Daniel F. Roses, M.D.

Loss of p27KIP1 Expression in Fully-staged Node-negative Breast Cancer: Association with Lack of Hormone Receptors in T1a/b, but not T1c Infiltrative Ductal Carcinoma
Mirchandani, Deepu; Roses, Daniel F; Inghirami, Giorgio; Zeleniuch-Jacquotte, Anne; Cangiarella, Joan; Guth, Amber; Safyan, Rachael Ann; Formenti, Silvia C; Pagano, Michele; Muggia, Franco
2011 Dec;31(12):4401-4405, Anticancer research
Nuclear expression of the cell cycle inhibitor p27(KIP1) is reduced in a variety of human malignancies, including breast cancer. Loss of nuclear p27(KIP1) during tumor progression, documented by immunohistochemistry (IHC), has been studied for its potential prognostic implication. We examined by IHC the association between nuclear p27(KIP1) expression and hormone receptor status in T1N0M0 breast cancer. PATIENTS AND METHODS: The correlation between nuclear p27(KIP1) expression and estrogen (ER) and progesterone (PR) hormone receptor status was analyzed in 122 human T1N0M0 (68 T1a/b, 54 T1c) breast cancer specimens. All patients were staged as N0 by axillary node dissection. RESULTS: A statistically significant reduction in p27(KIP1) expression was observed as tumor size increased from T1a/b (7%) to T1c (22%). The proportion of tumors with low nuclear p27(KIP1) expression was higher in the ER-negative/PR-negative group compared to the ER-positive/PR-positive group, but this difference was only statistically significant in the T1a/b subgroup (p=0.0007). CONCLUSION: Further investigations into causes of p27(KIP1) deregulation and their relationship to hormone receptor expression in T1N0M0 breast ductal carcinomas are warranted. Such studies may help identify prognostic, as well as predictive, markers of therapy resistance
— id: 149934, year: 2011, vol: 31, page: 4401, stat: Journal Article,

The Association Between Lobular Involution and Histology in Older Women With Nonpalpable Lesions
Checka, Cristina; Chun, Jennifer; Schnabel, Freya; Darvishian, Farbod; Axelrod, Deborah; Siegel, Beth; Roses, Daniel
2010 APR ;17(2):S166-S166, Annals of surgical oncology
— id: 132518, year: 2010, vol: 17, page: S166, stat: Journal Article,

The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I)
Faries, Mark B; Thompson, John F; Cochran, Alistair; Elashoff, Robert; Glass, Edwin C; Mozzillo, Nicola; Nieweg, Omgo E; Roses, Daniel F; Hoekstra, Harold J; Karakousis, Constantine P; Reintgen, Douglas S; Coventry, Brendon J; Wang, He-Jing; Morton, Donald L
2010 Dec;17(12):3324-3329, Annals of surgical oncology
BACKGROUND: Complete lymph node dissection, the current standard treatment for nodal metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the basin. We hypothesized that early dissection would be associated with less morbidity than delayed dissection at the time of clinical recurrence. MATERIALS AND METHODS: The Multicenter Selective Lymphadenectomy Trial I randomized patients to wide excision of a primary melanoma with or without sentinel lymph node biopsy. Immediate completion lymph node dissection (early CLND) was performed when indicated in the SLN arm, while therapeutic dissection (delayed CLND) was performed at the time of clinical recurrence in the wide excision-alone arm. Acute and chronic morbidities were prospectively monitored. RESULTS: Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have undergone delayed CLND. The 2 groups were similar for primary tumor features, body mass index, basin location, and demographics except age, which were higher for delayed CLND. The number of nodes evaluated and the number of positive nodes was greater for delayed CLND. There was no significant difference in acute morbidity, but lymphedema was significantly higher in the delayed CLND group (20.4% vs. 12.4%, P = .04). Length of inpatient hospitalization was also longer for delayed CLND. CONCLUSION: Immediate nodal treatment provides critical prognostic information and a likely therapeutic effect for those patients with nodal involvement. These data show that early CLND is also less likely to result in lymphedema
— id: 115444, year: 2010, vol: 17, page: 3324, stat: Journal Article,

Elastic fiber pattern in regressing melanoma: a histochemical and immunohistochemical study
Kamino, Hideko; Tam, Sam; Roses, Daniel; Toussaint, Sonia
2010 Jul;37(7):723-729, Journal of cutaneous pathology
BACKGROUND: Although histopathologic identification of regression of melanoma is usually straightforward, sometimes it can be difficult to distinguish it from scarring fibrosis. Therefore, this study investigates the elastic fiber pattern in melanomas associated with either regression or scars. METHODS: We compared 33 invasive melanomas with the fibrosing stage of regression to 10 cases of invasive melanomas with scarring fibrosis. None of the regression cases had a prior surgical procedure. Elastic fiber patterns were evaluated with Verhoeff's elastic van Gieson stain (EVG) and elastin immunostain. RESULTS: Elastin immunostain was superior to EVG in revealing the elastic fiber patterns. Both regression and scars had decreased to absent elastic fibers in the areas of fibrosis. However, areas of regression had a well-defined compressed layer of thin elastic fibers pushed down from the papillary dermis to the base of the fibrosis. In contrast, the base of scars lacked this compressed elastic layer and had instead an abrupt transition to the thick elastic fibers of the spared reticular dermis. CONCLUSIONS: We have identified distinct changes of the elastic tissue network, which more accurately define the presence of regression in melanoma and distinguish it from scarring fibrosis
— id: 138171, year: 2010, vol: 37, page: 723, stat: Journal Article,

Papillary thyroid carcinoma metastatic to skin may herald aggressive disease
Khan, Oona A; Roses, Daniel F; Peck, Valerie
2010 May-Jun;16(3):446-448, Endocrine practice
OBJECTIVE: To describe an unusual case of papillary thyroid carcinoma presenting as a skin lesion on the nose. METHODS:We describe the clinical, pathologic, and immunohistochemistry findings of the patient and briefly review the relevant literature. RESULTS: An asymptomatic 73-year-old man noted a skin lesion on his nose, which when biopsied, revealed histopathologic characteristics consistent with papillary thyroid cancer and was immunohistochemistry positive for thyroid transcription factor-1 and thyroglobulin, also consistent with a neoplasm of thyroid origin. Subsequent physical examination showed a large left thyroid mass, and further workup demonstrated invasion of the trachea and surrounding musculature. In addition, metastases to the sternum, spine, lungs, and liver were noted. Fine-needle aspiration biopsy performed on the thyroid mass confirmed papillary thyroid carcinoma. Although there was evidence of systemic metastases, total thyroidectomy was suggested to the patient to allow optimal treatment by radioactive iodine. At operation, the cancer demonstrated fixation to the trachea and musculature, as well as infiltration of the surrounding soft tissues. Only the portion of the left thyroid mass that could be mobilized was removed. Final pathologic examination confirmed papillary thyroid carcinoma. Cutaneous metastases of thyroid carcinoma are infrequent, and, as the presenting feature of thyroid carcinoma, are even more rare. This case is noteworthy because a skin lesion was the presenting feature of thyroid carcinoma and histopathologic findings together with immunophenotyping provided the initial diagnosis. CONCLUSIONS: In this patient, as in most published cases, the cutaneous metastasis was shown to occur in the setting of extensive metastases. This case also demonstrates that papillary thyroid carcinoma in men older than age 50 years can behave very aggressively
— id: 110074, year: 2010, vol: 16, page: 446, stat: Journal Article,

Evolution of elective lymph node dissection for cutaneous malignant melanoma
Roses DF
Principles and practice of surgical oncology : multidisciplinary approach to difficult problems Philadelphia PA : Lippincott Williams & Wilkins, 2010,
— id: 5256, year: 2010, vol: , page: 472, stat: Chapter,

Immunohistochemical evaluation of napsin, PAX-8, beta-catenin, TIFIg, Cyclin D1, p16, and EGFR in papillary thyroid carcinoma
Sun, W.; Yee, M.; Nonaka, D.; Roses, D.; Heller, K.; Han, E. Y.; Wang, B. Y.
2010 OCT ;57(11):70-70, Histopathology
— id: 113924, year: 2010, vol: 57, page: 70, stat: Journal Article,

Mammographic Density and Lobular Involution in Older Women with Abnormal Breast Imaging
Checka, CM; Chun, J; Schnabel, FR; Darvishian, F; Lee, J; Bergknoff, Y; Axelrod, DM; Siegel, BM; Roses, DF
2009 DEC 15 ;69(24):847S-847S, Cancer research
— id: 106458, year: 2009, vol: 69, page: 847S, stat: Journal Article,

Encapsulated anaplastic thyroid carcinoma transformed from follicular carcinoma: a case report
Rapkiewicz, Amy; Roses, Daniel; Goldenberg, Alec; Levine, Pascale; Bannan, Michael; Simsir, Aylin
2009 May-Jun;53(3):332-336, Acta cytologica
BACKGROUND: Anaplastic thyroid carcinoma (ATC) is rare but is one of the most aggressive and lethal human malignancies. Cytologically, ATC has a variable morphologic appearance, including squamoid, giant, spindled and pleomorphic cells. The coexistence of ATC and differentiated or poorly differentiated thyroid carcinoma has been described and usually is diagnosed when the disease is locally advanced. CASE: We describe a case of surgically resectable, encapsulated, well-circumscribed ATC occurring in association with a better differentiated follicular carcinoma diagnosed by fine needle aspiration in a patient exposed to external ionizing radiation. CONCLUSION: Encapsulated variants of anaplastic carcinoma can be seen in association with lower grade thyroid carcinoma such as follicular carcinoma. Accurate diagnosis is dependent on adequate sampling
— id: 100202, year: 2009, vol: 53, page: 332, stat: Journal Article,

Sucess of Brochure/One Page Universal Consent for Biospecimen Donation
Singh, B; Roses, DF; Guth, AA; Schnabel, FR; Shapiro, RL; Axelrod, DM; Ginsberg, A; Ziguridis, N
2009 DEC 15 ;69(24):849S-850S, Cancer research
— id: 106460, year: 2009, vol: 69, page: 849S, stat: Journal Article,

Is surgical excision necessary for the management of atypical lobular hyperplasia and lobular carcinoma in situ diagnosed on core needle biopsy?: a report of 38 cases and review of the literature
Cangiarella, Joan; Guth, Amber; Axelrod, Deborah; Darvishian, Farbod; Singh, Baljit; Simsir, Aylin; Roses, Daniel; Mercado, Cecilia
2008 Jun;132(6):979-983, Archives of pathology & laboratory medicine
CONTEXT: Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. OBJECTIVE: To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. DESIGN: We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the radiologic findings. RESULTS: Thirty-eight PCBs with a diagnosis of ALH (18 cases) or LCIS (20 cases) were identified. Carcinoma was present at excision in 1 (6%) of the ALH cases and in 2 (10%) of the LCIS cases. In summary, 8% (3/38) of PCBs diagnosed as lobular neoplasia (ALH or LCIS) were upgraded to carcinoma (invasive carcinoma or ductal carcinoma in situ) at excision. CONCLUSIONS: Surgical excision is indicated for all PCBs diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision
— id: 79288, year: 2008, vol: 132, page: 979, stat: Journal Article,

Tissue inhibitor of metalloproteinases-2 binding to membrane-type 1 matrix metalloproteinase induces MAPK activation and cell growth by a non-proteolytic mechanism
D'Alessio, Silvia; Ferrari, Giovanni; Cinnante, Karma; Scheerer, William; Galloway, Aubrey C; Roses, Daniel F; Rozanov, Dmitri V; Remacle, Albert G; Oh, Eok-Soo; Shiryaev, Sergey A; Strongin, Alex Y; Pintucci, Giuseppe; Mignatti, Paolo
2008 Jan 4;283(1):87-99, Journal of biological chemistry
Membrane-type 1 matrix metalloproteinase (MT1-MMP), a transmembrane proteinase with a short cytoplasmic domain and an extracellular catalytic domain, controls a variety of physiological and pathological processes through the proteolytic degradation of extracellular or transmembrane proteins. MT1-MMP forms a complex on the cell membrane with its physiological protein inhibitor, tissue inhibitor of metalloproteinases-2 (TIMP-2). Here we show that, in addition to extracellular proteolysis, MT1-MMP and TIMP-2 control cell proliferation and migration through a non-proteolytic mechanism. TIMP-2 binding to MT1-MMP induces activation of ERK1/2 by a mechanism that does not require the proteolytic activity and is mediated by the cytoplasmic tail of MT1-MMP. MT1-MMP-mediated activation of ERK1/2 up-regulates cell migration and proliferation in vitro independently of extracellular matrix proteolysis. Proteolytically inactive MT1-MMP promotes tumor growth in vivo, whereas proteolytically active MT1-MMP devoid of cytoplasmic tail does not have this effect. These findings illustrate a novel role for MT1-MMP-TIMP-2 interaction, which controls cell functions by a mechanism independent of extracellular matrix degradation
— id: 79292, year: 2008, vol: 283, page: 87, stat: Journal Article,

Isolated tumor cells on sentinel lymph node biopsy: Our experience over a decade
Darvishian, F; Guth, A; Dhage, S; Singh, B; Roses, D; Axelrod, D; Mercado, C; Cangiarella, J
2008 JAN ;21(2):27A-28A, Modern pathology
— id: 75903, year: 2008, vol: 21, page: 27A, stat: Journal Article,

Isolated tumor cells on sentinel lymph node biopsy: Our experience over a decade
Darvishion, F; Guth, A; Dhage, S; Singh, B; Roses, D; Axelrod, E; Mercado, C; Cangiarella, J
2008 JAN ;88(2):27A-28A, Laboratory investigation
— id: 75925, year: 2008, vol: 88, page: 27A, stat: Journal Article,

Can axillary dissection be avoided in patients with sentinel node micrometastasis? The role of pathologic assessment of breast tumors in predicting non-sentinel node metastasis
Gupta, R; Cangiarella, J; Singh, B; Gath, A; Axelrod, D; Roses, D; Darvishian, F
2008 JAN ;21(2):35A-35A, Modern pathology
— id: 75905, year: 2008, vol: 21, page: 35A, stat: Journal Article,

Can axillary dissection be avoided in patients with sentinel node micrometastasis? The role of pathologic assessment of breast tumors in predicting non-sentinel node metastasis
Gupta, R; Cangiarella, J; Singh, B; Guth, A; Axelrod, D; Roses, D; Darvishian, F
2008 JAN ;88(2):35A-35A, Laboratory investigation
— id: 75927, year: 2008, vol: 88, page: 35A, stat: Journal Article,

A decade of change : an institutional experience with breast surgery in 1995 and 2005
Guth AA; Shanker BA; Roses DF; Axelrod D; Singh B; Toth H; Shapiro RL; Hiotis K; Diflo T; Cangiarella JF
2008 ;1:51-55, Breast cancer : basic & clinical research
— id: 93532, year: 2008, vol: 1, page: 51, stat: Journal Article,

Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature
Guth, Amber A; Mercado, Cecilia; Roses, Daniel F; Darvishian, Farbod; Singh, Baljit; Cangiarella, Joan F
2008 Jul-Aug;14(4):335-339, Breast journal
Ductal carcinoma in situ with microinvasion (DCISM) is a distinct clinicopathologic entity. Its true metastatic potential has been unclear, due in part to historical differences in the definition of microinvasion. The role of routine axillary staging for DCISM is controversial, given the reportedly low incidence of axillary metastases. We describe our institutional experience with DCISM, and define the role of axillary staging. A retrospective analysis was made of patients with DCISM. Forty-four patients underwent axillary staging (24 axillary lymph node dissection [ALND], 22 sentinel node biopsy [SNB]). Macrometastatic disease was present in three patients (7%), and two patients had isolated tumor cells (itc) in the sentinel node. Patients with axillary metastases tended to be younger. Comedonecrosis, nuclear grade, multifocal microinvasion or presentation as a clinical mass was not associated with a higher rate of axillary metastases. In this series, 7% of patients had macrometastatic disease, and two patients (5%) had itc only. Axillary staging is indicated, and SNB is appropriate for the identification of axillary metastatic disease
— id: 81349, year: 2008, vol: 14, page: 335, stat: Journal Article,

A decade of change: an institutional experience with breast surgery in 1995 and 2005
Guth, Amber A; Shanker, Beth Ann; Roses, Daniel F; Axelrod, Deborah; Singh, Baljit; Toth, Hildegard; Shapiro, Richard L; Hiotis, Karen; Diflo, Thomas; Cangiarella, Joan F
2008 ;1:51-55, Breast cancer : basic & clinical research
INTRODUCTION: With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery? METHODS: The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test. RESULTS: Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%. CONCLUSIONS: While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases
— id: 149787, year: 2008, vol: 1, page: 51, stat: Journal Article,

A cautionary tale: anaphylaxis to isosulfan blue dye after 12 years and 3339 cases of lymphatic mapping
Kaufman, Gabriel; Guth, Amber A; Pachter, H Leon; Roses, Daniel F
2008 Feb;74(2):152-155, American surgeon
Sentinel node biopsy has become the standard method for lymphatic staging in early-stage breast cancer and melanomas. The most commonly used technique uses both a radioactive tracer as well as blue dye, usually isosulfan blue. In this report, we discuss two episodes of anaphylaxis to isosulfan blue during lymphatic mapping, occurring 12 years and 3339 lymphatic mapping cases after adoption of the technique, and discuss management issues raised by these events
— id: 77869, year: 2008, vol: 74, page: 152, stat: Journal Article,

Rapid enlargement of a malignant melanoma in a child with vitiligo vulgaris after application of topical tacrolimus
Mikhail, Maryann; Wolchok, Jedd; Goldberg, Stacie M; Dunkel, Ira J; Roses, Daniel F; Silverberg, Nanette B
2008 Apr;144(4):560-561, Archives of dermatology
— id: 94520, year: 2008, vol: 144, page: 560, stat: Journal Article,

Impact of micropapillary type of ductal carcinoma in situ on rate of re-excision after breast conserving therapy
Wen, H; Roses, D; Guth, A; Axelrod, D; Singh, B
2008 OCT ;53(1):72-72, Histopathology
— id: 91388, year: 2008, vol: 53, page: 72, stat: Journal Article,

Rate of re-excision with breast conserving therapy with and without additional margins in patients with ductal carcinoma in situ
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Berman, R; Singh, B
2008 FEB ;15(1):75-76, Annals of surgical oncology
— id: 98149, year: 2008, vol: 15, page: 75, stat: Journal Article,

Phase I-II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue
Formenti, Silvia C; Gidea-Addeo, Daniela; Goldberg, Judith D; Roses, Daniel F; Guth, Amber; Rosenstein, Barry S; DeWyngaert, Keith J
2007 Jun 1;25(16):2236-2242, Journal of clinical oncology
PURPOSE: To report the clinical feasibility of a trial of accelerated whole-breast intensity modulated radiotherapy, with the patient in prone position, optimally to spare the heart and lung. PATIENTS AND METHODS: Patients with stages I or II breast cancer, excised by breast conserving surgery with negative margins, were eligible for this institutional review board-approved prospective trial. Computed tomography simulation was performed with the patient prone on a dedicated breast board, in the exact position used for treatment. A dose of 40.5 Gy, delivered at 2.7 Gy in 15 fractions, was prescribed to the index breast with an additional concomitant boost of 0.5 Gy delivered to the tumor bed, for a total dose of 48 Gy to the lumpectomy site. Physics constraints consisted of limiting 5% of the heart volume to receive > or = 18 Gy and < or = 10% of the ipsilateral lung volume to receive > or = 20 Gy. RESULTS: Between September 2003 and August 2005, 91 patients were enrolled on the study. Median length of follow-up was 12 months (range, 1 to 28 months). In all patients the technique was feasible and heart and lung sparing was achieved as prescribed by the protocol. Acute toxicities consisting mostly of reversible grades 1-2 skin dermatitis (67%) and fatigue (18%) occurred in 75 patients. One patient sustained a regional recurrence rapidly followed by distant metastases. CONCLUSION: Accelerated whole breast intensity modulated radiotherapy in the prone position is feasible and it permits a drastic reduction in the volume of lung and heart tissue exposed to significant radiation.
— id: 72870, year: 2007, vol: 25, page: 2236, stat: Journal Article,

