: 2008, vol: 58, page: S129, stat: Journal Article,

Imiquimod 5% cream following curettage without electrodesiccation for basal cell carcinoma: preliminary report
Rigel, Darrell S; Torres, Abel M; Ely, Haines
2008 Jan;7(1 Suppl 1):s15-s16, Journal of drugs in dermatology : JDD
BACKGROUND: Using more than one therapeutic approach in the treatment of basal cell carcinomas (BCCs) has the potential to enhance cure rates. MATERIALS AND METHODS: In this study, 57 nodular and superficial BCCs were curetted without electrodesiccation. One week later, imiquimod 5% cream therapy was initiated once daily 5 times per week for 6 weeks. At 1-year follow-up, 0 of 57 BCCs (0%) had clinical recurrences. Cosmetic results were very good to excellent. CONCLUSION: Combination therapy with imiquimod 5% cream followed by curettage represents an effective method for treating BCCs with a high cure rate
— id: 76156, year: 2008, vol: 7, page: s15, stat: Journal Article,

Natural advances in eczema care
Eichenfield, Lawrence F; Fowler, Joseph F Jr; Rigel, Darrell S; Taylor, Susan C
2007 Dec;80(6 Suppl):2-16, Cutis
Atopic dermatitis (AD) is a chronic relapsing dermatitis characterized by increased transepidermal water loss (TEWL) and subjective symptoms of pruritus, inflammation, skin sensitivity, and dryness. AD is a frequent issue for individuals of color, though it may be underrecognized. Therapy for AD is based on reducing pruritus and inflammation, and normalizing skin surface lipids, particularly ceramides. Topical corticosteroids are the gold-standard treatment for controlling disease flares, but a variety of active natural ingredients can be used adjunctively to help control itch, inflammation, and dryness. Oatmeal, particularly avenanthramides, a newly discovered oat fraction, may be of particular value in restoring the cutaneous barrier and reducing symptoms of AD. Feverfew, licorice, and dexpanthenol also have been shown to be effective in the management of inflammation. Licorice, which has some skin-lightening activity, may be helpful in patients with postinflammatory hyperpigmentation (PIH). The compromised skin barrier in AD is especially vulnerable to UV radiation exposure. Several new long-lasting photostable sunscreen ingredients provide longer durations of protection with improved cosmetic attributes
— id: 94445, year: 2007, vol: 80, page: 2, stat: Journal Article,

Risk factors for presumptive melanoma in skin cancer screening: American Academy of Dermatology National Melanoma/Skin Cancer Screening Program experience 2001-2005
Goldberg, Matthew S; Doucette, John T; Lim, Henry W; Spencer, James; Carucci, John A; Rigel, Darrell S
2007 Jul;57(1):60-66, Journal of the American Academy of Dermatology
BACKGROUND: Since its inception in 1985, the American Academy of Dermatology (AAD) National Melanoma/Skin Cancer Screening Program has strived to enhance early detection of cutaneous malignant melanoma (MM) by providing nationwide skin cancer education campaigns in combination with free skin cancer screenings. OBJECTIVE: To analyze the AAD screening data from 2001 to 2005 in order to identify factors associated with MM detection, and thereby derive a model of increased likelihood for MM detection through visual skin examinations at screenings. MATERIALS AND METHODS: Patients completed a standardized AAD pre-screening form with historical and phenotypic information. Clinicians then recorded suspected clinical findings noted at visual skin examination. Statistical analyses were conducted using SPSS 14 (SPSS Inc., Chicago, Ill). RESULTS: Five factors, which can be remembered with the acronym HARMM, independently increased the likelihood of suspected MM being found in the 362,804 persons screened: History of previous melanoma (odds ratio [OR] = 3.3; 95% confidence interval [CI], 2.9-3.8); Age over 50 (OR = 1.2; 95% CI, 1.1-1.3); Regular dermatologist absent (OR = 1.4; 95% CI, 1.3-1.5); Mole changing (OR = 2.0; 95% CI, 1.9-2.2); and Male gender (OR = 1.4; 95% CI, 1.3-1.5). Individuals at highest risk (4 or 5 factors) comprised only 5.8% of the total population, yet accounted for 13.6% of presumptive MM findings, and were 4.4 times (95% CI, 3.8-5.1) more likely to be diagnosed with suspected MM than individuals at lowest risk (0 or 1 factor). Receipt of a total skin examination at screening independently increased the likelihood for identifying suspected MM (OR = 1.4; 95% CI, 1.3-1.6). However, significantly fewer screenees in the highest risk group versus those in the lowest risk group underwent total skin examinations (53.7% vs 62.5%). LIMITATIONS: Risk factors studied limited to variables collected in screenee enrollment form. CONCLUSIONS: A higher-risk subgroup of the skin cancer screening population can be identified through assessment of MM risk factors using the HARMM criteria. Refocusing efforts to provide a total skin examination to those individuals with multiple risk factors has the potential to both reduce costs and increase yields for suspected MM in future mass screening initiatives
— id: 94447, year: 2007, vol: 57, page: 60, stat: Journal Article,

Commentary: A responsible approach to maintaining adequate serum vitamin D levels
Lim, Henry W; Carucci, John A; Spencer, James M; Rigel, Darrell S
2007 Oct;57(4):594-595, Journal of the American Academy of Dermatology
— id: 94446, year: 2007, vol: 57, page: 594, stat: Journal Article,

The use of photodynamic therapy in dermatology: results of a consensus conference
Nestor, Mark S; Gold, Michael H; Kauvar, Arielle N B; Taub, Amy F; Geronemus, Roy G; Ritvo, Eva C; Goldman, Mitchel P; Gilbert, Dore J; Richey, Donald F; Alster, Tina S; Anderson, R Rox; Bank, David E; Carruthers, Alastair; Carruthers, Jean; Goldberg, David J; Hanke, C William; Lowe, Nicholas J; Pariser, David M; Rigel, Darrell S; Robins, Perry; Spencer, James M; Zelickson, Brian D
2006 Feb;5(2):140-154, Journal of drugs in dermatology : JDD
Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source
— id: 65268, year: 2006, vol: 5, page: 140, stat: Journal Article,