Microinvasive breast cancer: The role of sentinel node biopsy
Guth, AA; Mercado, C; Roses, DF; Darvishian, F; Singh, B; Cangiarella, JF
2007 FEB ;14(2):43-43, Annals of surgical oncology
— id: 71054, year: 2007, vol: 14, page: 43, stat: Journal Article,

Accuracy of intraoperative sentinel lymph node evaluation for breast
Richards, V; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F
2007 ;20(3):195-273, Modern pathology
— id: 93501, year: 2007, vol: 20, page: 195, stat: Journal Article,

Accuracy of intraoperative sentinel lymph node evaluation for breast cancer
Richards, V; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Singh, B
2007 ;87(3):195-273, Laboratory investigation
— id: 93502, year: 2007, vol: 87, page: 195, stat: Journal Article,

Trends in breast cancer surgery: Comparison of an institutional experience between 1995 and 2005
Shanker, BA; Guth, AA; Roses, DF; Axelrod, D; Singh, B; Shapiro, RL; Diflo, T; Cangiarella, JA
2007 FEB ;14(2):88-88, Annals of surgical oncology
— id: 71055, year: 2007, vol: 14, page: 88, stat: Journal Article,

Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction
Tepper, OM; Karp, NS; Small, K; Unger, J; Pritchard, A; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2007 DEC ;106(1):S239-S239, Breast cancer research & treatment
— id: 75806, year: 2007, vol: 106, page: S239, stat: Journal Article,

Impact of complete removal of breast carcinoma by aggressive biopsy techniques
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Mercado, C; Singh, B
2007 ;20(2):226-50, Modern pathology
— id: 93504, year: 2007, vol: 20, page: 226, stat: Journal Article,

Impact of complete removal of breast carcinoma by aggressive biopsy techniques
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Mercado, C; Singh, B
2007 ;87(2):226-50, Laboratory investigation
— id: 93505, year: 2007, vol: 87, page: 226, stat: Journal Article,

Prophylactic mastectomy - trends in pathology findings
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, J; Ziguridis, N; Darvishian, F; Singh, B
2007 DEC ;106(1):S136-S136, Breast cancer research & treatment
— id: 75803, year: 2007, vol: 106, page: S136, stat: Journal Article,

Breast carcinoma in women 30 years and younger
Wen, YH; Roses, DF; Axelrod, DM; Guth, AA; Shapiro, RL; Cangiarella, JF; Ziguridis, N; Darvishian, F; Singh, B
2007 ;14(2):50-50, Annals of surgical oncology
— id: 93503, year: 2007, vol: 14, page: 50, stat: Journal Article,

The management of atypical lobular hyperplasia and lobular carcinoma in-situ diagnosed by core biopsy: is surgical excision necessary?
Cangiarella, J; Axelrod, D; Guth, A; Singh, B; Skinner, K; Roses, D; Simsir, A; Mercado, C
2006 FEB ;100(2):S176-S176, Breast cancer research & treatment
— id: 71008, year: 2006, vol: 100, page: S176, stat: Journal Article,

Intramammary lymph nodes and breast cancer: a marker for disease severity, or just another lymph node?
Guth, Amber A; Mercado, Cecilia; Roses, Daniel F; Hiotis, Karen; Skinner, Kristin; Diflo, Thomas; Cangiarella, Joan
2006 Oct;192(4):502-505, American journal of surgery
BACKGROUND: Axillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease? METHODS: We reviewed the cancer center pathology database from 1991 to 2005 for all cases of breast cancer with IMLNs. RESULTS: IMLNs were identified in 64 breast cancer patients, with metastatic spread in 20 patients, and benign IMLNs described in 44 patients. Positive IMLNs were associated with more aggressive disease, including higher rates of invasive versus noninvasive cancers (5% ductal carcinoma-in-situ [DCIS] with positive IMLNs vs. 23% with negative IMLNs), lymphovascular invasion (55% vs. 11%), and a higher rate of axillary lymph node involvement (72% vs. 18%). Patients with positive IMLNs were also more likely to undergo mastectomy (75% vs. 54%). CONCLUSIONS: IMLN metastases are a marker for disease severity; recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLN is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection. Preoperative lymphoscintigraphy may help identify these extra-axillary metastases
— id: 69076, year: 2006, vol: 192, page: 502, stat: Journal Article,

Sentinel-node biopsy or nodal observation in melanoma
Morton, Donald L; Thompson, John F; Cochran, Alistair J; Mozzillo, Nicola; Elashoff, Robert; Essner, Richard; Nieweg, Omgo E; Roses, Daniel F; Hoekstra, Harald J; Karakousis, Constantine P; Reintgen, Douglas S; Coventry, Brendon J; Glass, Edwin C; Wang, He-Jing
2006 Sep 28;355(13):1307-1317, New England journal of medicine
BACKGROUND: We evaluated the contribution of sentinel-node biopsy to outcomes in patients with newly diagnosed melanoma. METHODS: Patients with a primary cutaneous melanoma were randomly assigned to wide excision and postoperative observation of regional lymph nodes with lymphadenectomy if nodal relapse occurred, or to wide excision and sentinel-node biopsy with immediate lymphadenectomy if nodal micrometastases were detected on biopsy. RESULTS: Among 1269 patients with an intermediate-thickness primary melanoma, the mean (+/-SE) estimated 5-year disease-free survival rate for the population was 78.3+/-1.6% in the biopsy group and 73.1+/-2.1% in the observation group (hazard ratio for recurrence[corrected], 0.74; 95% confidence interval [CI], 0.59 to 0.93; P=0.009). Five-year melanoma-specific survival rates were similar in the two groups (87.1+/-1.3% and 86.6+/-1.6%, respectively). In the biopsy group, the presence of metastases in the sentinel node was the most important prognostic factor; the 5-year survival rate was 72.3+/-4.6% among patients with tumor-positive sentinel nodes and 90.2+/-1.3% among those with tumor-negative sentinel nodes (hazard ratio for death, 2.48; 95% CI, 1.54 to 3.98; P<0.001). The incidence of sentinel-node micrometastases was 16.0% (122 of 764 patients), and the rate of nodal relapse in the observation group was 15.6% (78 of 500 patients). The corresponding mean number of tumor-involved nodes was 1.4 in the biopsy group and 3.3 in the observation group (P<0.001), indicating disease progression during observation. Among patients with nodal metastases, the 5-year survival rate was higher among those who underwent immediate lymphadenectomy than among those in whom lymphadenectomy was delayed (72.3+/-4.6% vs. 52.4+/-5.9%; hazard ratio for death, 0.51; 95% CI, 0.32 to 0.81; P=0.004). CONCLUSIONS: The staging of intermediate-thickness (1.2 to 3.5 mm) primary melanomas according to the results of sentinel-node biopsy provides important prognostic information and identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy. (ClinicalTrials.gov number, NCT00275496 [ClinicalTrials.gov].)
— id: 94521, year: 2006, vol: 355, page: 1307, stat: Journal Article,

Qualitative criteria to evaluate sentinel lymph node frozen sections for breast cancer
Singh, B; Ziguridis, N; Guzman, SA; Axelrod, DM; Shapiro, RL; Guth, AA; Skinner, KA; Cangiarella, J; Roses, DF
2006 ;100(2):S173-S173, Breast cancer research & treatment
— id: 93506, year: 2006, vol: 100, page: S173, stat: Journal Article,

Three-dimensional imaging in breast reconstruction: a useful adjunct to surgical planning and assessment
Tepper, OM; Karp, NS; Small, K; Rudolph, L; Roses, D; Shapiro, R; Guth, A; Axelrod, D; Choi, M
2006 FEB ;100(2):S119-S119, Breast cancer research & treatment
— id: 71006, year: 2006, vol: 100, page: S119, stat: Journal Article,

Association of low P27 with loss of hormone receptors in small (T1a/b) breast cancers
Wu, J; Mirchandani, D; Smith, JA; Inghirami, G; Roses, D; Zeleniuch-Jacquotte, A; Muggia, F
2006 JUN 20 ;24(18):33S-33S, Journal of clinical oncology
— id: 69294, year: 2006, vol: 24, page: 33S, stat: Journal Article,

Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial
Morton, Donald L; Cochran, Alistair J; Thompson, John F; Elashoff, Robert; Essner, Richard; Glass, Edwin C; Mozzillo, Nicola; Nieweg, Omgo E; Roses, Daniel F; Hoekstra, Harald J; Karakousis, Constantine P; Reintgen, Douglas S; Coventry, Brendon J; Wang, He-jing
2005 Sep;242(3):302-311, Annals of surgery
OBJECTIVE: The objective of this study was to evaluate, in an international multicenter phase III trial, the accuracy, use, and morbidity of intraoperative lymphatic mapping and sentinel node biopsy (LM/SNB) for staging the regional nodal basin of patients with early-stage melanoma. SUMMARY BACKGROUND DATA: Since our introduction of LM/SNB in 1990, this technique has been widely adopted and has become part of the American Joint Committee on Cancer (AJCC) staging system. Eleven years ago, the authors began the international Multicenter Selective Lymphadenectomy Trial (MSLT-I) to compare 2 treatment approaches: wide excision (WE) plus LM/SNB with immediate complete lymphadenectomy (CLND) for sentinel node (SN) metastases, and WE plus postoperative observation with CLND delayed until the subsequent development of clinically evident nodal metastases. METHODS: After each center achieved 85% accuracy of SN identification during a 30-case learning phase, patients with primary cutaneous melanoma (> or =1 mm with Clark level > or =III, or any thickness with Clark level > or =IV) were randomly assigned in a 4:6 ratio to WE plus observation (WEO) with delayed CLND for nodal recurrence, or to WE plus LM/SNB with immediate CLND for SN metastasis. The accuracy of LM/SNB was determined by comparing the rates of SN identification and the incidence of SN metastases in the LM/SNB group versus the subsequent development of nodal metastases in the regional nodal basin of those patients with tumor-negative SNs. Early morbidity of LM/SNB was evaluated by comparing complication rates between the 2 treatment groups. Trial accrual was completed on March 31, 2002, after enrollment of 2001 patients. RESULTS: Initial SN identification rate was 95.3% overall: 99.3% for the groin, 95.3% for the axilla, and 84.5% for the neck basins. The rate of false-negative LM/SNB during the trial phase, as measured by nodal recurrence in a tumor-negative dissected SN basin, decreased with increasing case volume at each center: 10.3% for the first 25 cases versus 5.2% after 25 cases. There were no operative mortalities. The low (10.1%) complication rate after LM/SNB increased to 37.2% with the addition of CLND; CLND also increased the severity of complications. CONCLUSIONS: LM/SNB is a safe, low-morbidity procedure for staging the regional nodal basin in early melanoma. Even after a 30-case learning phase and 25 additional LM/SNB cases, the accuracy of LM/SNB continues to increase with a center's experience. LM/SNB should become standard care for staging the regional lymph nodes of patients with primary cutaneous melanoma
— id: 57874, year: 2005, vol: 242, page: 302, stat: Journal Article,

Development of modern breast cancer treatment
Roses DF
Breast cancer Philadelphia : Elsevier Churchill Livingstone, 2005,
— id: 3613, year: 2005, vol: , page: ?, stat: Chapter,

Surgery for breast cancer
Roses DF; Giuliano AE
Breast cancer Philadelphia : Elsevier Churchill Livingstone, 2005,
— id: 3614, year: 2005, vol: , page: ?, stat: Chapter,

Breast cancer
Roses, Daniel F
Philadelphia : Elsevier Churchill Livingstone, 2005,
— id: 843, year: 2005, vol: , page: , stat: ,

Prone accelerated partial breast irradiation after breast-conserving surgery: Preliminary clinical results and dose-volume histogram analysis
Formenti, Silvia C; Truong, Minh Tam; Goldberg, Judith D; Mukhi, Vandana; Rosenstein, Barry; Roses, Daniel; Shapiro, Richard; Guth, Amber; Dewyngaert, J Keith
2004 Oct 1;60(2):493-504, International journal of radiation oncology biology physics
PURPOSE: To report the clinical and dose-volume histogram results of the first 47 patients accrued to a protocol of accelerated partial breast irradiation. Patients were treated in the prone position with three-dimensional conformal radiotherapy after breast-conserving surgery. METHODS AND MATERIALS: Postmenopausal women with Stage T1N0 breast cancer were eligible only after they had first refused to undergo 6 weeks of standard radiotherapy. Planning CT in the prone position was performed on a dedicated table. The postoperative cavity was defined as the clinical target volume, with a 1.5-cm margin added to determine the planning target volume. A total dose of 30 Gy at 6 Gy/fraction was delivered in five fractions within 10 days. RESULTS: The median age of the patients was 67.5 years (range, 51-88 years). The median tumor diameter was 9 mm (range, 1.3-19 mm). In all patients, the prescribed dose encompassed the planning target volume. The mean volume of the ipsilateral breast receiving 100% of the prescription dose was 26% (range, 10-45%), and the mean volume contained within the 50% isodose surface was 47% (range, 23-75%). The lung and heart were spared by treating in the prone position. Acute toxicity was modest, limited mainly to Grade 1-2 erythema. With a median follow-up of 18 months, only Grade 1 late toxicity occurred, and no patient developed local recurrence. CONCLUSION: These data suggest that this approach is well tolerated, with only mild acute side effects and sparing of the heart and lung
— id: 45301, year: 2004, vol: 60, page: 493, stat: Journal Article,

Reoperation for Primary Hyperparathyroidism
Roses DF
Endocrine surgery New York : Marcel Dekker, 2004,
— id: 3161, year: 2004, vol: , page: 265, stat: Chapter,

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed After Segmental Mastectomy
Formenti, Silvia C; Roses, Daniel; Harris, Matthew; Shapiro, Richard; Guth, Amber
[Ft. Belvoir, VA] : Ft. Belvoir Defense Technical Information Center, 2003,
The current trial tests a regimen of conformal hypo-fractionated radiotherapy (5 fractions) directed to the original tumor bed with margins in a selected subset of post- menopausal women with breast cancer with a very low risk for local recurrence elsewhere in the breast. We are currently reporting the feasibility results and DVH analysis of the first 4% patients accrued. After planning CT is conducted in the prone position the breast tissue and tumor bed are contoured on a 3D planning system and a 2 cm margin added to determine the PTV. A plan is generated to treat the PTV to 90% of the prescription dose. Six Gy per fraction are delivered to the 95% isodose surface in 5 fractions over ten days weeks to a total dose of 30 Gy. All patients appeared to tolerate treatment very well. DVH varied based on the position of the original tumor bed and the size of the breast. In most cases it was possible to successfully plan and treat a quadrant of the breast with parallel opposed tangent fields without exceeding 50% of the dose to 50% of the breast volume. We continue accrual as planned, to a total of 99 patients
— id: 2130, year: 2003, vol: , page: , stat: ,

Assessment of hormone receptor status and HER2 expression by fine needle aspiration biopsy in breast cancer
Hussain, M; Cangiarella, J; Volm, M; Harris, MN; Roses, DF; Berman, RS
2003 JAN ;10(1):S54-S55, Annals of surgical oncology
— id: 38553, year: 2003, vol: 10, page: S54, stat: Journal Article,

Limitations of technetium 99m sestamibi scintigraphic localization for primary hyperparathyroidism associated with multiglandular disease
Katz, Steven C; Wang, Grace J; Kramer, Elissa L; Roses, Daniel F
2003 Feb;69(2):170-175, American surgeon
Successful surgical treatment of primary hyperparathyroidism requires the localization and excision of the parathyroid tissue responsible for excessive parathyroid hormone secretion while ensuring that the patient will have sufficient endogenous parathyroid hormone production to maintain eucalcemia. In selecting patients with primary hyperparathyroidism for unilateral parathyroidectomy the surgeon should be able to diagnose multiglandular disease either preoperatively or intraoperatively. We performed a retrospective review of 123 patients who underwent surgical treatment for primary hyperparathyroidism to determine the potential feasibility of selecting patients for minimally invasive surgery based on preoperative imaging studies. All patients were studied preoperatively with 99m technetium-sestamibi scintigraphy. High-resolution ultrasonography was performed in 119 of these patients. All patients except one underwent bilateral cervical exploration. A patient with an intrathoracic adenoma was successfully diagnosed by scintigraphy thereby allowing treatment by a limited thoracotomy. One hundred eight patients had solitary adenomas and 15 had multiglandular disease. In none of the patients with bilateral multiglandular disease were all abnormal glands localized preoperatively. Patients in our study with primary hyperparathyroidism and multiglandular disease were underdiagnosed by preoperative imaging. A minimally invasive approach based solely on preoperative imaging studies may result in treatment failure in patients with multiglandular involvement
— id: 39269, year: 2003, vol: 69, page: 170, stat: Journal Article,

Changes in the presence of multiple markers of circulating melanoma cells correlate with clinical outcome in patients with melanoma
Reynolds, Sandra R; Albrecht, Jeff; Shapiro, Richard L; Roses, Daniel F; Harris, Matthew N; Conrad, Andrew; Zeleniuch-Jacquotte, Anne; Bystryn, Jean-Claude
2003 Apr;9(4):1497-1502, Clinical cancer research
PURPOSE: Melanoma cells can be found in the circulation of patients with melanoma. The following study was conducted to examine whether changes in their presence could provide an early marker of response to therapy. EXPERIMENTAL DESIGN: We measured the presence of several markers of melanoma cells in the peripheral blood of 118 patients with resected stage IIb, III, or IV melanoma before and after immunotherapy with a polyvalent, shed antigen, melanoma vaccine using reverse transcription-PCR assays for tyrosinase, gp100, MART-1, and MAGE-3. Assays were conducted at baseline and after 3, 5, and 11 months of therapy. RESULTS: Overall, 47% of patients were positive for at least one marker during the study. Before vaccine treatment, circulating melanoma cell markers were present in 23% of patients. After 5 and 7 months of vaccine therapy, the proportion of patients with circulating markers decreased by 27% and 55%, respectively (P for trend = 0.02). The recurrence-free survival of patients whose melanoma cell markers disappeared during vaccine treatment was significantly longer than that of patients in whom they increased, i.e., the percentage of patients who were recurrence free at 1 year was 80% versus 58% (P = 0.03). CONCLUSIONS: Therapy with a polyvalent melanoma vaccine was associated with clearance of melanoma cell markers from the circulation, and the clearance was associated with an improved prognosis. These findings suggest that the sequential assay of tumor cells in the circulation by reverse transcription-PCR may provide an early indication of the effectiveness of cancer therapy
— id: 34746, year: 2003, vol: 9, page: 1497, stat: Journal Article,