Taking the sting out of pediatric sunburn
Rigel DS
2006 ;Supplement:4p- Jul, Contemporary pediatrics
— id: 68765, year: 2006, vol: Supplement, page: 4p, stat: Journal Article,

Protection at high altitudes in extreme sun conditions: Sunscreen effectiveness and reapplication need evaluation
Rigel, D; Cole, C
2006 MAR ;54(3):AB191-AB191, Journal of the American Academy of Dermatology
— id: 62898, year: 2006, vol: 54, page: AB191, stat: Journal Article,

Photostability of UVA/UVB sunscreens under extreme tropical sun exposure
Rigel, DS; Cole, C; Chen, T; Appa, Y
2006 MAR ;54(3):AB191-AB191, Journal of the American Academy of Dermatology
— id: 62897, year: 2006, vol: 54, page: AB191, 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,

Sunlight, tanning booths, and vitamin D
Lim, Henry W; Gilchrest, Barbara A; Cooper, Kevin D; Bischoff-Ferrari, Heike A; Rigel, Darrell S; Cyr, W Howard; Miller, Sharon; DeLeo, Vincent A; Lee, Tim K; Demko, Catherine A; Weinstock, Martin A; Young, Antony; Edwards, Laura Saul; Johnson, Timothy M; Stone, Stephen P
2005 May;52(5):868-876, Journal of the American Academy of Dermatology
— id: 94448, year: 2005, vol: 52, page: 868, stat: Journal Article,

Cancer of the skin
Rigel, Darrell S
Philadelphia : Elsevier Saunders, 2005,
— id: 969, year: 2005, vol: , page: , stat: ,

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,

Sun protection attitudes and behaviors of solid-organ transplant recipients
Robinson, June K; Rigel, Darrell S
2004 Apr;30(4 Pt 2):610-615, Dermatologic surgery
BACKGROUND: Solid-organ transplant recipients (OTRs) with sun-sensitive skin, a history of sun exposure, and clinical signs of photoaging have an increased risk of developing squamous cell carcinoma. OBJECTIVE: The objective of this study was to compare the sun protection attitudes and behaviors of OTRs with those of the general public. METHODS: In spring 2003, a telephone survey of 200 OTRs and a random sample of 1091 U.S. residents were performed with standardized questions previously used in population surveys. RESULTS: Seventy-nine percent of OTRs and 69% of the U.S. public believe that the appearance of a tan is attractive. The attitude was expressed more often by men than by women and is not related to the education of the person. A greater proportion of OTRs believed that people looked 'healthier' with a tan and 88% of OTRs were not aware of their increased risk of developing skin cancer. Thirty-five percent of OTRs reported regularly using sunscreen, which is the principal form of sun protection used. Women report more regular use of sunscreen than men. OTRs wear less protective clothing and seek less shade when outdoors than the public. Sunburning was reported by 35% of OTRs, which is similar to the rate reported by the public. CONCLUSION: OTRs' attitude that people look 'better, healthier' with a tan inhibits effective sun protection. Although physicians who care for OTRs provide patient education in the hope that it increases their awareness of their risk of developing skin cancer and will promote change in their sun protection behaviors, the OTRs' perception of risk is influenced by many concerns. Interpersonal motives, particularly for OTRs, the self-presentational ones related to appearance and the social image or prototype of a tanned person being healthy, mitigate risk perception of the health problem. Risk perception does not always inhibit risk behavior; therefore, unprotected sun exposure occurs in OTRs
— id: 94449, year: 2004, vol: 30, page: 610, stat: Journal Article,

Ultraviolet radiation in alpine skiing: magnitude of exposure and importance of regular protection
Rigel, Ethan G; Lebwohl, Mark G; Rigel, Adam C; Rigel, Darrell S
2003 Jan;139(1):60-62, Archives of dermatology
BACKGROUND: Participation in outdoor alpine sports has been increasing over the last decade. Ultraviolet exposure levels for these activities can be extreme owing to the venue altitudes. The purpose of this study was to measure the levels of UV-A and UV-B radiation exposure incurred by performance skiers in a typical alpine venue and to determine the need for protection in that environment. OBSERVATIONS: Total UV-B exposure ranged from 12 to 185 mJ/cm(2) (0.5-7.6 times the minimum erythemal dose [MED] for individuals with type II skin). Ten percent of subjects received more than 1 MED/h at peak exposure times. Daily UV-A exposure ranged from 10.6 to 28 J/cm( 2) (daily average, 0.55 minimum melanogenic dose). CONCLUSIONS: Alpine skiers with skin types I and II are exposed to measurable erythemal and suberythemal levels of UV radiation repeatedly over the long term at levels that can cause photodamage to their skin and potentially increase their later risk for skin cancer. Programs should be developed to educate skiers regarding the need for UV protection. Given the high levels of exposure noted, skiers should use UV protective measures, including sun-protection factor 30 broad-spectrum sunscreen
— id: 94451, year: 2003, vol: 139, page: 60, stat: Journal Article,

Daily UVB exposure levels in high-school students measured with digital dosimeters
Rigel, Ethan G; Lebwohl, Mark; Rigel, Adam C; Rigel, Darrell S
2003 Dec;49(6):1112-1114, Journal of the American Academy of Dermatology
UV radiation exposure increases skin cancer risk. A substantial portion of a person's UV exposure occurs before the age of 18 years. We sought to determine UVB radiation exposure levels in high-school students during normal daily activity. Digital dosimeters were worn by 4 high-school students during 11 school days. Students were subjected to daily erythemal and suberythemal doses of UVB radiation. Programs to educate high-school students in sun-protective practices even during regular school activities are needed
— id: 94450, year: 2003, vol: 49, page: 1112, stat: Journal Article,

Photoprotection: a 21st century perspective
Rigel, D S
2002 Apr;146 Suppl 61:34-37, British journal of dermatology
— id: 32201, year: 2002, vol: 146 Suppl 61, page: 34, stat: Journal Article,

Malignant melanoma: prevention, early detection, and treatment in the 21st century
Rigel DS; Carucci JA
2000 Jul-Aug;50(4):215-236, CA: a cancer journal for clinicians
Malignant melanoma continues to present a significant public health problem as its incidence is rising faster than that of any other cancer in the US. At current rates, 1 in 74 Americans will develop melanoma during his or her lifetime. Management of melanoma is a complex issue requiring a multidisciplinary approach. The most effective method of protection against the development of melanoma is minimization of ultraviolet exposure from sunlight. Early detection and treatment are critical and result in improved patient survival rates. Surgical excision remains the mainstay of treatment but many new promising therapies are being investigated. It is hoped that increased public and professional awareness and education in all areas relating to the prevention, detection, and treatment of malignant melanoma will contribute to decreasing trends in the incidence and mortality from this cancer in the future
— id: 11500, year: 2000, vol: 50, page: 215, stat: Journal Article,

What is the evidence for a sunscreen and melanoma controversy?
Rigel DS; Naylor M; Robinson J
2000 Dec;136(12):1447-1449, Archives of dermatology
— id: 16818, year: 2000, vol: 136, page: 1447, stat: Journal Article,

Summertime sun protection used by adults for their children
Robinson JK; Rigel DS; Amonette RA
2000 May;42(5 Pt 1):746-753, Journal of the American Academy of Dermatology
BACKGROUND: Because an estimated 50% to 80% of the skin's lifetime sun damage is thought to occur in childhood and adolescence, it is during these critical periods that intense, intermittent sun exposure causing burning increases melanoma risk. METHODS: A 1997 telephone survey of 503 households evaluated parental attitudes about their child having a tan, and ease of practicing sun protection, sun protection methods used, and sunburning on 5 successive summer weekends. RESULTS: In a random sample of 1 child from each household, 13% of children sunburned during the past week or weekend, and 9% of their parents experienced a sunburn during the past weekend. Children's sunburn was significantly associated with sunburn in the adult respondent, increasing age of the child, having fair skin, being white, and using sunscreens. Duration and peak hours of sun exposure were associated for children and parents. Sunscreen with a sun protection factor of at least 15 was the predominant form of sun protection used. Sunscreen use in children was significantly associated with longer duration of sun exposure, sunny weather conditions, younger age, fair skin, a history of sunburns before this study, a family history of skin cancer, and a higher family income. Feeling that a tan appeared healthy was associated with male gender of the adult and increasing age of the child. Complimenting the child on the appearance of a tan was associated with male gender of the adult, older children, children with skin type reported as olive or dark, and lower educational levels. CONCLUSION: Although there has been a promising initial effort to alert parents to the need to protect their children from sunburns, many view a tan as healthy and do not effectively implement sun protection behaviors for their children, which results in sunburns. Sun protection that prevents sunburning could be achieved by more children seeking shade, wearing protective clothing, limiting exposure during peak hours, and effectively using sunscreen
— id: 16819, year: 2000, vol: 42, page: 746, 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,

The American Academy of Dermatology: challenges and opportunities as we approach the new century
Rigel DS
1999 Nov;26(11):711-712, Journal of dermatology
— id: 16820, year: 1999, vol: 26, page: 711, stat: Journal Article,

Effects of altitude and latitude on ambient UVB radiation
Rigel DS; Rigel EG; Rigel AC
1999 Jan;40(1):114-116, Journal of the American Academy of Dermatology
— id: 7434, year: 1999, vol: 40, page: 114, stat: Journal Article,

Deaths related to liposuction
Rigel DS; Wheeland RG
1999 Sep 23;341(13):1001-1002, New England journal of medicine
— id: 16821, year: 1999, vol: 341, page: 1001, stat: Journal Article,

Skin cancer: in your face
Robinson JK; Rigel DS
1999 Jun 5;318(7197):1564-1564, British medical journal. BMJ (International ed.)
— id: 16822, year: 1999, vol: 318, page: 1564, stat: Journal Article,

Is the ounce of screening and prevention for skin cancer worth the pound of cure?
Rigel DS
1998 Jul-Aug;48(4):236-238, CA: a cancer journal for clinicians
— id: 7758, year: 1998, vol: 48, page: 236, stat: Journal Article,

What promotes skin self-examination?
Robinson JK; Rigel DS; Amonette RA
1998 May;38(5 Pt 1):752-757, Journal of the American Academy of Dermatology
The American Academy of Dermatology's national program of Melanoma/Skin Cancer Detection and Prevention, developed in response to the rising incidence of invasive melanoma in the United States, has annually produced extensive print, radio, and television coverage about performing skin self-examination (SSE). This study was conducted to determine factors that motivate people to perform SSE. A 1996 telephone survey evaluated performance of SSE for skin cancer and used questions to identify self-perceived. The performance of SSE was directly correlated with the self-perceived risk of the development of melanoma or skin cancer and discussions with physicians or nurses. People were motivated to perform SSE based on their perceived risk and discussions with doctors. Because patients most easily have access to primary care physicians, these physicians must be educated to identify those who are at risk for the development of melanoma. Primary care physicians and nurses should be encouraged to counsel patients about risk levels, the utility of SSE in limiting their risk, and how to perform SSE. To facilitate this process, risk levels for the development of melanoma (defined on the basis of simple and readily ascertained characteristics that help to educate physicians, nurses, and patients) are provided
— id: 16823, year: 1998, vol: 38, page: 752, stat: Journal Article,