Vaccine-induced CD8+ T-cell responses to MAGE-3 correlate with clinical outcome in patients with melanoma
Reynolds, Sandra R; Zeleniuch-Jacquotte, Anne; Shapiro, Richard L; Roses, Daniel F; Harris, Matthew N; Johnston, Dean; Bystryn, Jean-Claude
2003 Feb;9(2):657-662, Clinical cancer research
PURPOSE: Vaccine-induced antitumor CD8+ T-cell responses are believed to play an important role in increasing resistance to melanoma. The following study was conducted to examine whether these responses are associated with improved clinical outcome in melanoma vaccine-treated patients. EXPERIMENTAL DESIGN: We measured CD8+ T-cell responses to gp100, MART-1, MAGE-3, and tyrosinase by enzyme-linked immunospot assay in peripheral blood of 131 HLA-A*01- or HLA-A*02-positive melanoma patients before and after immunization to a polyvalent, shed antigen, melanoma vaccine, and correlated the results with clinical outcome. RESULTS: Fifty-six percent of patients had a vaccine-induced CD8+ T-cell response to at least one of the four antigens. Recurrences were significantly reduced in patients with vaccine-induced responses to MAGE-3 (hazard ratio, 0.42; 95% confidence interval, 0.18-0.99; P = 0.03) by the Cox proportional hazard model but were unrelated to responses to the other three antigens. Patients with a preexisting response to any of the four antigens were significantly more likely to have a further vaccine-boosted response to that same antigen (P < 0.0001-0.036). CONCLUSIONS: There was a correlation between vaccine-induced CD8+ T-cell responses to melanoma-associated antigens and improved clinical outcome, but the correlation depended on the antigen against which the response is directed. The only significant correlation was with responses to MAGE-3
— id: 34747, year: 2003, vol: 9, page: 657, stat: Journal Article,

Hypo-Fractionated Conformal Radiation Therapy to the Tumor Bed After Segmental Mastectomy
Formenti, Silvia C; Roses, Daniel; Harris, Matthew; Shapiro, Richard; Guth, Amber
[Ft. Belvoir, VA] : Ft. Belvoir Defense Technical Information Center, 2002,
The current trial tests a regimen of conformal hypo-fractionated radiotherapy (5 fractions) directed to the original tumor bed with margins in a selected subset of post- menopausal women with breast cancer with a very low risk for local recurrence elsewhere in the breast. We are currently reporting the feasibility results and DVN analysis of the first 29 patients accrued. After planning CT is conducted in the prone position the breast tissue and tumor bed are contoured on a 3D planning system and a 2 cm margin added to determine the PTV. A plan is generated to treat the PTV to 90% of the prescription dose. Six Gy per fraction are delivered to the 95 isodose surface in 5 fractions over ten days weeks to a total dose of 30 Gy. All patients appeared to tolerate treatment very well. DVH varied based on the position of the original tumor bed and the size of the breast. In most cases it was possible to successfully plan and treat a quadrant of the breast with parallel opposed tangent fields without exceeding 50% of the dose to 50% of the breast volume. We continue accrual as planned, to a total of 99 patients
— id: 2129, year: 2002, vol: , page: , stat: ,

Long-term survival of stage IV melanoma patients treated with a polyvalent, shed antigen, melanoma vaccine
Laky, D; Shapiro, RL; Harris, MN; Roses, DF; Jacquotte, AZ; Reynolds, SR; Bystryn, J
2002 JUL ;119(1):240-240, Journal of investigative dermatology
— id: 55284, year: 2002, vol: 119, page: 240, stat: Journal Article,

Presence of Mab 465.12 defined cytoplasmic melanoma-associated antigen in sera of patients with melanoma and relation to prognosis
Levy, D; Reynolds, SR; Ferrone, S; Shapiro, RL; Harris, MN; Roses, DF; Bystryn, J
2002 JUL ;119(1):240-240, Journal of investigative dermatology
— id: 55283, year: 2002, vol: 119, page: 240, stat: Journal Article,

Management or regional lymph nodes in patients with cutanesou melanoma
Roses DF
Surgical oncology : multidisciplinary approach to difficult problems New York : Arnold, 2002,
— id: 2768, year: 2002, vol: , page: 416, stat: Chapter,

Prognostic significance of the high molecular weight-melanoma associated antigen in sera of patients with melanoma
Wainwright, BD; Reynolds, SR; Ferrone, S; Harris, RL; Harris, MN; Roses, DF; Bystryn, J
2002 JUL ;119(1):242-242, Journal of investigative dermatology
— id: 55285, year: 2002, vol: 119, page: 242, stat: Journal Article,

Serum S100 level is predictive of recurrence-free survival in patients with intermediate risk melanoma
Amin, P; Bar, A; Reynolds, S; Shapiro, R; Harris, M; Roses, D; Bystryn, J
2001 AUG ;117(2):467-467, Journal of investigative dermatology
— id: 54900, year: 2001, vol: 117, page: 467, stat: Journal Article,

Decreases in serum levels of S100 may predict response to therapy in melanoma patients treated with a polyvalent melanoma vaccine
Bar, A; Amin, P; Reynolds, S; Shapiro, R; Roses, D; Harris, M; Bystryn, J
2001 AUG ;117(2):540-540, Journal of investigative dermatology
— id: 54910, year: 2001, vol: 117, page: 540, stat: Journal Article,

Decrease in circulating tumor cells as an early marker of therapy effectiveness
Bystryn JC; Albrecht J; Reynolds SR; Rivas MC; Oratz R; Shapiro RL; Roses DF; Harris MN; Conrad A
2001 ;158:204-207, Recent results in cancer research = Fortschritte der Krebsforschung = Progres dans les recherches sur le cancer
As melanoma cells are present in the circulation of many patients with this cancer, decreases in their number could provide an early indication of therapy effectiveness. To evaluate this possibility, we examined the effect of treatment with a melanoma vaccine on the number of melanoma cells present in the circulation. PCR was used to detect melanoma cells that expressed the melanoma-associated antigens MART-1, MAGE-3, tyrosinase and/or gp100 in 91 patients with melanoma. Melanoma cells that expressed one or more of these markers were present more often in advanced disease, i.e. in 80% of patients with advanced stage IV compared to in less than one-third of patients with less advanced disease. We then measured circulating melanoma cells in a subset of 43 of these patients who were treated with a polyvalent, shed antigen, melanoma vaccine. The vaccine contains multiple melanoma-associated antigens including MART-1, MAGE-3, tyrosinase and gp100. Immunizations were given intradermally q2-3 weeks x4 and then monthly x3. Prior to vaccine treatment, circulating melanoma cells were detected in 14 (32%) patients. Following 4 and 7 months of vaccine treatment, melanoma cells that expressed any of these markers were present in only nine (21%) and three (7%) of patients, respectively. Thus, vaccine therapy was associated with clearance of melanoma cells from the circulation in 78% of initially positive patients. As the number of these cells declined steadily with increasing length of therapy, it is unlikely that this was due to a random change in their number. Rather it suggests that the decline was a result of the therapy. These observations suggest that the presence of melanoma cells in the circulation is related to the extent of the melanoma, and that their disappearance may provide an early marker of the efficacy of therapy. However, the practical utility of assaying circulating tumor cells as a guide to the effectiveness of therapy or of prognosis will need to be confirmed by correlations with clinical outcome
— id: 16214, year: 2001, vol: 158, page: 204, stat: Journal Article,

Double-blind trial of a polyvalent, shed-antigen, melanoma vaccine
Bystryn JC; Zeleniuch-Jacquotte A; Oratz R; Shapiro RL; Harris MN; Roses DF
2001 Jul;7(7):1882-1887, Clinical cancer research
A polyvalent melanoma vaccine prepared from shed antigens stimulates humoral and cellular immune responses and improves survival compared with historical controls. We conducted a double-blind, prospectively randomized, placebo-controlled trial to assess whether this vaccine could slow the progression of resected melanoma. Thirty-eight patients with resected melanoma metastatic to regional nodes (American Joint Committee on Cancer stage III) who had a particularly poor prognosis on the basis of the nodes being clinically positive or two or more histologically positive nodes were randomly assigned in a 2:1 ratio to treatment with 40 microg of melanoma or placebo (human albumin) vaccine, both of which were bound to alum as an adjuvant. Immunizations were given intradermally into the extremities every 3 weeks x 4, monthly x 3, every 3 months x 2, and then every 6 months for 5 years or until disease progression. Twenty-four patients were treated with the melanoma, and 14 patients were treated with the placebo vaccine. The groups were evenly balanced with respect to prognostic factors. Median length of observation was 2.5 years. There was no local or systemic toxicity. By Kaplan-Meier analysis, median time to disease progression was two and a half times longer in patients treated with melanoma vaccine compared with that in patients treated with placebo vaccine, i.e., 1.6 years (95% confidence interval, 1.0-3.0 years) compared with 0.6 year [95% confidence interval, 0.3-1.9 year(s)]. By Cox proportional hazards analysis, this difference was significant at P = 0.03. Overall survival was 40% longer in the melanoma vaccine-treated group (median overall survival of 3.8 years versus 2.7 years), but this difference was not statistically significant. In a double-blind and placebo-controlled trial, these results suggest that immunization with a melanoma vaccine may be able to slow the progression of melanoma. Although statistically significant, these results must be interpreted with caution because they are based on a small number of patients
— id: 21126, year: 2001, vol: 7, page: 1882, stat: Journal Article,

Elective radiation therapy for high-risk malignant melanomas
Cooper JS; Chang WS; Oratz R; Shapiro RL; Roses DF
2001 Nov-Dec;7(6):498-502, Cancer journal
PURPOSE: Local-regional recurrence rates of 30%-50% have been reported after resection of high-risk malignant melanomas (multiple node involvement, extracapsular spread, deep invasion, recurrent disease, and/or microscopically involved margins). Recently, we have been offering elective radiation therapy, after definitive surgery, to selected patients who have high-risk malignant melanomas. We herein report our initial results. PATIENTS AND METHODS: From 1993 to 1999, 40 patients who underwent surgery for high-risk malignant melanomas (multiple involved lymph nodes [21 patients]; close or microscopically involved surgical margins [nine patients]; extracapsular extension [six patients]; previously resected, recurrent disease [three patients]; and/or primary tumors more than 4 mm thick [four patients]) received elective radiation therapy. Thirty-six patients received 3000 cGy in five fractions (600 cGy per fraction given twice weekly), and four patients received 3600 cGy in six fractions. RESULTS: At a median follow-up of 18.4 months (range, 3.8-74.1 months), the actuarial 5-year local-regional control rate was 84%. Systemic recurrence rates in these patients were similar to those reported for this subset of patients, and the actuarial overall survival rate at 5 years was 39%. Acute toxicity was limited to erythema of the skin and, in one instance, probable cellulitis, with no late sequelae. DISCUSSION: Elective radiation therapy (600 cGy per fraction for five or six fractions) effectively controlled residual subclinical disease after surgery; however, better adjuvant systemic therapies need to be designed to eliminate distant metastases and to alter survival rates
— id: 25143, year: 2001, vol: 7, page: 498, stat: Journal Article,

Poland's syndrome and carcinoma of the breast: a case report
Katz SC; Hazen A; Colen SR; Roses DF
2001 Jan-Feb;7(1):56-59, Breast journal
Poland's syndrome is a rare congenital anomaly that may include mammary hypoplasia and has been described in association with various malignancies. We report the case of a 42-year-old woman with unilateral Poland's syndrome who developed carcinoma in the hypoplastic breast. A review of the literature reveals no previous report of carcinoma of the hypoplastic breast with Poland's syndrome
— id: 20671, year: 2001, vol: 7, page: 56, stat: Journal Article,

Low p27 in T1N0M0 breast cancers - association with other unfavorable molecular markers of prognosis
Mirchandani, D; Tang, T; Inghirami, G; Roses, D; Shapiro, R; Harris, M; Muggia, F
2001 WIN ;69(3):337-119, Breast cancer research & treatment
— id: 98269, year: 2001, vol: 69, page: 337, stat: Journal Article,

Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes
Cangiarella J; Symmans WF; Shapiro RL; Roses DF; Cohen JM; Chhieng D; Harris MN; Waisman J
2000 Jun 25;90(3):162-166, Cancer
BACKGROUND: The presence of lymph node metastases in patients with malignant melanoma implies a significant decrease in survival. The authors investigated the efficacy of fine-needle aspiration biopsy (FNAB) in the diagnosis of metastatic malignant melanoma in 115 patients with melanoma and clinically suspicious regional lymph nodes. METHODS: One hundred thirty-three FNABs were performed by cytopathologists after referral from surgeons or oncologists using a 25-gauge or 27-gauge needle. RESULTS: The cytologic diagnosis was negative in 35, atypical in 1, suspicious in 2, and positive for malignant melanoma in 95. Regional lymph node dissections were performed in 78 patients. Of these, 70 positive FNABs were confirmed with no false-positive results. The atypical FNAB was proven positive for malignant melanoma at surgery. Of the two suspicious FNABs, one was confirmed as positive and one showed dermatopathic lymphadenopathy. Of the 35 negative FNAB specimens, 5 patients underwent surgery; 3 FNABs were found to be negative and 2 FNABS were falsely negative. Twenty patients with negative aspirates were followed clinically for 22-45 months (mean, 32 months); 19 patients had no evidence of disease and 1 patient died of disseminated melanoma. CONCLUSIONS: FNAB of palpable lymphadenopathy in patients with malignant melanoma can provide a rapid and accurate assessment of lymph node status and expedite the therapeutic management of these patients
— id: 11596, year: 2000, vol: 90, page: 162, stat: Journal Article,

Invasive carcinoma in clinically suspicious breast masses diagnosed as adenocarcinoma by fine-needle aspiration
Chhieng DC; Fernandez G; Cangiarella JF; Cohen JM; Waisman J; Harris MN; Roses DF; Shapiro RL; Symmans WF
2000 Apr 25;90(2):96-101, Cancer
BACKGROUND: Fine-needle aspiration (FNA) biopsy of palpable breast masses along with clinical and radiologic findings can provide rapid distinction between benign and malignant lesions. A preoperative determination of invasive or in situ carcinoma assists in the planning of definitive treatment. Previous studies have concentrated on whether cytologic features adequately distinguish invasion, but to the authors' knowledge the predictive value of clinicopathologic correlation has not been investigated. The authors attempted to determine whether a malignant cytologic diagnosis for a palpable breast mass is sufficient for its definitive surgical management as an invasive neoplasm. METHODS: The authors reviewed 351 FNAs from palpable breast lesions with a cytologic diagnosis of 'adenocarcinoma.' The presence of invasive disease was determined by histologic demonstration of invasive carcinoma in the corresponding surgical specimen or by identifying metastatic carcinoma in the absence of another primary source. RESULTS: Three hundred forty-three (97.7%) palpable tumors diagnosed as adenocarcinoma by FNA proved to be invasive adenocarcinoma. The remaining eight tumors contained high grade ductal carcinoma in situ, and two of these contained foci suggestive of microinvasion. CONCLUSIONS: A palpable breast mass with an FNA diagnosis of adenocarcinoma usually represents invasive carcinoma. A definitive treatment plan therefore can be planned based on these clinical and FNA findings
— id: 11721, year: 2000, vol: 90, page: 96, stat: Journal Article,

Depletion of polymorphonuclear neutrophis inhibits angiogenesis in vivo
Chuang N; Shapiro RL; Mignatti P; Roses DF; Shamamian P
2000 ;61:246-248, Surgical forum
— id: 25207, year: 2000, vol: 61, page: 246, stat: Journal Article,

Melanoma growth in wild-type, urokinase-type plasminogen activator knockout and tissue-type plasminogen activator knockout mice
Chuang N; Shamamian P; Roses DF; Rifkin DB; Shapiro RL
1999 ;60:367-368, Surgical forum
— id: 25206, year: 1999, vol: 60, page: 367, stat: Journal Article,

Tubular Carcinoma of the Breast: Immunohistochemical and DNA Flow Cytometric Profile
Fasano M; Vamvakas E; Delgado Y; Inghirami G; Mitnick J; Roses D; Feiner H
1999 Jul;5(4):252-255, Breast journal
Molecular markers of ordinary invasive ductal carcinoma of the breast have been extensively studied and their prognostic significance has been assessed. A common variant of breast cancer, tubular carcinoma, has an excellent prognosis as judged from several clinicopathologic studies. One would assume that tubular carcinomas have 'favorable' molecular markers, however, published series of tubular carcinomas do not include molecular markers. We describe the molecular markers of 39 consecutive tubular carcinomas collected between January 1995 and July 1997. DNA ploidy, S-phase, estrogen and progesterone receptor (ER and PR, respectively) expression, and immunoreactivity for MIB-1, p53, and erbB2 were evaluated. Seventy-two percent of tubular carcinomas were DNA diploid, 49% had an S-phase less than 5%, 95% were ER positive, 69% were PR positive, 88% had less than 10% MIB-1-positive cells, 97% were p53 negative, and 97% did not overexpress erbB2 protein. Thus tubular carcinomas exhibit favorable molecular characteristics, which may play a role in their good prognosis
— id: 20674, year: 1999, vol: 5, page: 252, stat: Journal Article,

Tubular carcinoma of the breast: sensitivity of diagnostic techniques and correlation with histopathology
Mitnick JS; Gianutsos R; Pollack AH; Susman M; Baskin BL; Ko WD; Pressman PI; Feiner HD; Roses DF
1999 Feb;172(2):319-323, American journal of roentgenology
OBJECTIVE: Our objective was to assess our experience in diagnosing pure tubular carcinoma of the breast and to correlate the radiologic and histopathologic features. MATERIALS AND METHODS: A retrospective review of 932 consecutive cases of proven breast cancer diagnosed between 1990 and 1997 revealed 78 cases (8.4%) of tubular carcinoma in 69 patients. Clinical, imaging, cytologic, and histologic findings were analyzed. RESULTS: Mammography revealed tubular carcinoma in 68 (87%) of the 78 cases. Sonography showed tubular carcinoma in all 38 cases in which it was used; nine of these lesions were mammographically occult. These nine lesions were slightly, but not significantly (p < .05), smaller than the 29 lesions that had also been detected on mammography. Large core needle biopsy was performed in 22 patients (sensitivity, 91%). At biopsy, diagnoses were malignant (n = 16 [73%]), suspicious (n = 4 [18%]), atypia (n = 1 [4.5%]), and benign (n = 1 [4.5%]). Fine-needle aspiration biopsy was used to evaluate 36 cases of tubular carcinoma (sensitivity, 50%); cytologic diagnoses were malignant (n = 15 [42%]), suspicious (n = 3 [8%]), atypia (n = 10 [28%]), and benign (n = 8 [22%]). Only 15 (19%) of the 78 tubular carcinomas were palpable. Other tumors were detected within the excised tissue in 47 of the patients (68%); of these other types of lesions, ductal carcinoma in situ was found most often. CONCLUSION: Most cases of tubular carcinoma can be revealed by mammography; for mammographically occult tubular carcinoma, sonography can be performed. The rate of accuracy for determining the presence of tubular carcinoma is higher with large core needle biopsy than with fine-needle aspiration biopsy. Finally, when tubular carcinoma is diagnosed, other histologic types of carcinoma often occur in the same breast
— id: 25103, year: 1999, vol: 172, page: 319, stat: Journal Article,

Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group
Morton DL; Thompson JF; Essner R; Elashoff R; Stern SL; Nieweg OE; Roses DF; Karakousis CP; Mozzillo N; Reintgen D; Wang HJ; Glass EC; Cochran AJ
1999 Oct;230(4):453-463, Annals of surgery
OBJECTIVE: To evaluate the multicenter application of intraoperative lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection (LM/SL/SCLND) for the management of early-stage melanoma. SUMMARY BACKGROUND DATA: The multidisciplinary technique of LM/SL/SCLND has been widely adopted, but not validated in a multicenter trial. The authors began the international Multicenter Selective Lymphadenectomy Trial (MSLT) 5 years ago to evaluate the survival of patients with early-stage primary melanoma after wide excision alone versus wide excision plus LM/SL/SCLND. This study examined the accuracy of LM/SL/SCLND in the MSLT, using the experience of the organizing center (John Wayne Cancer Institute [JWCI]) as a standard for comparison. METHODS: Before entering patients into the randomization phase, each center in the MSLT was required to finish a 30-case learning phase with complete nuclear medicine, pathology, and surgical review. Selection of MSLT patients in the LM/SL/SCLND treatment arm was based on complete pathologic and surgical data. The comparison group of JWCI patients was selected using these criteria: primary cutaneous melanoma having a thickness > or =1 mm with a Clark level > or =III, or a thickness <1 mm with a Clark level > or =IV (MSLT criterion); LM/SL performed between June 1, 1985, and December 30, 1998; and patient not entered in the MSLT. The accuracy of LM/SL/SCLND was determined by comparing the rates of sentinel node (SN) identification and the incidence of SN metastases in the MSLT and JWCI groups. RESULTS: There were 551 patients in the MSLT group and 584 patients in the JWCI group. In both groups, LM performed with blue dye plus a radiocolloid was more successful (99.1 %) than LM performed with blue dye alone (95.2%) (p = 0.014). After a center had completed the 30-case learning phase, the success of SN identification in the MSLT group was independent of the center's case volume or experience in the MSLT. CONCLUSIONS: Lymphatic mapping and sentinel lymphadenectomy can be successfully learned and applied in a standardized fashion with high accuracy by centers worldwide. Successful SN identification rates of 97% can be achieved, and the incidence of nodal metastases approaches that of the organizing center. A multidisciplinary approach (surgery, nuclear medicine, and pathology) and a learning phase of > or =30 consecutive cases per center are sufficient for mastery of LM/SL in cutaneous melanoma. Lymphatic mapping performed using blue dye plus radiocolloid is superior to LM using blue dye alone
— id: 25137, year: 1999, vol: 230, page: 453, stat: Journal Article,

Centennial of a landmark event
Roses DF
1999 ;52:32-32, NYU physician
— id: 25202, year: 1999, vol: 52, page: 32, stat: Journal Article,

Development of modern breast cancer treatment
Roses DF
Breast cancer New York : Churchill Livingstone, 1999,
— id: 2717, year: 1999, vol: , page: 289, stat: Chapter,

Surgery for in situ, stage I, and stage II breast cancer
Roses DF
Breast cancer New York : Churchill Livingstone, 1999,
— id: 2718, year: 1999, vol: , page: 343, stat: Chapter,

Complications of level I and II axillary dissection in the treatment of carcinoma of the breast
Roses DF; Brooks AD; Harris MN; Shapiro RL; Mitnick J
1999 Aug;230(2):194-201, Annals of surgery
OBJECTIVE: To assess the complications of level I and II axillary lymph node dissection in the treatment of stage I and II breast cancer, with breast-conservation surgery and mastectomy. SUMMARY BACKGROUND DATA: The role of axillary dissection for staging, and as an effective means of controlling regional nodal disease, has long been recognized. As small and low-grade lesions have been detected more frequently, and as its therapeutic impact has been questioned, axillary dissection has increasingly been perceived as associated with significant complications. METHODS: Two hundred patients, 112 of whom had breast-conservation surgery with axillary dissection and 88 of whom had total mastectomy with axillary dissection, were evaluated 1 year or more after surgery for arm swelling as well as nonedema complications. All patients had arm circumference measurements at the same four sites on both the operated and nonoperated sides. RESULTS: No patient had an axillary recurrence. The mean difference in circumference on the nonoperated versus operated side was 0.425 cm +/- 1.39 at the midbiceps (p < 0.001), 0.315 cm +/- 1.27 at the antecubital fossa (p < 0.001), 0.355 cm +/- 1.53 at the midforearm (p < 0.005), and 0.055 cm +/- 0.75 at the wrist (n.s.). Seven patients (3.5%) had mild swelling of the hand. Heavy and obese body habitus were the only significant predictors of edema on multivariate analysis. One hundred fifty-three (76.5%) patients had numbness or paresthesias of the medial arm and/or axilla after surgery; in 125 (82%) of these, the problem had lessened or had resolved on follow-up assessment. CONCLUSIONS: The characterization of a level I and II axillary dissection as a procedure with significant complications does not appear justified based on this experience
— id: 6178, year: 1999, vol: 230, page: 194, stat: Journal Article,

Breast cancer
Roses, Daniel F
New York : Churchill Livingstone, c1999,
— id: 602, year: 1999, vol: , page: , stat: ,

Treatment or regionally recurrent malignant melanoma
Shapiro RL; Oratz R; Roses DF
1999 ;15:15-15, Advances in oncology (Greenwich, CT)
— id: 25201, year: 1999, vol: 15, page: 15, stat: Journal Article,

Lipid-rich follicular carcinoma of the thyroid in a patient with McCune-Albright syndrome
Yang GC; Yao JL; Feiner HD; Roses DF; Kumar A; Mulder JE
1999 Oct;12(10):969-973, Modern pathology
A 41-year-old woman with McCune-Albright syndrome and a 2-cm thyroid nodule of ten years' duration presented for fine-needle aspiration, which yielded vacuolated clear cells with granular chromatin in pseudopapillary arrangement. The resected tumor showed 90% clear cells and 10% nonclear cells with capsular and vascular invasion. The cytoplasmic vacuoles in the clear cells were 3+ for oil red O stain in touch imprint cytology. Immunohistochemistry demonstrated thyroglobulin positivity in the nonclear neoplastic cells, whereas most of the clear cells were negative. Ultrastructural study demonstrated the gradual transition from protein synthesis to lipid synthesis as the neoplastic cells progressed from nonclear to clear. The study suggested that the lipid accumulation resulted from the uncontrolled fatty acid synthesis in the neoplastic cells rather than metaplasia. The karyotype of the tumor cells was normal, 46XX. Literature of lipid-rich thyroid neoplasms were reviewed
— id: 11943, year: 1999, vol: 12, page: 969, stat: Journal Article,

Randomized, double-blind, clinical trial of a polyvalent melanoma vaccine in patients with stage III melanoma
Bystryn, JC; Oratz, R; Shapiro, R; Harris, M; Roses, D; Jacquotte, A
1998 APR ;110(4):498-498, Journal of investigative dermatology
— id: 53522, year: 1998, vol: 110, page: 498, stat: Journal Article,

Randomized, double-blind phase III trial of a polyvalent, shed, melanoma antigen vaccine in stage III melanoma
Bystryn, JC; Oratz, R; Shapiro, RL; Harris, MN; Roses, DF; Jacquotte, A; Chen, DL; Rivas, M
1998 AUG 25 ;9(4):84-84, Annals of oncology
— id: 53387, year: 1998, vol: 9, page: 84, stat: Journal Article,

Inhibition of angiogenesis and matrix metalloproteinase-2 activity by dexrazoxane (zinecard) may mediate its antitumor effects
Chuang JN; Ren CJ; Mendoza S; Shamamian P; Roses DF; Rifkin DB; Chachoua A; Shapiro RL
1998 ;49:424-426, Surgical forum
— id: 25210, year: 1998, vol: 49, page: 424, stat: Journal Article,

Melanoma lung metastases in wild-type urokinase- and tissue-type plasminogen activator knockout mice.
Chuang N; Ren CJ; Roses DF; Rifin DB; Shapiro RL
1998 ;39(6):297-297, Proceedings of the annual meeting of the American Association for Cancer Research
— id: 20285, year: 1998, vol: 39, page: 297, stat: Journal Article,

Periorbital melanocytic lesions: excision and reconstruction in 40 patients [see comments]
Glat PM; Longaker MT; Jelks EB; Spector JA; Roses DF; Shapiro RA; Zide BM; Jelks GW
1998 Jul;102(1):19-27, Plastic & reconstructive surgery
The treatment of melanoma arising in the periorbital region is a difficult reconstructive problem. The abundance of vital structures in close proximity to one another makes the resection and subsequent reconstructive procedures extremely challenging. Reported here is experience with periorbital melanocytic lesions in 40 patients with the emphasis on the types of reconstruction performed. Forty patients with periorbital melanocytic lesions were treated between 1984 and 1995. The periorbital region was subdivided into five zones. These zones are the following: zone I, upper eyelid; zone II, lower eyelid; zone III, medial canthus; zone IV, lateral canthus; and zone V, contiguous structures. Ocular melanomas were not included in this study. The distribution of the lesions in our 40 patients was zone I (n = 1), zone II (n = 14), zone III (n = 1), zone IV (n = 9), and zone V (n = 31). The ages of the patients ranged from 3 to 84 years at the time of reconstruction, with an average age of 57 years. Resection and reconstruction were performed simultaneously in all patients. Thirty-six of the patients were reconstructed with one procedure, three patients required two procedures, and one patient required five procedures. The tumor type was superficial spreading melanoma in 15 patients, melanoma in situ in 17 patients, malignant spindle cell neoplasm in 2 patients, desmoplastic melanoma in 2 patients, amelanocytic melanoma in 1 patient, epithelioid melanoma in 1 patient, and atypical melanocytic nevus in 2 patients in which an early, evolving melanoma could not be excluded. Elective lymph node dissection was performed in four patients for intermediate thickness lesions (1.5 to 4.0 mm). The types of reconstructions performed included full-thickness skin grafts, upper lid myocutaneous flaps, cheek advancement flaps, cervicofacial flaps, inferiorly based nasolabial flaps, tarsoconjunctival flaps, frontalis muscle flaps, medial transposition Z-plasty, and primary closure. The resection of periorbital melanomas can be difficult because of the number of important anatomic structures in the region. The challenge to the surgeon in handling head and neck melanomas in general lies in the need to provide the best functional and aesthetic result while still resecting the primary lesion with the intent of effecting a cure. We present our series to demonstrate that the adequacy of margins of resection need not be compromised to facilitate reconstruction and that excellent results are obtainable with reconstructive procedures performed after adequate resections. Several different types of flaps and grafts can be used, with the indications varying depending on the location of the lesion and the extent of resection. The major reconstructive options will be reviewed in detail
— id: 7578, year: 1998, vol: 102, page: 19, stat: Journal Article,

Numerical abnormalities of chromosomes 7, 18, and x in precancerous breast disease defined by fluorescent in situ hybridization
Illei, P B; Feiner, H D; Symmans, W F; Mitnick, J S; Roses, D F; Perle, M A
1998 Jul;4(4):252-257, Breast journal
Nonrandom numerical chromosomal abnormalities (NCA) are frequent in invasive breast cancer, but little is known about such changes in microscopic precursor lesions. Mammographically detected 'suspicious' breast lesions were localized by specimen radiology of sliced breast tissue. The slices containing the lesion were imprinted onto coated slides by gentle scraping. The corresponding hematoxylin and eosin stained histologic sections and Diff-Quik stained imprints were used for classification as ductal hyperplasia (DH), atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS). Additional slide imprints were evaluated for copy number of chromosomes 7, 18, and X by using fluorescent in situ hybridization with alpha satellite probes. NCA were detected in 1 of 9 (11%) cases of DH, in 2 of 8 (25%) cases of ADH, and in 14 of 16 (87%) cases of DCIS. There was selective loss (chromosome 18) in one case of DCIS; all other cases with NCA had a gain of at least one chromosome. There is a progressive increase in incidence of NCA in DH, ADH and DCIS. The majority of NCA are chromosomal gains
— id: 119238, year: 1998, vol: 4, page: 252, stat: Journal Article,

Lymphatic mapping and sentinel node biopsy in patients with breast cancer and melanoma -- part 1 [Symposium]
Morton DL; Giuliano AE; Reintgen DS; Roses DF; Ross MI; Thompson JF
1998 ;53(4):281-298, Contemporary surgery
— id: 25211, year: 1998, vol: 53, page: 281, stat: Journal Article,

Lymphatic mapping and sentinel node biopsy in patients with breast cancer and melanoma -- part 2 [Symposium]
Morton DL; Giuliano AE; Reintgen DS; Roses DF; Ross MI; Thompson JF
1998 ;53(5):353-361, Contemporary surgery
— id: 25212, year: 1998, vol: 53, page: 353, stat: Journal Article,

Irsogladine maleate inhibits angiogenesis in wild-type and plasminogen activator-deficient mice
Ren CJ; Ueda F; Roses DF; Harris MN; Mignatti P; Rifkin DB; Shapiro RL
1998 Jul 1;77(2):126-131, Journal of surgical research
BACKGROUND: The activation of the zymogen plasminogen to the serine protease plasmin by urokinase-type (uPA) and tissue-type (tPA) plasminogen activators (PA) is an important event in a variety of physiologic and pathophysiologic processes in mammals. Enhanced PA activity occurs during angiogenesis and has been correlated in vitro and in vivo with increased tumor aggressiveness and is an indicator of poor prognosis in a variety of tumors in humans. Preliminary studies suggest that the antiulcer drug irsogladine maleate (IM) diminishes PA activity in vitro and may inhibit angiogenesis in vivo. To define the precise mechanism of angiogenesis inhibition by IM in vivo, we tested the ability of IM to blunt angiogenesis in a mouse cornea neovascularization model performed in wild-type and PA-knockout mice. METHODS: Three days prior to pellet implantation, groups of C57Bl/6 wild-type, uPA-deficient (upA-/-), and tPA-deficient (tPA-/-) mice received IM (300 mg/kg), IM (500 mg/kg), or vehicle (0.5% carboxymethylcellulose) via oral gavage. After 3 days of treatment, hydron polymer-coated pellets of sucrose aluminum sulfate containing 100 ng of basic fibroblast growth factor (bFGF) were inserted into surgically created pockets in the cornea of each mouse. On postoperative day 6, the neovascularization of each cornea was evaluated by a blinded observer using slit lamp microscopy and photographed. Angiogenesis was quantified by calculating vascular area (mm2) +/- SEM using a modified formula for a half ellipse that incorporates calibrated vessel measurements [Vessel length (mm) x Clock hours x pi x 0.2]. RESULTS: IM treatment (300 and 500 mg/kg/day) resulted in a dose-dependent reduction of angiogenesis in wild-type mice by 21 and 45.3% (P < 0.02, P < 0.001), in tPA-deficient mice by 42.6 and 46% (P < 0.001, P < 0.001), and in uPA-deficient mice by 27.2 and 46% (P < 0.05, p < 0.001), respectively. No quantitative differences in neovascularization were observed in either treatment group between transgenic mouse strains. No toxicity was noted in any group. CONCLUSION: IM inhibits bFGF-induced angiogenesis in wild-type, tPA-knockout, and uPA-knockout mice. The observation that IM significantly diminishes angiogenesis in both PA-deficient mice and wild-type mice suggests that the mechanism of action of IM may be independent of plasminogen activation.
— id: 12076, year: 1998, vol: 77, page: 126, stat: Journal Article,

Stimulation of CD8+ T cell responses to MAGE-3 and MART-1 by immunization to a shed antigen melanoma vaccine
Bystryn, JC; Reynolds, SR; Oratz, R; Shapiro, RL; Harris, M; Roses, D
1997 APR ;108(4):113-113, Journal of investigative dermatology
— id: 53215, year: 1997, vol: 108, page: 113, stat: Journal Article,

Poly(ADP-ribose) polymerase in human breast cancer: a case-control analysis
Hu JJ; Roush GC; Dubin N; Berwick M; Roses DF; Harris MN
1997 Aug;7(4):309-316, Pharmacogenetics
The importance of a genetic polymorphism (A/B allele) of poly(ADP-ribose) polymerase (PARP) pseudogene on chromosome 13q34-qter, and PARP enzyme activities in the development of human breast cancer were evaluated in a cancer case-control study. A total of 309 Caucasian women (> or = 50 years old) were evaluated for the PARP genotype, 70 of whom had histologically confirmed breast cancer, 128 women with benign breast diseases as study controls, and 111 reference controls. Age was significantly associated with case-control status (p < 0.0001), but family history of breast cancer, age at menarche, age at first live birth and parity were not. The frequency of the PARP B allele was similar in breast cancer cases (0.14), study controls (0.13), and reference controls (0.15). In a subset of 14 breast cancer cases and 32 study controls, the mean PARP enzyme activities (induced by H2O2 or oligonucleotide) were observed to be lower in cancer cases; an age-adjusted odds ratio of 3.40 (95% confidence interval = 0.70-19.54) for the below-median oligonucleotide-induced PARP was suggestive of an association. In subjects with the AB or BB genotype, the mean H2O2-induced PARP enzyme activity was significantly higher (p = 0.02, adjusted for case-control status and age) compared with that in subjects with the AA genotype. These findings indicate that: (a) the genetic polymorphism of the PARP pseudogene on chromosome 13 is not associated with the development of breast cancer in our study population; (b) oligonucleotide-induced PARP activity may be useful for identifying postmenopausal women at increased risk for breast cancer; and (c) there is a possible functional link between the genotype of the PARP pseudogene and enzyme activation
— id: 25128, year: 1997, vol: 7, page: 309, stat: Journal Article,

A polyvalent melanoma vaccine induces MAGE-3 and MART-1/Melan-A specific CD8+ T cell responses that correlate with clinical outcome
Oratz R; Reynolds SR; Shapiro RL; Harris M; Roses D; Vukmanovic S; Bystryn JC
1997 ;16:A1548-A1548, Proceedings (American Society of Clinical Oncology)
A critical requirement to use tumor antigens as vaccines is that they stimulate CD8+ T cell responses. In this study, we tested the ability of a shed, polyvalent, melanoma antigen vaccine to induce such responses to the melanoma-associated antigens, MAGE-3 and MART-1/Melan-A. Fifteen HLA-A2+ patients with resected malignant melanoma were immunized to the vaccine sc every 2-3 weeks x 4, and monthly thereafter. CD8+ T cells in peripheral blood reacting to HLA-A2 restricted epitopes on MAGE-3 (FLWGPRALV) and/or MART-1/Melan-A (AAGIGILTV) were quantitated directly using a filter spot assay at baseline and following 4 immunizations. Vaccine immunization induced CD8+ T cells reacting specifically to one or both of these antigens in 9 (60%) patients. These cells were CD8+ and HLA-A2 restricted, as reactivity was abrogated by monoclonal antibodies to CD8 and to class I HLA, but not by anti-CD4. The CD8+ T cells were specifically directed to these antigens, as they did not react to the same targets pulsed with a control HLA-A2 restricted peptide recognized by T cells. All responding patients remained recurrence-free during a follow-up of 12-21 months, whereas melanoma recurred within 3-5 months in non-responders. The differences in outcome were unrelated to differences in disease-severity or overall immunological competence between CD8+ T cell responders and non-responders. These results demonstrate that a polyvalent vaccine can stimulate a CD8+ T cell response to MAGE-3 and MART-1/Melan-A in humans, and suggest that the responses are protective and surrogate markers of vaccine efficacy. (C) American Society of Clinical Oncology 1997
— id: 6031, year: 1997, vol: 16, page: A1548, stat: Journal Article,

Alexis Carrel and vascular surgery
Roses DF
1997 ;3:1-1, Traditions in surgery
— id: 25412, year: 1997, vol: 3, page: 1, stat: Journal Article,