Epiluminescence microscopy in clinical diagnosis of pigmented skin lesions?
Rigel DS
1997 May 31;349(9065):1566-1567, Lancet
— id: 7246, year: 1997, vol: 349, page: 1566, stat: Journal Article,

Malignant melanoma: incidence issues and their effect on diagnosis and treatment in the 1990s
Rigel DS
1997 Apr;72(4):367-371, Mayo Clinic proceedings
The incidence of melanoma is increasing at a rate faster than that for any other cancer in the United States and worldwide. Several factors show that this increase in incidence is real and not due to artifact. The rapid increase is not attributable to better overall counting of the cases of cancer (because the incidence of other cancers is decreasing). Furthermore, it is not due to changes in histologic criteria. Finally, the mortality rate from melanoma continues to increase at a time when survival rates are also increasing. This apparent paradox can be true only if the actual incidence is increasing at an even faster rate than the death rate. This dramatic increase in the incidence of melanoma highlights the need for improved methods of prevention, diagnosis, and treatment as melanoma becomes increasingly important as a public health issue
— id: 12334, year: 1997, vol: 72, page: 367, stat: Journal Article,

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,

Trends in sun exposure knowledge, attitudes, and behaviors: 1986 to 1996
Robinson JK; Rigel DS; Amonette RA
1997 Aug;37(2 Pt 1):179-186, Journal of the American Academy of Dermatology
BACKGROUND: The American Academy of Dermatology's national program Melanoma/Skin Cancer Detection and Prevention, developed in response to the rising incidence of invasive melanoma in the United States, has annually during the past decade produced extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection. OBJECTIVE: We measured the progress achieved in increasing the awareness and knowledge of skin cancer and changing the attitudes, beliefs, and behaviors that affect skin cancer risk. We also describe current sun-related behavior including sunburning, assess the likelihood of practicing sun protection strategies, and provide a baseline against which future changes in sun protection behavior may be evaluated. METHODS: A 1996 telephone survey repeated questions used in 1986 to evaluate change and used classifying questions to better define attitudes and behaviors. RESULTS: From 1986 to 1996, the knowledge of the perceived harmful effects of the sun significantly broadened, but the UV exposure behavior as measured by sunburning (30% to 39%) and regular use of a tanning booth (2% to 6%) also increased. There was a decline in the attitude that having a tan was healthy; however, in 1996 having a tan was still considered to enhance appearance, particularly by men. Sunscreen use increased (35% to 53%). Women, younger persons, persons residing in areas with fewer sunny days, and whites were more likely to tan intentionally, but men who lived in the South were more likely to sunburn. CONCLUSION: During the past decade, the early process of change involving cognitive and emotional activities began. With this study, high-risk population subsets performing specific adverse behavior were identified. In the future, they can be targeted with messages that promote attitudinal and behavioral change
— id: 16824, year: 1997, vol: 37, page: 179, stat: Journal Article,

Predicting ten-year survival of patients with primary cutaneous melanoma: corroboration of a prognostic model
Sahin S; Rao B; Kopf AW; Lee E; Rigel DS; Nossa R; Rahman IJ; Wortzel H; Marghoob AA; Bart RS
1997 Oct 15;80(8):1426-1431, Cancer
BACKGROUND: Recently, the Pigmented Lesion Group at the University of Pennsylvania described a 4-variable model for predicting 10-year survival for patients with primary cutaneous melanoma. The variables are tumor thickness, anatomic site of the lesion, age, and gender. The objective of the current study was to test the validity of this model, employing the large data base of the New York University Melanoma Cooperative Group. METHODS: The predicted probabilities of 10-year survival for 780 patients with primary cutaneous melanoma were determined by multivariate logistic regression, using the 4 variables. RESULTS: The overall 10-year survival rate of the current study group was 78.4%. Of the four variables, tumor thickness, anatomic site of the lesion, and age were found to be independent predictors of survival. Although survival was better for women, gender was not a statistically significant factor in predicting 10-year survival when entered into the multivariate logistic regression model. In the current study, the probability of 10-year survival of patients with melanomas < 0.76 mm ranged from 93-99%, depending on the age and primary site. Age and site had more impact on the prognosis of intermediate and thick melanomas than on thin melanomas. Thus, for melanomas 0.76-1.69 mm, 1.70-3.60 mm, and thicker than 3.60 mm, the probabilities of survival ranged from 70-94%, 39-82%, and 23-68%, respectively. CONCLUSIONS: The wider ranges in survival rates for thicker melanomas, depending on the other variables, emphasize the importance of including variables in addition to tumor thickness in a prognostic model. Using a large data base from a medical center, the current study supports the prognostic multivariate model of the Pigmented Lesions Group of the University of Pennsylvania; however, the authors of the current study did not find gender to be statistically significant in this multivariate model
— id: 12271, year: 1997, vol: 80, page: 1426, stat: Journal Article,

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program
Koh HK; Norton LA; Geller AC; Sun T; Rigel DS; Miller DR; Sikes RG; Vigeland K; Bachenberg EU; Menon PA; Billon SF; Goldberg G; Scarborough DA; Ramsdell WM; Muscarella VA; Lew RA
1996 Jun;34(6):971-978, Journal of the American Academy of Dermatology
BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or 'thin' lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality
— id: 16827, year: 1996, vol: 34, page: 971, stat: Journal Article,