Surgical management of malignant melanoma
Roses DF
Grabb and Smith's plastic surgery Philadelphia : Lippincott-Raven, 1997,
— id: 2713, year: 1997, vol: , page: 131, stat: Chapter,

Urokinase-type plasminogen activator-deficient mice are predisposed to staphylococcal botryomycosis, pleuritis, and effacement of lymphoid follicles
Shapiro RL; Duquette JG; Nunes I; Roses DF; Harris MN; Wilson EL; Rifkin DB
1997 Jan;150(1):359-369, American journal of pathology
Urokinase-type plasminogen activator (uPA) is thought to be an important mediator in the proteolytic degradation of extracellular matrix components observed in a wide variety of normal physiological and pathological conditions. However, the phenotype of a recently developed strain of urokinase-deficient (uPA-/-) mice appears to be normal when maintained under ideal nonstressful conditions. We report an outbreak of botryomycosis, an unusual staphylococcal infection, in a colony of uPA-deficient mice. A detailed histological examination of these uPA-deficient animals also revealed a variety of previously unreported phenotypic abnormalities such as pleuritis and the effacement of lymphoid follicles in the regional lymph nodes and spleen. Additional phenotypic abnormalities such as dystrophic calcifications and rectal prolapse were also observed in the uPA-deficient population. These abnormalities were also noted in ostensibly healthy uPA-deficient animals. Botryomycosis did not affect a colony of wild-type (uPA+/+) animals maintained concurrently under identical conditions in the same room. The peculiar predisposition of the uPA-deficient animals to this rare bacterial infection and the development of phenotypic abnormalities associated with the targeted disruption the uPA gene suggests that uPA contributes significantly to the cutaneous microenvironment and is additional evidence of the extensive involvement of the plasminogen activators in mammalian physiology
— id: 12426, year: 1997, vol: 150, page: 359, stat: Journal Article,

Axillary dissection for tubular carcinoma of the breast
Berger AC; Miller SM; Harris MN; Roses DF
1996 ;2:204-208, Breast journal
— id: 25213, year: 1996, vol: 2, page: 204, stat: Journal Article,

Potentiation of melanoma vaccine activity by IL-2 liposomes
Bystryn JC; Oratz R; Shapiro RL; Johnston D; Harris MN; Roses DF; Zeleniuch-Jacquotte A; Chen DF; Lax A
1996 ;106(4):845-845 #235, Journal of investigative dermatology
— id: 25218, year: 1996, vol: 106, page: 845, stat: Journal Article,

Use of vaccines in treatment of malignant melanoma
Bystryn JC; Shapiro RL; Harris M; Roses DF; Oratz R
1996 Jul-Aug;14(4):337-341, Clinics in dermatology
— id: 12583, year: 1996, vol: 14, page: 337, stat: Journal Article,

Potentiation of melanoma vaccine activity by IL-2 liposomes
Bystryn, JC; Oratz, R; Shapiro, R; Johnston, D; Harris, M; Roses, D; ZeleniuchJacquotte, A; Chen, DL; Lax, A
1996 APR ;106(4):235-235, Journal of investigative dermatology
— id: 98386, year: 1996, vol: 106, page: 235, stat: Journal Article,

The management of pigmented lesions of the nail bed
Glat PM; Spector JA; Roses DF; Shapiro RA; Harris MN; Beasley RW; Grossman JA
1996 Aug;37(2):125-134, Annals of plastic surgery
Pigmented lesions of the nail bed, especially without a history of trauma, represent a diagnostic challenge to the clinician. These lesions are often categorized as melanonychia striata (MS), which refers to any linear tan-brown-black pigmentation of the nail bed. The differential diagnosis of MS includes subungual hematomas, onchomycosis nigricans, junctional nevi, melanoma in situ (MIS), and malignant melanoma (MM). Our algorithm at the New York University (NYU) Medical Center for the treatment of pigmented lesions of the nail bed is presented. A histopathologic diagnosis with any evidence of melanocytic atypia, however subtle, requires absolute confirmation by complete excision. The absence of a clear margin or recurrence requires total nail bed excision and reconstruction using a full-thickness graft. The diagnosis of MIS is similarly treated. The surgical management of subungual MM is discussed. All cases of MM of the hand treated at NYU were reviewed. In all, 30 patients were treated from 1982 to 1995. Follow-up ranged from 6 months to 13 years. In our series, there were 8 cutaneous and 22 subungual melanomas. There was a marked delay in treatment of both groups, with subungual melanomas more often erroneously treated as other pathology prior to correct diagnosis. The 5-year survival rate was 100% for patients with cutaneous lesions, but only 80% for those with the subungual variety. There was a statistical difference in the depths of the lesions (subungual, 3.68 mm; cutaneous, 1.36 mm) with a p-value of 0.008. The role of elective lymph node dissection in the absence of clinical metastases as well as intraoperative sentinel lymphatic mapping remains controversial and is discussed
— id: 12566, year: 1996, vol: 37, page: 125, stat: Journal Article,

Mammographically detected breast lesions: clinical importance of cytologic atypia in stereotaxic fine-needle aspiration biopsy samples [see comments]
Mitnick JS; Vazquez MF; Feiner HD; Pressman P; Roses DF
1996 Feb;198(2):319-322, Radiology
PURPOSE: To correlate cytologic findings of stereotaxic fine-needle aspiration biopsy samples with histologic findings of excised samples of nonpalpable mammographically detected lesions. MATERIALS AND METHODS: In a retrospective review of 2,988 consecutive stereotaxic fine-needle aspiration biopsy samples of nonpalpable breast lesions obtained within 5 years, 70 samples were categorized as atypical. Excision with needle localization and specimen radiography were performed in all lesions; cytologic findings of aspirates were correlated with histologic findings of excised samples. Histologic findings were the standard of reference. RESULTS: Of the 70 atypical aspirates, 27 were benign (38%) and 43 were malignant (61%). Both the benign and the malignant lesions had an average size at mammography of 1.1 cm. The nuclear grade was low in 21 (49%), moderate in 16 (37%), and high in six (14%) of the malignant lesions. There were axillary lymph node metastases in four samples (9%). CONCLUSION: Although lesions with atypical aspirates usually are benign, to achieve a low prevalence of false-negative diagnoses atypia must be interpreted as potential malignancy
— id: 6939, year: 1996, vol: 198, page: 319, stat: Journal Article,

Stereotactic fine-needle aspiration biopsy for the evaluation of nonpalpable breast lesions: report of an experience based on 2,988 cases
Mitnick JS; Vazquez MF; Pressman PI; Harris MN; Roses DF
1996 Mar;3(2):185-191, Annals of surgical oncology
BACKGROUND: The increasing use of mammography has led to a significant increase in the detection of clinically occult lesions, the majority of which prove to be benign. SFNB has been suggested as a means of expediting a diagnosis for lesions that are malignant while limiting surgical biopsies for those that are benign. METHODS: Clinically occult mammographic lesions were assessed by SFNB in 2,988 patients. Definitive histologic diagnoses were made on surgical specimens in all instances in which the cytologic diagnosis was malignant, suspicious, or atypical. Patients with benign cytology were either followed with interval mammograms or underwent surgical biopsy. RESULTS: Two hundred ninety-one of the 295 lesions (99%) diagnosed as cancer via SFNB were confirmed by histopathology. Twenty-two of the 22 lesions (100%) that were diagnosed as suspicious were diagnosed on histopathology as malignant. Forty-three of the 70 lesions (61%) with cytologic atypia were diagnosed on histopathology to be malignant. CONCLUSIONS: SFNB is an accurate means of diagnosing carcinoma, but must be followed by surgical biopsy when the cytology shows atypia. For lesions diagnosed as benign by SFNB, close interval mammography is essential
— id: 56884, year: 1996, vol: 3, page: 185, stat: Journal Article,

Morphological and biological characteristics of mammogram-detected invasive breast cancer
Moezzi M; Melamed J; Vamvakas E; Inghirami G; Mitnick J; Quish A; Bose S; Zelman G; Roses D; Harris M; Feiner H
1996 Sep;27(9):944-948, Human pathology
Thirty-nine mammographically detected, (M-detected) small invasive carcinomas of the breast (< or = 5 mm) were compared with 78 consecutive clinical cancers (> or = 10 mm) for a variety of morphological and biological markers of prognostic importance. There were more tubular carcinomas in the M-detected group (12.8% v 3.8%), but this did not reach statistical significance. Incidences of other histological types were similar. The types of associated in situ component were similar in the two groups. M-detected cancers were of lower overall grade (P < .001), lower architectural and nuclear grades (P = .0164 and P < .0001 respectively), and had fewer mitotic cells (P < .0001). None showed positive lymph nodes (P < .0001). Estrogen and progesterone receptor expression was similar in both groups. M-detected cancers expressed p53 nuclear protein less frequently than clinical cancers (P = .0398), had lower levels of microvessel density (P = .0001), and were more often diploid (P = .0131). S-phase of diploid tumors in the two groups was similar, but S-phase of aneuploid tumors was lower in the M-detected group (P = .0057). Ki67 expression was lower in M-detected cancers (P < .0001). In conclusion, M-detected small breast cancers, although invasive, represent an evolutionary phase of breast cancer that generally lacks morphological and biologic markers of aggressive behavior. The presence or absence of these markers, collectively, may explain the influence of tumor size on survival in patients with breast cancer
— id: 7020, year: 1996, vol: 27, page: 944, stat: Journal Article,

Theodore Kocher and thyroid surgery
Roses DF
1996 ;2:3-3, Traditions in surgery
— id: 25411, year: 1996, vol: 2, page: 3, stat: Journal Article,

Vaccination's bicentennial: a surgical landmark
Roses DF
1996 May;81(5):28-35, Bulletin of the American College of Surgeons
— id: 12031, year: 1996, vol: 81, page: 28, stat: Journal Article,

Induction of primary cutaneous melanocytic neoplasms in urokinase-type plasminogen activator (uPA)-deficient and wild-type mice: cellular blue nevi invade but do not progress to malignant melanoma in uPA-deficient animals
Shapiro RL; Duquette JG; Roses DF; Nunes I; Harris MN; Kamino H; Wilson EL; Rifkin DB
1996 Aug 1;56(15):3597-3604, Cancer research
Evidence suggests that the plasminogen activators (PAs), in particular urokinase-type PA (uPA), play a pivotal role in tumor invasion and metastasis. We studied the contribution of the PAs to the malignant phenotype through the chemical induction of melanocytic neoplasms in uPA-deficient mice. Primary tumors were induced and promoted concurrently in 35 uPA-/- deficient and 35 uPA+/+ wild-type mice using a single application of 7,12-dimethylbenz(a)anthracene followed by repetitive applications of croton oil. Animals were sacrificed at 60-day intervals for 1 year. At necropsy, the four largest pigmented lesions in each animal were excised, characterized histologically, and evaluated microscopically for evidence of invasion. The regional lymph nodes, lungs, and solid abdominal visceral organs were sectioned and examined microscopically for evidence of metastatic disease. Cellular blue nevi were induced in 100% of uPA-/- and uPA+/+ promoted animals. Although a reduction in the radial and vertical progression of these lesions was noted in the uPA-deficient mice compared with the wild-type group, more than 95% of cellular blue nevi induced in both groups of animals invaded the underlying tissues. These lesions did not metastasize to the regional lymph nodes. Malignant melanoma arose in 5 of 35 (14.3%) of promoted wild-type mice. These tumors were locally aggressive, produced tissue-type PA, but were not metastatic to the regional nodes, lungs, or abdominal viscera. These results indicate that the invasive capability of melanocytic lesions may depend more on tissue-type PA than uPA activity. No melanomas were induced in the uPA-/- mice. The resistance of the uPA -/- strain to melanoma induction suggests that uPA contributes to malignant progression. We propose that the absence of uPA negatively affects tumorigenesis by decreasing the liberation and availability of growth factors such as basic fibroblast growth factor
— id: 12575, year: 1996, vol: 56, page: 3597, stat: Journal Article,

Management considerations for melanonychia striata and melanoma of the hand
Glat PM; Shapiro RL; Roses DF; Harris MN; Grossman JA
1995 May;11(2):183-189, Hand clinics
This article discusses the diagnosis and management of pigmented lesions of the hand, especially the nail bed
— id: 25113, year: 1995, vol: 11, page: 183, stat: Journal Article,

Malignant melanoma. Primary surgical management (excision and node dissection) based on pathology and staging [see comments] [published erratum appears in Cancer 1995 Apr 1;75(7):1727]
Harris MN; Shapiro RL; Roses DF
1995 Jan 15;75(2 Suppl):715-725, Cancer
The diagnosis of malignant melanoma is based on clinical grounds and a properly performed biopsy, preferably excision, so that the type of melanoma and the thickness can be assessed by methods described by Clark and Breslow. These facilitate clinical and pathologic staging. Excisions with conservative margins for thin lesions (less than 1.0 mm in thickness) and more extensive margins for thicker lesions are appropriate. The issue of elective lymph node dissection is controversial. Most authors agree it is not indicated for lesions less than 1.0 mm thick and may offer little advantage for lesions greater than 4.0 mm thick. Several retrospective studies show a survival advantage in patients with 'intermediate' thickness melanomas who may have occult nodal metastases. However, there are prospective randomized clinical trials supporting the concept that positive lymph nodes are a manifestations of systemic disease, and survival is equivalent in patients who have subsequent therapeutic lymph node dissections. A procedure using intraoperative lymphatic mapping and selective lymphadenectomy may identify those patients who are likely to benefit from lymphadenectomy
— id: 12814, year: 1995, vol: 75, page: 715, stat: Journal Article,

Improved survival of patients with melanoma with an antibody response to immunization to a polyvalent melanoma vaccine
Miller K; Abeles G; Oratz R; Zeleniuch-Jacquotte A; Cui J; Roses DF; Harris MN; Bystryn JC
1995 Jan 15;75(2):495-502, Cancer
BACKGROUND. Melanoma vaccine treatment appears to slow the progression of melanoma in some patients, particularly in patients in whom it stimulates cellular antimelanoma immune responses. The relationship of vaccine-induced antibody responses to clinical outcome is less clear. The purpose of this study was to investigate the clinical relevance of antibody responses to melanoma vaccine immunization. METHODS. Eighty-two evaluable patients with surgically resected American Joint Committee on Cancer Stage III malignant melanoma were immunized to a partially purified, polyvalent, melanoma antigen vaccine. Antimelanoma antibodies were measured by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis before vaccine treatment and 1 week after the fourth immunization. RESULTS. Vaccine treatment induced or augmented antibody responses to melanoma in 32 (39%) of the patients. The antibodies were directed to one or more antigens of 38-43, 75, 110, 150 and/or 210 kDs, which previously have been shown to be expressed preferentially in cultured human melanoma cells. The median disease free survival of patients with a vaccine-induced antibody response to one or more of these antigens was 5.4 years compared with 1.4 years for nonresponders (P = 0.06), and 5-year overall survival was 71% compared with 44%, respectively (P = < 0.01). As determined by Cox multivariate analysis, the difference in overall survival was independent of disease severity or of immunologic competence as evaluated by ability to be sensitized to dinitrochlorobenzene. The difference in survival between antibody responders and nonresponders improved with time. CONCLUSIONS. The antibody response to vaccine treatment is an immune marker of vaccine activity that appears to be predictive of a later reduction in the recurrence of melanoma and is unrelated to the vaccine's ability to induce cellular immune responses. This finding suggests that vaccine treatment may be effective in slowing the progression of melanoma in some patients and that the protective effect is mediated partly by vaccine-induced antimelanoma antibodies
— id: 12813, year: 1995, vol: 75, page: 495, stat: Journal Article,

Malpractice litigation involving patients with carcinoma of the breast [see comments]
Mitnick JS; Vazquez MF; Kronovet SZ; Roses DF
1995 Oct;181(4):315-321, Journal of the American College of Surgeons
BACKGROUND: We sought to evaluate recent trends in the United States of America regarding malpractice awards for patients with carcinoma of the breast. STUDY DESIGN: A retrospective review was performed of 118 cases of purported malpractice in the diagnosis and management of patients with carcinoma of the breast and related problems. The information was tabulated from Westlaw Transmission, a computerized database. RESULTS: Gynecologists were the specialists most often sued and accounted for 47 percent of the physicians involved in lawsuits. Radiologists were cited in only 13 percent of the cases. Health maintenance organizations (HMOs) were cited in 5 percent of the cases. The most common complaint was delay in diagnosis, made by a plaintiff who detected her own breast mass (52 percent). In 15 percent of the cases, the plaintiffs complained that a mammogram was not obtained, and 9 percent complained that other diagnostic tests, such as ultrasound or fine-needle aspiration biopsy, were not performed. The average delay in diagnosis was 14 months. The average award to plaintiffs with carcinoma of the breast was $691,449. The average plaintiff's age was 44 years. CONCLUSIONS: Most malpractice complaints related to carcinoma of the breast are instituted by women under the age of 50 years who identified the breast mass by themselves and were assumed by their physicians to have fibrocystic disease of the breast. Complaints can be expected to increase regarding failure to order further diagnostic tests, such as ultrasound or fine-needle aspiration biopsy, despite a negative mammogram. Complaints against HMOs are now also being made, citing failure to properly diagnose or treat patients with carcinoma of the breast
— id: 7019, year: 1995, vol: 181, page: 315, stat: Journal Article,

Alpha-interferon and cis-retinoic acid in the treatment of metastatic malignant melanoma
Oratz R; Roses D; Harris M
1995 ;14:A1313-A1313, Proceedings (American Society of Clinical Oncology)
Alpha interferon (IFN) has single agent activity in the treatment of metastatic malignant melanoma. Preclinical data suggests that cis-retinoic acid (cRA) may potentiate the activity of IFN. Clinical trials of this combination in the treatment of squamous cell carcinoma report higher response rates than that expected for IFN alone. We tested the activity of the combination of IFN and cRA in patients (pts) with metastatic malignant melanoma. 13 pts were treated with IFN 5 x 10 (6) units/m2 tiw and cRA 100 mg/kg/day. 11 pts were previously treated with chemotherapy; 2 had no prior treatment. Sites of metastases include: lung (9), liver (4), soft tissue (7), adrenals (2) nodes (2). 1 PR was seen in lung and adrenal mets (for 6 mo), 2 pts had stabilization of pulmonary mets for 2 mo. All other pts had progressive disease within 8 wk of beginning treatment. Toxicity was substantial. All pts experienced ECOG Grade 1-2 fatigue, myalgias, anorexia, stomatitis and cheilitis. Serum cholesterol and triglycerides became elevated in all pts. Dose reductions included: 1 pt 50% IFN for fatigue, 1 pt 50% cRA for stomatitis, 3 pts 50% cRA for hypertriglyceridemia. 1 pt discontinued therapy for decline in PS to ECOG Level 3. The mean duration of treatment was 8.8 wk; range (3 -28 wk). The combination of cRA and IFN in this study did not demonstrate any improvement over the single agent activity of IFN. (C) American Society of Clinical Oncology 1997
— id: 6022, year: 1995, vol: 14, page: A1313, stat: Journal Article,

Harvey Cushing and hemostasis
Roses DF
1995 ;2:1-1, Traditions in surgery
— id: 25409, year: 1995, vol: 2, page: 1, stat: Journal Article,

John H. Gibbon Jr and the heart-lung machine
Roses DF
1995 ;2:2-2, Traditions in surgery
— id: 25410, year: 1995, vol: 2, page: 2, stat: Journal Article,