Risk of developing multiple primary cutaneous melanomas in patients with the classic atypical-mole syndrome: a case-control study
Marghoob AA; Slade J; Kopf AW; Salopek TG; Rigel DS; Bart RS
1996 Nov;135(5):704-711, British journal of dermatology
The classic atypical-mole syndrome (CAMS) and/or a history of malignant melanoma (MM) increases the risk for multiple melanomas. Case notes of 118 CAMS and 173 control patients, each with a history of MM, were reviewed for the occurrence of second primary MMs. The mean (+/-SD) age at diagnosis of the first MM was 38.8 +/- 12.8 and 48.9 +/- 14.7 years (P < 0.001) for CAMS cases and controls, respectively. Thirty-two of 118 CAMS and 18 of 173 controls developed second primary MMs, for a cumulative 10-year life-table risk of 35.5% and 17.0%, respectively (P < 0.0001). The mean number of months from the time of diagnosis of the first to the second MM was 33.9 +/- 41.8 and 58.6 +/- 57.3 months for the CAMS and controls, respectively (P = 0.08). In both cohorts the second MMs were significantly thinner, compared with the first MMs. The relative risk (RR) for developing second MMs for CAMS patients was 3.2. The RR for the CAMS cohort compared with a matched population from the United States Statistics, Epidemiology. End Results data base was 337, and for the controls, the RR was 84. All patients with MMs are at significant risk for developing multiple MMs: the risk is greater for patients with CAMS. Periodic total cutaneous examinations are indicated for life in an attempt to identify new MMs when they are thin
— id: 12482, year: 1996, vol: 135, page: 704, stat: Journal Article,

Malignant melanoma: perspectives on incidence and its effects on awareness, diagnosis, and treatment
Rigel DS
1996 Jul-Aug;46(4):195-198, CA: a cancer journal for clinicians
— id: 7039, year: 1996, vol: 46, page: 195, 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,

Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications
Marghoob AA; Slade J; Salopek TG; Kopf AW; Bart RS; Rigel DS
1995 Jan 15;75(2 Suppl):707-714, Cancer
BACKGROUND. This study was designed to determine the risk of developing malignant melanoma (MM) in patients with a history of basal cell and/or squamous cell skin cancer (BCC/SCC) and to determine whether surveillance efforts can be directed toward these patients for the detection of early MMs. METHODS. The study cohort was followed by annual total cutaneous examination (TCE). Controls consisted of individuals from the United States population matched for age, sex, and length of follow-up. The anatomic locations of the study cohorts' newly diagnosed MMs were plotted on an anatomic chart. The setting was a private dermatology practice. Two hundred, ninety consecutive white patients with a history of BCC/SCC but with no personal or family history of MM were followed by annual TCEs. The main outcome measures were the relative risk of developing MM and their prognosis. RESULTS. Ten of the 290 patients developed an MM within an average of 109 months of follow-up (range, 3-17 years). All MMs were less than 0.70 mm in Breslow thickness and 80% occurred on usually clothed cutaneous sites. The expected number of MMs in the control population was 0.59 (P = 0.006), resulting in a relative risk of 17. CONCLUSION. Patients with BCC/SCC skin cancer are at substantial increased risk for developing MM. Regular and life-long surveillance TCE is an inexpensive and effective method for detecting curable MMs in such patients
— id: 12815, year: 1995, vol: 75, page: 707, stat: Journal Article,

Occupation and the risk of malignant melanoma
Pion IA; Rigel DS; Garfinkel L; Silverman MK; Kopf AW
1995 Jan 15;75(2 Suppl):637-644, Cancer
BACKGROUND. The incidence of malignant melanoma is increasing rapidly. The risk for development of malignant melanoma has been reported to be higher in persons of higher socioeconomic status. METHODS. This case-control study explores the relation between occupation and malignant melanoma relative risk through analysis of data collected by the American Cancer Society. A total of 1.2 million people were enrolled in a study of lifestyles and environmental factors in relation to mortality from cancer and other diseases. A total of 2780 persons had a history of malignant melanoma when the study began or developed malignant melanoma during the 6-year study follow-up period. The controls were matched for age, sex, race, and geographic location on an approximately 1:3 basis to persons selected from the remaining people enrolled. RESULTS. In men, malignant melanoma risk was significantly higher in high-paying versus low-paying occupations (odds ratio [OR], = 1.58; P < 0.001) and in white-collar versus blue-collar occupations (OR = 1.33; P < 0.001). No significant conclusions could be drawn for women. No significant difference in risk was noted between those with indoor versus outdoor occupations. Among specific occupational exposures, only exposure to X-rays significantly raised malignant melanoma risk (OR = 1.37; P = 0.002). CONCLUSION. Upper pay scale and white-collar occupations significantly increase the risk for development of malignant melanoma
— id: 6715, year: 1995, vol: 75, page: 637, stat: Journal Article,

Identification of those at highest risk for development of malignant melanoma
Rigel DS
1995 ;10:151-170, Advances in dermatology
Multiple factors have been identified to be associated with increasing risk for MM developing. These factors are summarized in Table 2. As the incidence of MM continues to rise and the magnitude of this problem becomes more significant, the issue of identifying those at increased risk for MM developing in the future will become even more important
— id: 6862, year: 1995, vol: 10, page: 151, stat: Journal Article,

An estimate of the incidence of malignant melanoma in the United States. Based on a survey of members of the American Academy of Dermatology
Salopek TG; Marghoob AA; Slade JM; Rao B; Rigel DS; Kopf AW; Bart RS
1995 Apr;21(4):301-305, Dermatologic surgery
BACKGROUND. The incidence of malignant melanoma (MM) in the United States (US) must be known to accurately evaluate the costs that MM imposes on the health care system and society in general. Furthermore, knowledge of the incidence is needed to determine the benefit of MM prevention programs. OBJECTIVE. To obtain an estimate of the incidence of MM in the US. METHODS. The data for this study were collected by means of a questionnaire that was sent to all members of the American Academy of Dermatology practicing in the US (N = 7412). RESULTS. Based on the mean number of MMs seen annually per dermatologist in each state and the number of dermatologists per state, the number of new in situ and invasive MMs in the US in 1992 was calculated to be 80,000. This translates to an incidence of 32 MMs per 100,000 persons. CONCLUSIONS. Our estimate of 80,000 new MMs diagnosed in 1992 in the US suggests that MM places much greater burdens on the US health care system and society than that based on current published estimates
— id: 6739, year: 1995, vol: 21, page: 301, 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,