Diagnosis of metastatic melanoma to the breast by aspiration biopsy
Vazquez MF; Mitnick JS; Roses DF
1995 ;8(4):387-390, Breast disease
Three needle aspiration biopsies were performed in three patients with unsuspected metastatic malignant melanoma to the breast. Each patient presented with well-circumscribed, dense nodules on the mammogram and two had ultrasound examinations that proved that the nodules were solid. Fine-needle aspiration biopsy showed metastatic malignant melanoma in each case
— id: 25182, year: 1995, vol: 8, page: 387, stat: Journal Article,

Induction of cytolytic antibodies to melanoma by immunization to a polyvalent melanoma antigen vaccine
Cui J; Chen D; Oratz R; Zeleniuch-Jacquotte A; Harris M; Roses D; Bystryn J-C
1994 ;3(4):175-182, Vaccine research
This study was conducted to examine whether immunization to a melanoma vaccine can induce antibodies that are functionally effective in killing melanoma cells. A group of 79 evaluable patients with surgically resected AJCC stage III melanoma were immunized every 3 weeks to a polyvalent melanoma antigen vaccine (40 mug/immunization). Cytolytic antibodies to melanoma cells, assayed by europium-based complement-dependent cytolysis before vaccine treatment and 1 week following the fourth immunization, were detected in 7 patients (9%) before vaccine treatment but in none of 17 control individuals. Vaccine treatment induced or increased the level of these antibodies in 37 patients (47%; p = 0.0001). Vaccine-induced cytolytic antibodies were predominantly directed to melanoma cells. There was no correlation between the induction of these antibodies and improved clinical outcome. These results indicate that melanoma vaccine treatment can induce antibodies that have the functional ability to kill melanoma cells in vitro but suggest that the induction of such cytolytic antibodies is not associated with a delay in the progression of melanoma
— id: 25185, year: 1994, vol: 3, page: 175, stat: Journal Article,

Use of artificial intelligence to analyze clinical database reduces workload on surgical house staff
Grossi EA; Steinberg BM; LeBoutillier M 3rd; Coppa GF; Roses DF
1994 Aug;116(2):250-253, Surgery
BACKGROUND. The current quantity and diversity of hospital clinical, laboratory, and pharmacy records have resulted in a glut of information, which can be overwhelming to house staff. This study was performed to measure the impact of artificial intelligence analysis of such data on the junior surgical house staff's workload, time for direct patient care, and quality of life. METHODS. A personal computer was interfaced with the hospital computerized patient data system. Artificial intelligence algorithms were applied to retrieve and condense laboratory values, microbiology reports, and medication orders. Unusual laboratory tests were reported without artificial intelligence filtering. RESULTS. A survey of 23 junior house staff showed a requirement for a total of 30.75 man-hours per day, an average of 184.5 minutes per service twice a day for five surgical services each with an average of 40.7 patients, to manually produce a report in contrast to a total of 3.4 man-hours, an average of 20.5 minutes on the same basis (88.9% reduction, p < 0.001), to computer generate and distribute a similarly useful report. Two thirds of the residents reported an increased ability to perform patient care. CONCLUSIONS. Current medical practice has created an explosion of information, which is a burden for surgical house staff. Artificial intelligence preprocessing of the hospital database information focuses attention, eliminates superfluous data, and significantly reduces surgical house staff clerical work, allowing more time for education, research, and patient care
— id: 12926, year: 1994, vol: 116, page: 250, stat: Journal Article,

Management of melanoma [Symposium]
Kaleya RN; Coit D; Reintgen DS; Roses DF; Wanebo HM
1994 ;44:241-254, Contemporary surgery
— id: 25215, year: 1994, vol: 44, page: 241, stat: Journal Article,

Lobular carcinoma of the male breast
Michaels BM; Nunn CR; Roses DF
1994 Mar;115(3):402-405, Surgery
BACKGROUND. A case of lobular carcinoma in a male breast is described. Lobular carcinoma is a very uncommon histopathologic form of male breast cancer because of the absence of lobules in the normal male breast. The cytoarchitecture of the normal male breast can be deranged in conditions such as Klinefelter's syndrome or as a result of estrogen exposure. Lobular carcinoma of the male breast has been described in such instances where cytoarchitectural changes are likely to have occurred. METHODS AND RESULTS. After the pathologic diagnosis was made, a fibroblast karyotype was performed to confirm a male genotype. The patient had received no hormonal therapy. The English language literature was reviewed. CONCLUSIONS. This case represents the first report of lobular carcinoma in a proven genotypic male patient receiving no exogenous estrogens
— id: 12992, year: 1994, vol: 115, page: 402, stat: Journal Article,

Alfred Blalock and the problem of shock
Roses DF
1994 ;1:1-1, Traditions in surgery
— id: 25406, year: 1994, vol: 1, page: 1, stat: Journal Article,

Joseph Lister and antiseptic surgery
Roses DF
1994 ;7:299-299, Traditions in surgery
— id: 25408, year: 1994, vol: 7, page: 299, stat: Journal Article,

William Steward Halsted and the radical mastectomy
Roses DF
1994 ;1:2-2, Traditions in surgery
— id: 25407, year: 1994, vol: 1, page: 2, stat: Journal Article,

Radial scar: Cytologic evaluation by stereotactic aspiration
Vazquez MF; Mitnick JS; Pressman P; Harris MN; Roses DF
1994 ;7(4):299-306, Breast disease
Radial scars are characterized by an irregular stellate pattern of mammary dysplasia frequently detected by mammography in the absence of a palpable mass. We reviewed 300 consecutive nonpalpable stellate lesions of the breast aspirated stereotactically in patients without prior surgery, and 14 were radial scars (14/300, 5%). Six radial scars showed malignant cells focally (6/14, 43%); three showed one focus each of ductal carcinoma in situ (DCIS); two showed foci of lobular carcinoma in situ; and one showed a tubular carcinoma. Eight cases were radial scars without adenocarcinoma, although three showed atypical hyperplasia. In two instances, DCIS was identified in tissue separate from the radial scar. These findings support the hypothesis that a radial scar is a form of mammary dysplasia with a tendency toward high-grade atypia, and when it is present, a radial scar may be premalignant
— id: 25183, year: 1994, vol: 7, page: 299, stat: Journal Article,

Stereotactic aspiration biopsy of nonpalpable nodules of the breast
Vazquez MF; Mitnick JS; Pressman P; Harris MN; Roses DF
1994 Jan;178(1):17-23, Journal of the American College of Surgeons
To evaluate the reliability of stereotactic aspiration biopsy (SAB) in assessing which nonpalpable nodules of the breast should be excised, SAB was performed upon 373 nodules. The nodules were classified as well-circumscribed or irregular and evaluated for the presence of microcalcifications. The cytologic diagnoses were classified as malignant, atypical or benign. Cytologically malignant and atypical nodules were excised. Benign nodules were excised if there was a family or past history of carcinoma of the breast or if they changed mammographically. Twenty-five nodules proved to be malignant. Of these, the diagnoses by stereotactic aspiration biopsy were adenocarcinoma in 20 patients, atypical in three, malignant hemangiopericytoma in one patient and benign in one. The borders of the malignant nodules were well-defined in eight patients and irregular in 17. Three malignant nodules with irregular borders had clustered microcalcifications. One false-positive instance was a sclerosing papilloma with atypical hyperplasia. Twenty-four nodules with benign cytologic diagnoses, which were excised, proved to be benign. An additional 132 nodules with benign cytologic diagnoses had six month interval mammograms for two years; 131 were without interval change and one increased in size and proved to be a carcinoma. SAB is reliable for diagnosing nonpalpable nodules. Nodules with malignant and atypical results must be excised. It is reasonable to have follow-up evaluation of well-defined nodules mammographically when the aspirate is benign
— id: 6546, year: 1994, vol: 178, page: 17, stat: Journal Article,

Improved survival of melanoma patients with antibody responses to a polyvalent melanoma vaccine
Bystryn JC; Miller K; Abeles G; Oratz R; Roses D; Harris M
1993 ;3:51-51, Melanoma research
To investigate the clinical relevance of antimelanoma antibody responses induced by melanoma vaccine immunization, we studied prospectively 81 patients with resected AJCC stage III malignant melanoma who were immunized to a partially purified, polyvalent, melanoma antigen vaccine. Antibody responses to melanoma surface antigens were measured by immunoprecipitation SDS-PAGE analysis prior to treatment and one week after the 4th immunization. Vaccine treatment induced or augmented melanoma antibodies in 33 (41%) patients. The responses were directed to one or more antigens of approximately 210, 150, 110, 75, and/or 38-43 kD. The median disease-free survival of patients with any antibody response was 47 months vs 19 months for nonresponders and median overall survival was 62 months vs 46 months. The proportion of patients that was disease-free at 4 years increased by 57% (from 33% to 52%) and overall survival by 64% (from 50% to 80%) in responders vs nonresponders. These differences in outcome were unrelated to disease severity or overall immunological competence (evaluated by response to recall antigens and ability to be sensitized to DNCB), suggesting they resulted from vaccine treatment. Thus, the antibody response to vaccine treatment is an immune marker of vaccine activity that appears to be predictive of a later reduction in the recurrence of melanoma. This finding suggests that vaccine treatment effectively slows the progression of melanoma in some patients, and that the protective effect is mediated in part by vaccine induced antimelanoma antibodies
— id: 6018, year: 1993, vol: 3, page: 51, stat: Journal Article,

Melanoma vaccines
Bystryn JC; Shapiro RL; Roses DF; Ortaz R
1993 ;1:301-301, Hem/onc annals: the journal of continuing education in hematology & oncology
— id: 25200, year: 1993, vol: 1, page: 301, stat: Journal Article,

Localization of nonpalpable masses in patients with breast implants
Mitnick JS; Vazquez MF; Colen SR; Plesser K; Roses DF
1993 Sep;31(3):238-240, Annals of plastic surgery
Nonpalpable nodules in patients with breast implants may represent silicone granulomas, fibrocystic mastopathy, or cancer. We describe a modified technique for needle localization which facilitates the surgical excision of these nodules while minimizing the possibility of rupture
— id: 56564, year: 1993, vol: 31, page: 238, stat: Journal Article,

Fine needle aspiration biopsy in patients with augmentation prostheses and a palpable mass
Mitnick JS; Vazquez MF; Plesser K; Pressman P; Harris MN; Roses DF
1993 Sep;31(3):241-244, Annals of plastic surgery
Six patients with augmentation prostheses presented with a firm, painless, breast mass that could not be visualized by mammography. One lesion was demonstrated to be solid by ultrasound, and the remaining sonograms were nondiagnostic. The lesions were indistinguishable from carcinoma, by physical examination. All of the patients had fine needle aspiration biopsy despite close proximity to the implant. The patients all had silicone granulomas related to silicone leakage. Our experience suggests that fine needle aspiration biopsy is a useful technique to evaluate palpable breast masses that are not visualized by mammography in patients with augmentation prostheses
— id: 56563, year: 1993, vol: 31, page: 241, stat: Journal Article,

Distinction between postsurgical changes and carcinoma by means of stereotaxic fine-needle aspiration biopsy after reduction mammaplasty
Mitnick JS; Vazquez MF; Plesser KP; Pressman PI; Harris MN; Colen SR; Roses DF
1993 Aug;188(2):457-462, Radiology
Stereotaxic fine-needle aspiration biopsy (SFNAB) was performed to evaluate suspicious mammographic findings (31 stellate lesions, 20 regions of grouped calcifications, two nodules, and one area of prominent trabecular markings) in 54 patients who had undergone reduction mammaplasty. SFNAB findings were correlated with findings in histologic specimens whenever possible; the cytologic samples were classified as malignant, atypical, or benign. In 22 lesions, the abnormalities on mammograms were considered highly suspicious for malignancy. In the 32 others, the degree of suspicion was lower, but these lesions had a change in appearance since acquisition of the first postoperative mammogram. SFNAB enabled diagnosis of adenocarcinoma in five women. Patients who have undergone mastectomy with reconstruction of one breast and mammaplasty in the other are at higher risk for development of contralateral breast cancer, as are all patients who have had such cancer. SFNAB is reliable for evaluation of suspicious mammographic abnormalities that develop after mammaplasty and findings that change after acquisition of the first postoperative mammogram
— id: 6460, year: 1993, vol: 188, page: 457, stat: Journal Article,

Breast cancer malpractice litigation in New York State
Mitnick JS; Vazquez MF; Plesser KP; Roses DF
1993 Dec;189(3):673-676, Radiology
PURPOSE: To identify causes of purported malpractice in diagnosis and treatment of breast cancer. MATERIALS AND METHODS: The authors reviewed cases from The New York Jury Verdict Reporter listed between 1985 and 1991 to look for those in which there was alleged delay in diagnosis or treatment of breast cancer. RESULTS: Of 34 cases identified, 32 (94%) were based on presumed delay in diagnosis and only two (6%) on claims of therapeutic malpractice. Delay in diagnosis was commonly claimed in patients younger than 50 years (76%). Palpable masses were present in 94% of these cases. Either mammograms were not obtained (16 cases, 50%) or findings were interpreted as normal or as fibrocystic disease (12 cases, 38%). Specialists most frequently cited were gynecologists (16 of 39,41%). Highest awards (> or = $1 million) were more commonly given to patients younger than 50 years with proved distant or nodal metastasis (six of 34, 18%). CONCLUSION: Emphasis on early diagnosis has led to the perception that purported delay in diagnosis, however short, even in the presence of a palpable mass, changes the chances for survival
— id: 6459, year: 1993, vol: 189, page: 673, stat: Journal Article,

Stereotaxic aspiration biopsy of the breast
Mitnick JS; Vazquez MF; Roses DF; Harris MN; Waisman J
1993 Dec;189(3):924-925, Radiology
— id: 25104, year: 1993, vol: 189, page: 924, stat: Journal Article,

Management of matastatic melanoma
Roses DF
1993 ;4:70-70, Perspectives in general & laparoscopic surgery
— id: 25198, year: 1993, vol: 4, page: 70, stat: Journal Article,

Surgical management of cutaneous malignant melanoma
Roses DF; Harris MN; Shapiro RL
1993 ;1:263-263, Hem/onc annals: the journal of continuing education in hematology & oncology
— id: 25199, year: 1993, vol: 1, page: 263, stat: Journal Article,

Relationship between immune response to melanoma vaccine immunization and clinical outcome in stage II malignant melanoma
Bystryn JC; Oratz R; Roses D; Harris M; Henn M; Lew R
1992 Mar 1;69(5):1157-1164, Cancer
The authors investigated whether there was a relationship between the induction of a delayed-type hypersensitivity (DTH) response to melanoma vaccine immunization and disease recurrence. They studied prospectively 94 evaluable patients with surgically resected Stage II malignant melanoma who were immunized to a partially purified, polyvalent, melanoma antigen vaccine. The DTH response to skin tests to the vaccine was measured before treatment and at the fourth vaccine immunization. Vaccine treatment induced a strong DTH response in 29 (31%) patients, an intermediate response in 24 (25%), and no response in 41 (44%). The median disease-free survival (DFS) of patients with a strong, intermediate, and no DTH response to vaccine immunization was more than 72 months, 24 months, and 15 months, respectively. The relationship between an increase in the DTH response and a prolonged DFS was statistically significant (P = 0.02); clinically meaningful (the median DFS of patients with a strong DTH response was 4.7 years longer than that of nonresponders); and, by multivariate analysis, independent of disease severity or overall immune competence. These findings suggest, but do not prove, that vaccine treatment can slow the progression of melanoma in some patients
— id: 57484, year: 1992, vol: 69, page: 1157, stat: Journal Article,

Stereotactic localization for fine needle aspiration biopsy in patients with augmentation prostheses
Mitnick JS; Vazquez MF; Roses DF; Harris MN; Colen SR; Colen HS
1992 Jul;29(1):31-35, Annals of plastic surgery
Fifteen patients with augmentation mammoplasties had mammography demonstrating nonpalpable breast lesions. Of the 15 patients, three (20%) had adenocarcinoma confirmed by open biopsy and histopathology. All patients underwent stereotactic localization for fine needle aspiration biopsy. Four of the 15 patients had benign cysts (26%). None of the cysts could be diagnosed by ultrasound. The remaining eight patients had mammary dysplasia of a proliferative or nonproliferative type of fibroadenoma. These benign entities were followed with interval mammography demonstrating no change. The data suggest that fine needle aspiration biopsy is an effective technique to assess nonpalpable breast lesions in patients who have had augmentation mammoplasties
— id: 13553, year: 1992, vol: 29, page: 31, stat: Journal Article,

Recurrent breast cancer: stereotaxic localization for fine-needle aspiration biopsy. Work in progress
Mitnick JS; Vazquez MF; Roses DF; Harris MN; Schechter S
1992 Jan;182(1):103-106, Radiology
The efficacy of stereotaxic localization for fine-needle aspiration biopsy in the detection of recurrent cancer manifested as calcifications on mammograms was evaluated in 43 patients that had been treated with local resection and radiation therapy. Six patients had malignant aspirates and one had an atypical aspirate; examination of the surgical specimens revealed all seven of these to be malignant. Thirteen patients underwent surgical biopsies, the results of which were malignant in seven and benign in six. The remaining 30 patients were followed up with mammography. The follow-up mammograms were obtained at 6-month intervals and demonstrated no change in appearance. On the basis of this initial experience, stereotaxic localization for aspiration biopsy offers the potential to accurately distinguish benign from malignant lesions
— id: 13731, year: 1992, vol: 182, page: 103, stat: Journal Article,

From Hunter and the Great Pox to Jenner and smallpox
Roses DF
1992 Oct;175(4):365-372, Surgery, gynecology & obstetrics
— id: 13413, year: 1992, vol: 175, page: 365, stat: Journal Article,

Leviathan of surgical innovation
Roses DF
1992 ;48:34-34, NYU physician
— id: 25203, year: 1992, vol: 48, page: 34, stat: Journal Article,

IMPROVED SURVIVAL OF MELANOMA PATIENTS WITH DELAYED-TYPE HYPERSENSITIVITY RESPONSE TO MELANOMA VACCINE IMMUNIZATION
BYSTRYN, JC; ORATZ, R; ROSES, DF; HARRIS, MN; HENN, M; LEW, R
1991 APR ;39(2):A503-A503, Clinical research
— id: 51624, year: 1991, vol: 39, page: A503, stat: Journal Article,

IMPROVED SURVIVAL OF MELANOMA PATIENTS WITH DELAYED-TYPE HYPERSENSITIVITY RESPONSE TO MELANOMA VACCINE IMMUNIZATION
BYSTRYN, JC; ORATZ, R; ROSES, DF; HARRIS, MN; HENN, M; LEW, R
1991 APR ;96(4):549-549, Journal of investigative dermatology
— id: 51638, year: 1991, vol: 96, page: 549, stat: Journal Article,

Flow cytometric analysis of DNA ploidy and S-phase fraction in breast cancer using cells obtained by ex vivo fine-needle aspiration: an optimal method for sample collection
Eliasen CA; Opitz LM; Vamvakas EC; Espiritu EC; Marsh ER; Roses DF; Harris MN; Feiner HD
1991 Mar;4(2):196-200, Modern pathology
A total of 203 primary invasive breast cancers were sampled by ex vivo fine-needle aspiration (FNA), directly yielding adequate single cell suspensions for flow cytometric DNA analysis in 194 (96%). Labor-intensive and time-consuming steps of mechanical and enzymatic cellular disaggregation required by the use of fresh, frozen, or paraffin-embedded tissue were avoided, thereby minimizing preparation time. Conservation of tumor tissue allowed for the sampling of very small breast cancers. DNA ploidy and S-phase fraction data were comparable to flow cytometric data reported in other breast cancer studies using various sampling methods. Ex vivo FNA is the easiest and fastest method for sampling breast cancers for flow cytometric DNA analysis
— id: 14101, year: 1991, vol: 4, page: 196, 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: treatment
Harris MN; Roses DF
Cancer of the skin Philadelphia : Saunders, 1991,
— id: 2714, year: 1991, vol: , page: 177, stat: Chapter,