Atypical mole syndrome: risk factor for cutaneous malignant melanoma and implications for management
Slade J; Marghoob AA; Salopek TG; Rigel DS; Kopf AW; Bart RS
1995 Mar;32(3):479-494, Journal of the American Academy of Dermatology
The incidence of malignant melanoma is increasing faster than that of any other cancer. It is important to identify subsets of the population at high risk of its development so that they can be observed more closely to identify early melanomas when they are curable. It has been reported worldwide that persons with the atypical mole (dysplastic nevus) syndrome are such a subset at increased risk. A risk gradient for the development of melanoma exists and varies from persons with one or two atypical moles and no family history of melanoma at one end of the spectrum to persons with the familial atypical multiple-mole melanoma syndrome at the other. Guidelines for the management of atypical mole syndrome are presented
— id: 8190, year: 1995, vol: 32, page: 479, stat: Journal Article,

Risk of developing cutaneous malignant melanoma in atypical-mole syndrome: New York University experience and literature review
Slade J; Salopek TG; Marghoob AA; Kopf AW; Rigel DS
1995 ;139:87-104, Recent results in cancer research = Fortschritte der Krebsforschung = Progres dans les recherches sur le cancer
The presence of atypical moles (AM) is considered to be a marker for an increased risk of developing cutaneous malignant melanoma (MM). The extent to which individuals with the atypical-mole syndrome (AMS) are at risk for developing MM is unknown. We present a review of the world literature and of our experience at New York University. We conclude that the presence of AMS in Caucasians significantly increases the risk of developing MM, regardless of geographic location. A further increase in MM risk is noted if there is a personal and/or family history of MM
— id: 12841, year: 1995, vol: 139, page: 87, 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,

The gender-related issues in malignant melanoma
Rigel DS
1993 May;52(5):124, 146-, Hawaii medical journal
The problem of malignant melanoma is important in the United States, in the world as a whole, and particularly in Hawaii with its high levels of ultraviolet radiation. It is estimated that 32,000 Americans will develop melanoma and 6,800 will die of this tumor in 1993. Melanoma is now the seventh most frequent cancer in the United States. It is more common than ovarian, cervical, CNS cancer and leukemia. Both incidence and mortality from melanoma are rapidly increasing. The incidence of melanoma has consistently increased 6% a year and the death rate has increased 2% a year since 1950. At current rates, one in 400 will die of this tumor. Should this rate of increase continue, by the year 2000, it is estimated that one in 75 Americans will develop melanoma during a lifetime. The highest melanoma incidence in the U.S. is found in Hawaii. Melanoma is increasing faster than any other cancer in the United States and all over the world
— id: 13182, year: 1993, vol: 52, page: 124, 146, 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,

Level of education and the risk of malignant melanoma
Lee PY; Silverman MK; Rigel DS; Vossaert KA; Kopf AW; Bart RS; Garfinkel L; Levenstein MJ
1992 Jan;26(1):59-63, Journal of the American Academy of Dermatology
BACKGROUND: The risk for the development of malignant melanoma has been reported to be higher in persons with more formal education than in individuals with less. OBJECTIVE: To study whether those with more formal education are indeed at more risk for malignant melanoma than those with less formal education. METHODS: This case-control study explores the relation between education and melanoma risk by analyzing data collected by the American Cancer Society. A total of 1.2 million people were surveyed for a history of cancer and followed up for 6 years for the development of any cancer. In total, 2780 white persons had a history of malignant melanoma or developed malignant melanoma during the study period. The controls were age-, sex-, and geographically matched white persons selected from the remaining people enrolled. RESULTS: Both men and women were shown to have a statistically significant increase in the relative risk for malignant melanoma with increasing education level (p less than 0.001 and p = 0.001, respectively). This relation was more striking in men when the relative risk with 95% confidence interval was calculated by sex for each education level. CONCLUSION: Americans with more formal education are at greater risk for malignant melanoma than those with less education
— id: 13721, year: 1992, vol: 26, page: 59, stat: Journal Article,

Epidemiology and prognostic factors in malignant melanoma
Rigel DS
1992 Jan;28(1):7-8, Annals of plastic surgery
The rising rate of MM reflects damage to the skin that has been done in the past. If a difference is to be seen prospectively, we must use protection (sunscreens) and have suspicious areas evaluated early in their course so that MM can be treated when curable. Until further research yields a cure for advanced MM, the above approach remains the first line of defense in the fight against this cancer
— id: 13734, year: 1992, vol: 28, page: 7, stat: Journal Article,

The dilemma of the dysplastic nevus
Rigel DS
1992 Jan;28(1):9-10, Annals of plastic surgery
— id: 13733, year: 1992, vol: 28, page: 9, 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,

Melanoma
Rigel, Darrell S.; Thiers, Bruce H
Philadelphia, PA : Saunders, 1991,
— id: 363, year: 1991, vol: , page: , stat: ,

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,

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,

Skin aging
Rigel, Darrell S
Secaucus, NJ : Network for Continuing Medical Education, 1990, c1989,
Explores the causes of skin aging and outlines the differential diagnosis of benign and malignant lesions. Illustrates the aging process, covering the specturm from the early signs of sun damage (melanoma, basal cell carcinoma) when the repair process of the skin fails. Discusses prevention methods, including sunscreen and Retin A
— id: 263, year: 1990, vol: , page: , stat: ,