Stereotaxic localization for fine-needle aspiration breast biopsy. Initial experience with 300 patients
Mitnick JS; Vazquez MF; Roses DF; Harris MN; Gianutsos R; Waisman J
1991 Sep;126(9):1137-1140, Archives of Surgery (Chicago)
The efficacy of stereotaxic aspiration biopsy was evaluated in 300 consecutive patients with nonpalpable mammographic lesions. Sixty-eight patients (23%) had suspicious or malignant aspirates; all cases were proved malignant by subsequent examination of operative specimens. Two hundred sixteen patients (72%) had benign aspirates. Of these, 65 were confirmed by operation and 151 had subsequent mammography at 6- and 12-month intervals with no demonstrable mammographic change. In 10 instances (3%), the aspirates were atypical, and in six (2%), nondiagnostic. Biopsy specimens were obtained in all 16 instances, and eight were malignant. The sensitivity of stereotaxic breast aspiration for the diagnosis of cancer was 96%, and the specificity was 100%. Our experience confirms the efficacy of stereotaxic aspiration for the initial evaluation of mammographically detected, nonpalpable lesions
— id: 25105, year: 1991, vol: 126, page: 1137, stat: Journal Article,

Acute interval breast cancer case report and review of the literature
Morros JS; Mitnick J; Roses DF
1991 ;39(4):77-80, Contemporary surgery
Interval breast cancers are defined as those that arise within 12 months of normal routine screening by physical examination and mammography. The term 'acute breast cancer' has been used to identify a subset of interval breast cancers that not only arise after recent normal screening but also show early metastases or evidence of metastatic potential. Acute breast cancers currently elude attempts at early breast cancer detection and can undermine a patient-physician relationship when the patient discovers such a neoplasm shortly after routine screening
— id: 25184, year: 1991, vol: 39, page: 77, stat: Journal Article,

Lack of effect of cyclophosphamide on the immunogenicity of a melanoma antigen vaccine
Oratz R; Dugan M; Roses DF; Harris MN; Speyer JL; Hochster H; Weissman J; Henn M; Bystryn JC
1991 Jul 15;51(14):3643-3647, Cancer research
Melanoma antigen vaccines are a conceptually attractive approach to prevent or delay disease recurrence in patients with surgically resected malignant melanoma. However, the immunogenicity of current vaccines is relatively low. Cyclophosphamide, when given in low doses prior to antigen exposure, is an immunomodulator which has been shown to enhance both humoral and cellular antitumor responses in animals and humans. We conducted a prospective, randomized, clinical trial to study whether pretreatment with cyclophosphamide augments the immunogenicity of a polyvalent, allogeneic, melanoma antigen vaccine in patients with melanoma and low tumor burden. Forty-five patients with resected stage II melanoma (regional metastases) were randomly allocated to treatment with melanoma vaccine or melanoma vaccine plus cyclophosphamide. All patients received the same dose and schedule of vaccine immunizations; those randomized to cyclophosphamide received 300 mg/m2 i.v. 3 days prior to each vaccine immunization. Cellular immune responses were evaluated by delayed-type hypersensitivity (DTH) skin reactivity to a test dose of vaccine at baseline (prior to treatment) and following the fourth immunization. Humoral immune responses were measured by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiographic analysis of indirect immunoprecipitates of patients' sera at the same time points. Twenty-four patients were randomized to cyclophosphamide pretreatment and 21 to vaccine alone; 22 and 18 patients were evaluable in each group, respectively. Differences were statistically nonsignificant with respect to either cellular (DTH) or humoral (antibody) responses between the two groups. DTH responses were induced in 16 of 22 (73%) and 15 of 18 (83%) patients treated with cyclophosphamide plus vaccine and vaccine alone, respectively. The mean posttreatment augmentation in DTH response in the cyclophosphamide group was 9.5 mm, compared with 9.9 mm in the vaccine-only group. Eight of 12 (66%) cyclophosphamide-pretreated patients and 9 of 12 (75%) vaccine-only patients produced increased titers of antimelanoma antibodies following treatment. No differences were observed between the groups in disease-free or overall survival. In summary, low-dose cyclophosphamide pretreatment failed to augment the immunogenicity of a polyvalent, allogeneic, melanoma vaccine in patients with completely resected early-stage melanoma
— id: 13964, year: 1991, vol: 51, page: 3643, stat: Journal Article,

Stephen Smith. Pioneer of American surgery and public health
Roses DF
1991 Dec;76(12):10-17, Bulletin of the American College of Surgeons
— id: 12032, year: 1991, vol: 76, page: 10, stat: Journal Article,

Survival with regional and distant metastases from cutaneous malignant melanoma
Roses DF; Karp NS; Oratz R; Dubin N; Harris MN; Speyer J; Boyd A; Golomb FM; Ransohoff J; Dugan M; et al.
1991 Apr;172(4):262-268, Surgery, gynecology & obstetrics
The clinical course of 312 consecutive patients after initial presentation with metastatic melanoma, 165 of whom presented with regional metastases at cutaneous or subcutaneous, or both, nodal sites and 147 with metastases at distant sites, was reviewed. The five year survival rate for regional metastases was 43.4 per cent compared with a five year survival rate for distant metastases of 4.9 per cent (p less than 0.0001). Favorable prognostic variables for survival from first regional metastases included primary melanoma sites on the extremities compared with the head, neck and trunk (p = 0.043) and a disease-free interval of more than one year from primary surgical treatment to regional metastases (p = 0.0058). Favorable prognostic variables for survival from the first distant metastasis included a disease-free interval of more than one year from primary surgical treatment to distant metastases (p = 0.0092), the type of resection of metastatic disease (p = 0.00027) and the addition of systemic immunotherapy (p = 0.0011). Forty-nine patients with totally resectable distant metastases had a five year survival rate from the treatment of the initial metastasis of 13.1 per cent, whereas 33 patients having palliative resections had a five year survival rate of 7.5 per cent. All 165 patients who did not have resection for distant metastases died within five years. The results of our experience support therapeutic efforts to ablate both regional and distant metastases of malignant melanoma when feasible
— id: 25129, year: 1991, vol: 172, page: 262, stat: Journal Article,

The risk of carcinoma in wire localization biopsies for mammographically detected clustered microcalcifications
Roses DF; Mitnick J; Harris MN; Kaplon R; Karp N; Vazquez M; Dubin N
1991 Nov;110(5):877-886, Surgery
A total of 183 consecutive patients undergoing biopsies for unilateral microcalcifications concentrated in one or more segments of the breast in the absence of any palpable findings were analyzed to characterize their risk of cancer. Biopsy findings were benign in 86 patients (47%) and malignant in 97 (53%). Of the clinical and mammographic characteristics evaluated, an increasing number of linear microcalcifications, either without a dominant density (p = 0.014) or with a dominant density (p = 0.019) and the presence of heterogeneous microcalcifications (p = 0.055), were associated with a significantly increased risk of malignancy. Conversely a fibronodular parenchymal pattern (p = 0.008) was associated with a significantly decreased risk of malignancy. A high-risk group was identified, 95% (40/42) of whom had malignant biopsy findings, whose mammograms had more than 10 linear microcalcifications not associated with a dominant density (16/17) or at least one linear microcalcification associated with a dominant density (24/25). Conversely a low-risk group for cancer was identified, 88% (28/32) of whom had benign biopsy findings, whose mammograms had exclusively punctate microcalcifications within a fibronodular parenchymal milieu (26/30) or demonstrated some change in the configuration of the microcalcifications on the various mammographic views (10/10). For the remaining 109 patients there was an almost equal division between malignant and benign diagnoses (49% vs 51%)
— id: 13864, year: 1991, vol: 110, page: 877, stat: Journal Article,

FINE NEEDLE ASPIRATION (FNA) OF PRIMARY BREAST-CARCINOMA FOR FLOW CYTOMETRIC (FCM) DNA ANALYSIS
Eliasen, C; Opitz, L; Rizk, C; Vamvakas, E; Kleinberg, D; Roses, D; Harris, M; Feiner, H
1990 ;62(Suppl 1):A30-A30, Laboratory investigation
— id: 32017, year: 1990, vol: 62, page: A30, stat: Journal Article,

Thoracotomy for metastatic malignant melanoma of the lung
Karp NS; Boyd A; DePan HJ; Harris MN; Roses DF
1990 Mar;107(3):256-261, Surgery
The outcome of 29 patients who underwent lung resection for treatment of metastatic malignant melanoma from January 1976 to November 1988 was studied. Twenty-two patients underwent total resection for cure of all apparent metastatic disease, whereas seven patients did not undergo total resection. Of the 22 patients who underwent curative resection, the median survival was 11 months, with a 2-year survival of 13.6% and a 5-year survival of 4.5%. Four patients who underwent curative resection are currently alive and free of disease, with one patient surviving more than 10 years. The patients who underwent palliative resection had a median survival of 5 months, only one patient living longer than 10 months. The difference in survival of the patients who underwent curative resection compared with palliative resection was statistically significant. The thickness of the primary cutaneous malignant melanoma, the presence of regional lymph node metastases, the disease-free interval from primary diagnosis to metastatic pulmonary disease, and whether one or two metastatic nodules were removed during curative lung resection were not statistically significant in altering survival. These results demonstrate that although prolonged survival for metastatic melanoma is rare, lung resection in selected patients may be associated with long-term survival
— id: 25130, year: 1990, vol: 107, page: 256, stat: Journal Article,

SUBCLASSIFICATION OF INTRADUCTAL CARCINOMA AS A GUIDE TO THERAPY
Koenig, C; Vazquez, M; Vohra, R; Roses, D
1990 ;62(Suppl 1):A53-A53, Laboratory investigation
— id: 32019, year: 1990, vol: 62, page: A53, stat: Journal Article,

Calcifications of the breast after reduction mammoplasty
Mitnick JS; Roses DF; Harris MN; Colen SR
1990 Nov;171(5):409-412, Surgery, gynecology & obstetrics
Mammograms of 152 patients after mammoplasty were studied and 37 patients were noted to have calcifications. The pattern of these calcifications was studied to determine if specific characteristics could be identified. The calcifications were found to occur within the skin of the breast, mainly at a periareolar location. The ability to identify these benign calcifications further aids in reliably monitoring patients by mammography after reduction mammoplasty
— id: 14291, year: 1990, vol: 171, page: 409, stat: Journal Article,

Invasive papillary carcinoma of the breast: mammographic appearance
Mitnick JS; Vazquez MF; Harris MN; Schechter S; Roses DF
1990 Dec;177(3):803-806, Radiology
The mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively. The mammograms of 10 patients showed a multinodular pattern, and seven patients had solitary nodules. One patient had an irregular, ill-defined mass in the retroareolar region. Two patients were found to have carcinoma in the contralateral breast, and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma. The varied mammographic features that may occur with this rare breast malignancy are discussed
— id: 14258, year: 1990, vol: 177, page: 803, stat: Journal Article,

Vaccine immunotherapy of human malignant melanoma
Bystryn JC; Dugan M; Oratz R; Speyer J; Harris MN; Roses DF
Human tumor antigens and specific tumor therapy New York : Liss, 1989,
— id: 2722, year: 1989, vol: , page: 307, stat: Chapter,

Mammographic detection of carcinoma of the breast in patients with augmentation prostheses
Mitnick JS; Harris MN; Roses DF
1989 Jan;168(1):30-32, Surgery, gynecology & obstetrics
Evaluation of 85 patients who had augmentation mammaplasty with low-dose mammography detected microcalcifications in two patients. Both patients had biopsies that confirmed a diagnosis of intraductal carcinoma. A third patient with microcalcifications and a positive family history for carcinoma of the breast was found to have sclerosing adenosis. A fibroadenoma was visualized by mammography in a group of ten patients who were referred for the presence of palpable nodules of the breast. The remainder of the nodules were found to be related to the augmentation procedure
— id: 10834, year: 1989, vol: 168, page: 30, stat: Journal Article,

Circumscribed intraductal carcinoma of the breast [see comments]
Mitnick JS; Roses DF; Harris MN; Feiner HD
1989 Feb;170(2):423-425, Radiology
In a retrospective evaluation of 350 cases of proved intraductal carcinoma detected over a 3-year period, 13 had mammographic features similar to those of benign tumors. The carcinomas were sharply circumscribed, round or oval lesions that contained microcalcifications. These calcifications were smaller and more likely to be asymmetrically located within the nodule than those of the fibroadenomas that they mimicked. While the carcinomas appeared circumscribed on mammograms, microinvasion of surrounding tissue was proved histologically in five of 13 cases, and in another case biopsy revealed metastasis to an axillary lymph node. Although these carcinomas are relatively rare, mammographic detection is important as none were palpable at the time of diagnosis
— id: 10739, year: 1989, vol: 170, page: 423, stat: Journal Article,

Differentiation of radial scar from scirrhous carcinoma of the breast: mammographic-pathologic correlation
Mitnick JS; Vazquez MF; Harris MN; Roses DF
1989 Dec;173(3):697-700, Radiology
Radial scar, a sclerosing ductal breast lesion characterized by an irregular stellate pattern of epithelial proliferation around a central fibroelastic core, may be confused histologically with scirrhous carcinoma of the breast. Mammographic features used to distinguish these two entities were found unreliable in a retrospective review of 255 consecutive stellate lesions. Of 73 nonpalpable carcinomas, fourteen (19%) had radiographic features of radial scar. Only the presence of microcalcifications in 11 of those patients helped the authors distinguish carcinoma from radial scars. Four of nine biopsy-proved radial scars had a dense central region, simulating the appearance of scirrhous carcinoma. Stellate lesions with radiolucent centers should be considered suggestive of carcinoma, particularly if associated with microcalcifications
— id: 10419, year: 1989, vol: 173, page: 697, stat: Journal Article,

CIRCUMSCRIBED INTRADUCTAL CARCINOMA OF THE BREAST - RESPOND
Mitnick, JS; Roses, DF; Harris, MN; Feiner, HD
1989 Aug;172(2):579-580, Radiology
— id: 31681, year: 1989, vol: 172, page: 579, stat: Journal Article,

Induction of tumor-infiltrating lymphocytes in human malignant melanoma metastases by immunization to melanoma antigen vaccine
Oratz R; Cockerell C; Speyer JL; Harris M; Roses D; Bystryn JC
1989 Aug;8(4):355-358, Journal of biological response modifiers
We report a statistically significant increase in tumor-infiltrating lymphocytes in subcutaneous melanoma metastases removed from patients immunized with a melanoma vaccine. Dense cellular infiltrates were seen in 10 of 11 nodules from vaccine-immunized patients, compared with 9 of 22 nodules from non-immunized patients (p = 0.02). Furthermore, these dense lymphocytic collections more frequently infiltrated the body of tumor nodules from immunized patients, whereas in non-immunized patients, lymphocytes were more often present only in the dermal tissue at the periphery of the nodule. Thus, allogeneic melanoma vaccines may augment immune responses to a patient's own tumor
— id: 10530, year: 1989, vol: 8, page: 355, stat: Journal Article,

Primary hyperparathyroidism associated with two enlarged parathyroid glands
Roses DF; Karp NS; Sudarsky LA; Valensi QJ; Rosen RJ; Blum M
1989 Nov;124(11):1261-1265, Archives of Surgery (Chicago)
An increasingly recognized although small percentage of patients with primary hyperparathyroidism have enlargement of two parathyroid glands. We have treated nine patients with primary hyperparathyroidism associated with such double parathyroid gland enlargement. In four of these patients, marked asymmetry of the two enlarged glands was noted and the failure to recognize and excise a second enlarged parathyroid gland resulted in persistent or recurrent hyperparathyroidism. In one of these patients, the second enlargement was present in a super-numerary mediastinal gland. The subsequent excision of the second enlarged parathyroid gland resulted in normocalcemia in each instance. This contrasts with five patients in whom initial excision of two enlarged glands resulted in normocalcemia with no recurrence of hypercalcemia. Only three patients fulfilled the histologic criteria of true double adenomas. The remainder showed multiglandular hypercellularity. This experience supports identifying all parathyroid glands and recognizing that even minimal enlargement of a gland may be important pathophysiologically, regardless of its histopathologic classification. Excision of both enlarged glands, even if asymmetric, is appropriate
— id: 10429, year: 1989, vol: 124, page: 1261, stat: Journal Article,

The use of preoperative localization of adenomas of the parathyroid glands by thallium-technetium subtraction scintigraphy, high-resolution ultrasonography and computed tomography
Roses DF; Sudarsky LA; Sanger J; Raghavendra BN; Reede DL; Blum M
1989 Feb;168(2):99-106, Surgery, gynecology & obstetrics
Thirty-six patients with primary hyperparathyroidism were studied preoperatively by thallium-201 and technetium-99m pertechnetate subtraction (Tl-201/Tc-99m) scintigraphy, high-resolution real time ultrasonography and computed tomographic (CT) scanning. None of the patients had had previous surgical treatment of the parathyroid or thyroid glands. All of the patients underwent systematic bilateral exploration of the neck. All of the patients were successfully explored and 41 abnormal parathyroid glands were identified. Five patients had two adenomas. In six instances, adenomas were identified in ectopic anatomic sites. The sensitivity of correctly localizing the abnormal glands with these techniques was 49 per cent for the Tl-201/Tc-99m scintigraphy, 34 per cent for ultrasonography and 41 per cent for CT scanning. The Tl-201/Tc-99m scintigrams detected two of the six ectopically located adenomas, CT detected one, while ultrasound detected none. The five patients with multiple adenomas were not accurately identified as having multiple gland enlargement by any of these studies. Therefore, preoperative localization studies with these three techniques did not provide reliable information for initial bilateral exploration of the neck
— id: 10738, year: 1989, vol: 168, page: 99, stat: Journal Article,

Immunogenicity of a polyvalent melanoma antigen vaccine in humans
Bystryn JC; Oratz R; Harris MN; Roses DF; Golomb FM; Speyer JL
1988 Mar 15;61(6):1065-1070, Cancer
Fifty-five patients with Stage II (36 patients) or Stage III (19 patients) malignant melanoma confirmed histologically received adjuvant immunotherapy with a polyvalent melanoma antigen vaccine to evaluate toxicity and immunogenicity. There was no toxicity. Antibody and/or cellular immune responses to melanoma were induced more frequently in Stage II (36 patients [69%]) than Stage III (19 patients [53%]) disease. The ability of different immunization schedules, alum, or pretreatment with low-dose cyclophosphamide to potentiate immunogenicity was compared after 2 months of immunization. Immunization biweekly with a fixed intermediate dose of vaccine was more immunogenic than immunization weekly with escalating vaccine doses. Alum increased the intensity of cellular responses slightly, whereas pretreatment with cyclophosphamide augmented both the incidence and intensity of cellular immune responses slightly. However, these changes did not reach statistical significance. There was a reciprocal relationship between the induction of humoral and cellular immune responses. These results show that (1) active immunotherapy with a polyvalent melanoma vaccine is safe in patients with minimal disease, (2) the vaccine augments immunity to melanoma in many, but not all, patients, and (3) several immunization strategies failed to potentiate immunogenicity significantly
— id: 16244, year: 1988, vol: 61, page: 1065, stat: Journal Article,