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,

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,

DERM/INFONET: a concept becomes a reality
Kopf AW; Rigel DS; White R; Rosenthal L; Jordan WP; Carter DM; Everett MA; Moore J
1988 May;18(5 Pt 1):1150-1157, Journal of the American Academy of Dermatology
The DERMatology INFOrmation NETwork (DERM/INFONET) of the American Academy of Dermatology has become a reality. DERM/INFONET consists of a number of data bases providing information and educational programs for the dermatologist. Currently the components are: DERM/MLS (Medical Literature Search), DERM/RX (dermatologic therapy), DERM/USP (United States Pharmacopeia data base), DERM/ALLERGENS (Food and Drug Administration and Environmental Protection Agency Listings of allergens); Melanoma Prognosis Model; Electronic Mail; Bulletin Board; Meetings Calendar; ICD/CPT (International Classification of Diseases/Current Procedural Terminology) codes; AAD Membership/Committee Directories; and Dermatology Quiz. Additional data bases are planned. As audiovisual and alphanumeric communication systems evolve, newer opportunities for enhancing the DERM/INFONET Biomedical Communication Network will undoubtedly provide even greater opportunities for aiding the dermatologist in delivering state-of-the art management for their patients
— id: 11099, year: 1988, vol: 18, page: 1150, 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,

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,

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,

Computers in dermatology. Review of communication software for dermatology
Rigel DS
1987 Mar;16(3 Pt 1):606-609, Journal of the American Academy of Dermatology
— id: 16836, year: 1987, vol: 16, page: 606, 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,

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,

The future of computers in dermatology
Rigel DS
1986 Oct;4(4):665-668, Dermatologic clinics
Computer technology has advanced rapidly over the past 30 years as the computer has been more and more integrated into the practice of medicine. Current horizons of research have begun to make use of this newer technology in 1986. The numerous amounts of change and advances in computer systems with respect to medicine and specifically to dermatology will make the computer even more of an integral tool for the practice of this specialty in the future
— id: 16838, year: 1986, vol: 4, page: 665, 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,

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,

Medical office computer systems. The selection process
Rosenthal LE; Rigel DS
1986 Oct;4(4):559-566, Dermatologic clinics
This article highlights the process that a physician should undertake in selecting and implementing a business computer system for the office. Included are suggested approaches to identifying needs, establishing priorities, and communicating requirements to prospective vendors. Methods for reviewing various systems to evaluate whether they meet the practice's defined requirements are suggested
— id: 16839, year: 1986, vol: 4, page: 559, stat: Journal Article,

Computers in dermatology
Rosenthal, Lawrence E.; Rigel, Darrell S
Philadelphia : Saunders, 1986,
— id: 420, year: 1986, vol: , page: , stat: ,

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,

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,

Is it time for a computer in your practice? V. How to evaluate if a computer is appropriate for your practice
Rigel DS
1985 Mar;11(3):215-216, Journal of dermatologic surgery & oncology
In this article, a strategy for evaluating your practice in terms of its potential for computerization has been outlined. The rules that have been presented are general guidelines and exceptions may exist in any practice due to its specific needs. The use of a medical office computer consultant may help you to make this evaluation in a more effective manner. Once you have determined that your practice may benefit by the use of a computer, the next step is to select between the myriad of currently available systems. The next article in the series will be devoted to describing a method to help you select the system most appropriate for your setting
— id: 16852, year: 1985, vol: 11, page: 215, 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,

PROGNOSIS IN MALIGNANT-MELANOMA
Rigel, DS
1985 ;11(8):813-813, Journal of dermatologic surgery & oncology
— id: 30861, year: 1985, vol: 11, page: 813, 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,

Mohs surgery for periocular basal cell carcinomas
Robins P; Rodriguez-Sains R; Rabinovitz H; Rigel D
1985 Dec;11(12):1203-1207, Journal of dermatologic surgery & oncology
Cure rates for 631 periocular basal cell carcinomas treated by Mohs surgery proved to be 98.1% for primary lesions and 93.6% for previously treated lesions. All recurrences of primary lesions post-Mohs surgery were located in the medial canthus. Among lesions previously treated, recurrence rates after Mohs surgery were twice as high for medial canthal lesions as for other periocular basal cell carcinomas, 9.5 and 4.5%, respectively. A threefold increased risk of recurrence was observed for medial canthal lesions (post-Mohs surgery) previously treated by radiation as compared to all other treatment modalities. This high recurrence rate may reflect past practices of treating large medial canthal basal cell carcinomas with radiation rather than by other means. Results of our study indicate that primary basal cell carcinomas in the medial canthus can be treated by microscopically controlled excision with excellent results
— id: 16881, year: 1985, vol: 11, page: 1203, stat: Journal Article,

HAZARD-RATE ANALYSIS IN STAGE-I MELANOMA
Rogers, GS; Kopf, AW; Levenstein, M; Rigel, DS
1985 ;33(3):A773-A773, Clinical research
— id: 30726, year: 1985, vol: 33, page: A773, 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,

"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,

Is it time for a computer in your practice? IV. Which practices benefit?
Rigel DS
1983 Dec;9(12):961-962, Journal of dermatologic surgery & oncology
— id: 16856, year: 1983, vol: 9, page: 961, stat: Journal Article,

Surgical gem. modification of surgical gloves to prevent exposure to hepatitis during hair transplantation surgery
Rigel DS; Albom MJ; Geronemus RG; Freedberg IM
1983 Feb;9(2):114-115, Journal of dermatologic surgery & oncology
— id: 9213, year: 1983, vol: 9, page: 114, 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,

Risk factors for local recurrence of primary cutaneous squamous cell carcinomas. Treatment by microscopically controlled excision
Dzubow LM; Rigel DS; Robins P
1982 Nov;118(11):900-902, Archives of dermatology
Four hundred fourteen primary cutaneous squamous cell carcinomas were treated by microscopically controlled excision. A five-year mortality-table adjusted cure rate of 93.3% was achieved. The following six parameters were analyzed for correlation with the local recurrence rate: sex, age, lesion diameter, history of previous therapy, anatomic site, and number of stages of Mohs' surgery required for treatment. Only the number of stages correlated significantly with the recurrence rate. However, subpopulations at high risk for recurrent disease could be identified. These consisted of male patients younger than 60 years of age, male patients requiring five or more stages of Mohs' surgery, and patients of either sex with carcinoma of the lower extremity. Modifications of microscopically controlled excision may be warranted in selected patients
— id: 16861, year: 1982, vol: 118, page: 900, stat: Journal Article,

MICROSCOPIC SATELLITES ARE HIGHLY PREDICTIVE OF LYMPH-NODE METASTASES IN CLINICAL STAGE-I MELANOMA
Harrist, TJ; Rigel, D; Day, CL; Sober, AJ; Lew, RA; Harris, MN; Kopf, AW; Fitzpatrick, TB; Mihm, MC
1982 ;46(Suppl 1):A35-A35, Laboratory investigation
— id: 30586, year: 1982, vol: 46, page: A35, 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,

THE DERMATOPATHOLOGIST SINE AL
Kopf, AW; Rigel, DS
1982 ;4(5):388-389, American journal of dermatopathology
— id: 30519, year: 1982, vol: 4, page: 388, stat: Journal Article,

Is it time for a computer in your practice? II. What tasks your computer can perform
Rigel DS
1982 Mar;8(3):168-170, Journal of dermatologic surgery & oncology
In this article, the potential benefits of an office computer system have been detailed. As computer costs and sizes decrease, and computing capabilities increase, even more benefits will be had in the future. Of course, not all of these benefits are applicable to all practices. Equally important to note are the many problems associated with installation and use of computer systems, and these must be taken into account before an intelligent decision can be made as to whether its acquisition would benefit your practice. Helping the physician to weigh the benefits of an office computer system against its costs and potential problems will be the subject of the next article in this series
— id: 16864, year: 1982, vol: 8, page: 168, stat: Journal Article,

Is it time for a computer in your practice? III: Types of computer systems for medical offices
Rigel DS
1982 Jul;8(7):532-534, Journal of dermatologic surgery & oncology
The three basic types of medical-office computer systems have been described along with their basic advantages and disadvantages. A fourth option, that of keeping your current manual office system, may be a valid alternative. The next article of this series will discuss a method for evaluating the suitability of any computer system for your needs and will describe how to select the 'best' one for you
— id: 16863, year: 1982, vol: 8, page: 532, stat: Journal Article,

Acanthosis nigricans and the sign of Leser-Trelat associated with adenocarcinoma of the gallbladder
Jacobs MI; Rigel DS
1981 Jul 15;48(2):325-328, Cancer
A case of adenocarcinoma of the gallbladder associated with acanthosis nigricans and the sign of Leser-Trelat is presented. The significant underrepresentation of adenocarcinoma of the gallbladder in association with malignant acanthosis nigricans is noted. If malignant acanthosis nigricans is caused by an ectopic peptide, a relative lack of production of the postulated substance by gallbladder adenocarcinoma cells could account for this finding
— id: 16869, year: 1981, vol: 48, page: 325, 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,

Is it time for a computer in your practice? I. Introduction
Rigel DS
1981 Dec;7(12):964-965, Journal of dermatologic surgery & oncology
— id: 16865, year: 1981, vol: 7, page: 964, 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,

Squamous-cell carcinoma treated by Mohs' surgery: an experience with 414 cases in a period of 15 years
Robins P; Dzubow LM; Rigel DS
1981 Oct;7(10):800-801, Journal of dermatologic surgery & oncology
From their experience in treating squamous-cell carcinomas by microscopically controlled surgery, the authors found that such lesions in men, particularly in young men, on the extremities and of sizes larger than 5 cm or requiring more than four stages of excision had highest recurrence rates. They recommend one more stage of excision beyond an apparent plane free of malignancy as an insurance in selected cases
— id: 16868, year: 1981, vol: 7, page: 800, stat: Journal Article,

Basal-cell carcinomas on covered or unusual sites of the body
Robins P; Rabinovitz HS; Rigel D
1981 Oct;7(10):803-806, Journal of dermatologic surgery & oncology
Basal-cell carcinomas on covered, anatomically shielded, or otherwise unusual sites of the body are rare compared to the number on constantly exposed parts of the body, but since basal-cell carcinomas are so common, instances of the former sort are not infrequently encountered. Five such cases are described and illustrated
— id: 16885, year: 1981, vol: 7, page: 803, stat: Journal Article,

Malignant acanthosis nigricans: a review
Rigel DS; Jacobs MI
1980 Nov;6(11):923-927, Journal of dermatologic surgery & oncology
Malignant acanthosis nigricans is a dermatosis that appears grossly as a hyperpigmented, velvety, or verrucous hyperplasia of the epidermis, most marked in flexural areas. It is always associated with a malignancy. In 277 cases reviewed, the condition was associated with gastric carcinomas in 55.5%, with other intra-abdominal carcinomas in 17.7%, and with malignancies in other sites in 26.8%. Current theories for the association and pathogenesis of the cutaneous process are discussed
— id: 16870, year: 1980, vol: 6, page: 923, stat: Journal Article,

Passing a small-bore nasogastric feeding catheter
Rigel DS; Saper C
1980 Feb;92(2 Pt 1):264-264, Annals of internal medicine
— id: 16871, year: 1980, vol: 92, page: 264, stat: Journal Article,