DELAYED TUMOR PROGRESSION IN MELANOMA
DUGAN, M; ORATZ, R; HARRIS, MN; ROSES, DF; SPEYER, J; GOLOMB, F; HENN, M; BYSTRYN, JC
1988 APR ;36(3):A495-A495, Clinical research
— id: 41789, year: 1988, vol: 36, page: A495, stat: Journal Article,

Differentiation of postsurgical changes from carcinoma of the breast
Mitnick J; Roses DF; Harris MN
1988 Jun;166(6):549-550, Surgery, gynecology & obstetrics
Evaluation of 486 consecutive mammograms with biopsy and excision scars revealed 25 with spiculated radiodensities on mammography. Of these 25 patients, 17 were diagnosed as having benign scars, based upon the appearance of a central lucency, representing fat in the central portion of the spiculated radiodensity. Seven patients were diagnosed as having carcinoma by the absence of lucency in the radiodensity at a biopsy or excision site
— id: 11073, year: 1988, vol: 166, page: 549, stat: Journal Article,

Comparative value of mammography, fine needle aspiration biopsy, and core biopsy in the diagnosis of invasive lobular carcinomas
Mitnick JS; Gianustosos R; Pollack AH; Sussman M; Feiner JD; Pressman PI; Roses DF
1988 ;4:75-83, Breast journal
— id: 25214, year: 1988, vol: 4, page: 75, stat: Journal Article,

Extent of excision for primary malignant melanoma
Roses DF; Harris MN
1988 ;11:31-31, Surgical rounds
— id: 25209, year: 1988, vol: 11, page: 31, stat: Journal Article,

RELATIONSHIP BETWEEN IMMUNE-RESPONSES TO MELANOMA VACCINE IMMUNIZATION AND TUMOR PROGRESSION IN MAN
Dugan, M; Oratz, R; Speyer, J; Roses, DF; Harris, MN; Golomb, F; Bystryn, JC
1987 Apr;35(3):A523-A523, Clinical research
— id: 31370, year: 1987, vol: 35, page: A523, 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,

INDUCTION OF LYMPHOCYTIC CELL INFILTRATE IN HUMAN-MELANOMA NODULES BY ACTIVE IMMUNIZATION TO MELANOMA ANTIGEN VACCINE
Oratz, R; Cockerell, C; Speyer, J; Roses, DF; Harris, MN; Bystryn, JC
1987 Mar;28(3):374-374, Proceedings (American Association for Cancer Research)
— id: 31383, year: 1987, vol: 28, page: 374, stat: Journal Article,

Principles of biopsy of lesions suspected of being malignant melanomas
Roses DF
Pigmented lesions of the skin : clinicopathologic correlations Philadelphia : Lea & Febiger, 1987,
— id: 2723, year: 1987, vol: , page: 19, stat: Chapter,

Preparation and characterization of a polyvalent human melanoma antigen vaccine
Bystryn JC; Jacobsen S; Harris M; Roses D; Speyer J; Levin M
1986 Jun;5(3):211-224, Journal of biological response modifiers
A polyvalent melanoma tumor antigen vaccine was prepared from antigens shed by a pool of human melanoma cells cultured in serum-free medium. The vaccine contained multiple melanoma associated antigens (MAAs) and was free of detectable fetal calf serum (FCS) proteins and Dr antigens. Three batches of vaccine prepared several months apart contained the same spectrum of tumor antigens. Thirteen patients with metastatic malignant melanomas were immunized intradermally with escalating doses of the vaccine in a Phase I study. There was no toxicity other than transient urticaria at the injection site. Humoral immunity, assayed by indirect immunoprecipitation, was augmented in five (38%) patients. Cellular immunity, assayed by delayed-type cutaneous hypersensitivity, was induced in four (31%) patients. Skin tests to a control vaccine prepared from pooled allogeneic lymphocytes were negative. Cutaneous metastases regressed completely in one patient who is now disease free after 2 years, and multiple cutaneous metastases have remained stable for 14 months in another patient. These results indicate that active immunization to a partially characterized polyvalent melanoma antigen vaccine is safe and can increase immunity to melanoma in some patients
— id: 16253, year: 1986, vol: 5, page: 211, stat: Journal Article,

CELLULAR IMMUNE-RESPONSE TO A MELANOMA ANTIGEN VACCINE
Bystryn, JC; Oratz, R; Harris, M; Roses, D; Speyer, J
1986 Apr;34(2):A561-A561, Clinical research
— id: 31037, year: 1986, vol: 34, page: A561, 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,

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,

Pitfalls in the diagnosis and management of malignant melanoma
Roses DF
1986 ;3(1):70-84, Problems in general surgery
— id: 25181, year: 1986, vol: 3, page: 70, stat: Journal Article,

Malignant melanoma
Roses DF; Harris MN
Management of the patient with cancer Philadelphia : Saunders, 1986,
— id: 2721, year: 1986, vol: , page: ?, stat: Chapter,

Surgical treatment of dermatofibrosarcoma protuberans
Roses DF; Valensi Q; LaTrenta G; Harris MN
1986 May;162(5):449-452, Surgery, gynecology & obstetrics
The clinical course and histopathologic factors of 50 consecutive patients treated for dermatofibrosarcoma protuberans were reviewed. Forty-eight patients were observed until the present time or death. No patient had distant metastases develop, although 16 patients had 18 recurrences of the dermatofibrosarcoma protuberans at the site of initial therapy. There was no correlation between the diameter of the primary lesion and the incidence of recurrence. There was no correlation between the histologic pattern of invasion and recurrence. However, a trend toward decreasing recurrence was noted with increasing minimal margins of resections (41 per cent less than 2 centimeters versus 24 per cent greater than or equal to 2 centimeters). The lowest incidence of recurrence (20 per cent) was noted with minimal margins of resection greater than or equal to 3 centimeters. Five year recurrence free survival rates increased with increasing margins of resection--59 per cent less than 1 centimeter; 66 per cent greater than or equal to 1 centimeter; 70 per cent greater than or equal to 2 centimeters, and 80 per cent greater than or equal to 3 centimeters. No patient had distant metastases and no change in histologic pattern was noted with progressive local recurrence
— id: 25131, year: 1986, vol: 162, page: 449, stat: Journal Article,

Brahms and Billroth
Roses, D F
1986 Oct;163(4):385-398, Surgery, gynecology & obstetrics
— id: 133519, year: 1986, vol: 163, page: 385, stat: Journal Article,

EFFECTS OF A POLYVALENT TUMOR-ANTIGEN VACCINE IN HUMAN- MALIGNANT MELANOMA
Bystryn, JC; Bernstein, P; Harris, M; Roses, D; Speyer, J
1985 ;33(2):A628-A628, Clinical research
— id: 30755, year: 1985, vol: 33, page: A628, stat: Journal Article,

EFFECTS OF A POLYVALENT TUMOR-ANTIGEN VACCINE IN HUMAN- MALIGNANT MELANOMA
Bystryn, JC; Bernstein, P; Harris, M; Roses, D; Speyer, J
1985 ;84(4):338-339, Journal of investigative dermatology
— id: 30767, year: 1985, vol: 84, page: 338, stat: Journal Article,

IMMUNOGENICITY OF A POLYVALENT MELANOMA ANTIGEN VACCINE IN PATIENTS WITH EARLY MELANOMA
Bystryn, JC; Lonberg, M; Bernstein, P; Harris, M; Roses, D; Speyer, J
1985 ;26(MAR):312-312, Proceedings (American Association for Cancer Research)
— id: 30737, year: 1985, vol: 26, page: 312, stat: Journal Article,

Single-dose dacarbazine and dactinomycin in advanced malignant melanoma
Hochster H; Levin M; Speyer J; Dunleavy S; Harris M; Roses D; Golomb F; Muggia F
1985 Jan;69(1):39-42, Cancer treatment reports
Twenty-one patients with advanced malignant melanoma were treated with dacarbazine at a dose of 800 mg/m2 as a single infusion and dactinomycin at a dose of 1.2 mg/m2 every 3 weeks. Hematologic toxicity was mild and gastrointestinal toxicity was tolerable. The response rate for evaluable patients was 22%, which included both men and women with visceral disease. Three of the four responses were complete. Durations of response were 4, 6, 9, and 48+ months. We conclude that dacarbazine can be safely and effectively given as a single dose along with dactinomycin. The possibility that this combination may be more effective than single agents in obtaining complete responses in patients with visceral disease must be explored further
— id: 25132, year: 1985, vol: 69, page: 39, stat: Journal Article,

Sarcoidosis of the breast
Reitz ME; Seidman I; Roses DF
1985 Jun;85(6):262-263, New York state journal of medicine
— id: 25141, year: 1985, vol: 85, page: 262, stat: Journal Article,

Biopsy technique for suspected melanoma
Roses DF
Surgical approaches to cutaneous melanoma Basel : Karger, 1985,
— id: 2720, year: 1985, vol: , page: ?, stat: Chapter,

Evolution of surgery for malignant melanoma
Roses DF
1985 ;7 Suppl:193-195, American journal of dermatopathology
— id: 11448, year: 1985, vol: 7 Suppl, page: 193, stat: Journal Article,

Surgery for primary cutaneous malignant melanoma
Roses DF
1985 ;3(4):?-?, Melanoma letter
— id: 25197, year: 1985, vol: 3, page: ?, stat: Journal Article,

Male breast cancer
Roses DF; Harris MN
1985 Oct;21(10):23,27-8,33, Hospital medicine
— id: 25187, year: 1985, vol: 21, page: 23,27, stat: Journal Article,

Surgery for primary cutaneous malignant melanoma
Roses DF; Harris MN; Gumport SL
1985 Apr;3(2):315-326, Dermatologic clinics
In summary, we believe that in the following situations elective regional lymph node dissection should not usually be performed: Patients whose primary malignant melanomas are in situ or have a maximal thickness of less than 1.0 mm. The incidence of regional node metastases in the latter group is so low that regional lymph node dissection is not justified. Patients whose primary malignant melanomas are in the midline of the head and neck or the trunk. Bilateral nodal dissections in these two regions of the body in the absence of a clearly demonstrable therapeutic advantage are not justified. Whether radioisotopic localizing studies will add greater definition to this group remains to be seen. Elderly patients or those with serious intercurrent disease. They should not undergo elective nodal dissection unless the primary malignant melanoma is very thick and lies directly over its nodal group. Patients with systemic metastases. For all remaining patients, the therapeutic or at very least prognostic advantages of elective regional lymph node dissections have been outlined. Conversely, an adverse effect on the course of the disease has never been demonstrated. We adhere to a policy that includes these procedures as primary therapy, provided they are performed with minimal morbidity. Should a surgeon elect not to perform such a procedure in the absence of clinically suspicious lymphadenopathy, careful clinical evaluation at 2-month intervals for the first 2 to 3 years following primary excision, with more prolonged intervals thereafter, would appear prudent. Until such time as effective means of eradicating systemic metastatic malignant melanoma exist, surgery remains the treatment of choice for this potentially fatal neoplasm. Efforts to develop effective adjuvant treatment based on the precise means of delineating prognosis that have thus far been developed has eluded investigators. A reasoned surgical approach is still required in our judgment until the identification and treatment of premalignant precursor lesions are universal or effective systemic therapy is available
— id: 25115, year: 1985, vol: 3, page: 315, stat: Journal Article,

Prognosis of patients with pathologic stage II cutaneous malignant melanoma
Roses DF; Provet JA; Harris MN; Gumport SL; Dubin N
1985 Jan;201(1):103-107, Annals of surgery
The prognostic relevance of the extent of nodal metastases, lesion thickness, level of invasion, site of lesion, satellitosis, age, sex, and year of diagnosis and treatment were assessed in 213 consecutive patients with pathologic Stage II malignant melanoma (157 with clinical Stage I disease and 56 with clinical Stage II disease). Of these factors, only three were significant: 1) clinical status of the lymph nodes (p less than 0.0001); 2) thickness of the primary lesion in the ranges of less than 2.0 mm, 2.0 to 4.9 mm, and 5.0 mm or greater (p = 0.002); and 3) level of invasion (p = 0.0002). The extent of nodal metastases in those patients with clinical Stage I disease was not significant. The difference in survival between patients with clinically negative/histologically positive nodes (clinical Stage I) and clinically positive/histologically positive nodes (clinical Stage II) was apparent throughout the follow-up period. The 5- and 10-year survival rates for the clinical Stage I patients were 44% and 28%, respectively, and for the clinical Stage II patients 21% and 12%, respectively (p less than 0.0001). A 5-year cumulative survival rate of 65% was achieved for clinical Stage I patients having primary lesions of less than 2.0 mm in thickness, while it was 19% for patients having primary lesions of 5.0 mm or more in thickness. For pathologic Stage II malignant melanoma patients, prognosis is most dependent on the clinical status of the lymph nodes, not on the number of lymph nodes with micrometastases
— id: 25116, year: 1985, vol: 201, page: 103, stat: Journal Article,

Prospective evaluation of cardiotoxicity during a six-hour doxorubicin infusion regimen in women with adenocarcinoma of the breast
Speyer JL; Green MD; Dubin N; Blum RH; Wernz JC; Roses D; Sanger J; Muggia FM
1985 Apr;78(4):555-563, American journal of medicine
In order to test the possible cardiac-sparing effect of doxorubicin administered by six-hour intravenous infusion and to prospectively evaluate the role of resting left ventricular ejection fraction in monitoring these patients, 33 women with advanced breast cancer were treated with combination chemotherapy containing 5-fluorouracil, cyclophosphamide, and doxorubicin. Doxorubicin was administered via a femoral catheter as a six-hour infusion. Cardiac function was monitored prior to therapy and at intervals during therapy by history and physical examination and by measurement of resting left ventricular ejection fraction with gated pool radionuclide angiography. Twenty-six responses were observed (complete response, seven [21 percent]; partial response, 19 [57 percent]). Systemic toxicity included alopecia, myelosuppression, and nausea and vomiting. There was a progressive fall in resting left ventricular ejection fraction during treatment from a median baseline value of 0.63. Mean fall from baseline left ventricular ejection fraction at a cumulative doxorubicin dose of 200 to 300 mg/m2 was 0.06 (p less than 0.005); at 301 to 449 mg/m2 it was 0.09 (p less than 0.0005); and at 450 mg/m2 or greater it was 0.15 (p less than 0.0005). Clinical congestive heart failure developed in three patients. Even though the decrease in left ventricular ejection fraction was often within the 'normal range' (left ventricular ejection fraction 0.50 or greater), these changes were progressive and appeared to be part of a continuum of doxorubicin-induced myocardial damage. Steady-state infusion levels of doxorubicin in plasma ranged from 90 to 120 nM. They confirm the hypothesis that lower concentrations can be achieved by continuous infusion rather than by bolus infusion. In this study, however, administration of doxorubicin by six-hour infusion did not appear to have a major cardiac-sparing effect. Studies of anthracycline cardiac toxicity should include determination of baseline left ventricular ejection fraction and serial observations during therapy. Failure to include deteriorations in function above an arbitrary cutoff point or to make observations only at higher cumulative doses may underestimate drug-induced myocardial damage
— id: 15698, year: 1985, vol: 78, page: 555, stat: Journal Article,

Computerized axial tomography in the diagnosis and management of thyroid and parathyroid disorders
Blum M; Reede DL; Seltzer TF; Burroughs VJ; Greene LW; Roses DF
1984 Jan-Feb;287(1):34-39, American journal of the medical sciences
Computerized axial tomography (CAT) was used to study 39 patients with known thyroid disease and 14 patients with primary hyperparathyroidism. In all, CAT was performed only when information that was required for diagnosis or therapy was not available from other less expensive techniques. The greatest value was found in the evaluation of cryptic symptoms or structures in the neck after surgery for thyroid cancer, the assessment of the extent of thyroid cancer, the localization of aberrant thyroid tissue, the etiology of unexplained recurrent laryngeal nerve paralysis and the identification and delineation of mediastinal goiter. In six of 14 patients undergoing neck exploration for primary hyperparathyroidism CAT correctly localized the site of the enlarged parathyroid glands including one mediastinal parathyroid adenoma and one patient with two parathyroid adenomas
— id: 25107, year: 1984, vol: 287, page: 34, stat: Journal Article,

PHASE-I TRIAL OF SPECIFIC IMMUNOTHERAPY OF MELANOMA WITH A POLYVALENT MELANOMA ANTIGEN VACCINE
BYSTRYN, JC; LEVIN, M; SPEYER, S; HARRIS, M; ROSES, D; BERNSTEIN, P
1984 ;32(2):A574-A574, Clinical research
— id: 40837, year: 1984, vol: 32, page: A574, stat: Journal Article,

PHASE-I TRIAL OF SPECIFIC IMMUNOTHERAPY OF MELANOMA WITH A POLYVALENT MELANOMA ANTIGEN VACCINE
BYSTTRYN, JC; LEVIN, M; SPEYER, S; HARRIS, M; ROSES, D; BERNSTEIN, P
1984 ;82(4):425-426, Journal of investigative dermatology
— id: 40819, year: 1984, vol: 82, page: 425, stat: Journal Article,

The carcinogenicity of radiation therapy
Pizzarello DJ; Roses DF; Newall J; Barish RJ
1984 Aug;159(2):189-200, Surgery, gynecology & obstetrics
Ionizing radiation as used for therapy for cancer is probably weakly carcinogenic at worst. The probability that cancers will be induced at a distance from the treatment volume is so small that it can only be inferred from experiences with large populations exposed to much higher radiation doses. The risk of cancer in and adjacent to the treatment volume also appears to be small, especially in adults. Intensive radiotherapy or radiotherapy of children 20 to 30 years ago appears to have induced secondary cancers in about 3 to 4 per cent of those treated, but modern practice has every expectation of reducing this incidence. No precise risk factor can be offered, but it seems likely that less than 3 to 4 per cent is a reasonable projection. The reason for the low carcinogenicity in the treatment volume probably lies in the fact that the irradiation dose is high and many cells are killed rather than transformed. The frequency of the induction of radiogenic cancer adjacent to or near the treatment volume is expected to vary according to the tissue exposed. It is not estimated to exceed a few per cent in the worst instances (for example, breast and thyroid gland) and is much less than 1 per cent in most tissues
— id: 25138, year: 1984, vol: 159, page: 189, stat: Journal Article,

Defining the definitive excision for primary cutaneous malignant melanoma
Roses DF
1984 Summer;6 Suppl(6):119-122, American journal of dermatopathology
— id: 25146, year: 1984, vol: 6 Suppl, page: 119, stat: Journal Article,

Malignant melanoma : how much surgery?
Roses DF
1984 ;31(19):?-?, Surgery (Audio-Digest) [sound recording]
— id: 25243, year: 1984, vol: 31, page: ?, stat: Journal Article,

Diagnosing and managing common skin cancers
Roses DF; Harris MN; Gumport SL
1984 ;112(6):5-5, Medical times & Long Island medical journal
— id: 25204, year: 1984, vol: 112, page: 5, stat: Journal Article,

Prediction of lymph node metastases from the histologic features of primary cutaneous malignant melanomas
Weissmann A; Roses DF; Harris MN; Dubin N
1984 Summer;6 Suppl(1):35-41, American journal of dermatopathology
Elective regional lymph-node dissection was performed on 98 patients with clinical Stage I cutaneous malignant melanoma and 26 of them were found to have microscopic evidence of metastases. The histology of the primary lesions was reviewed in order to find possible prognostic parameters that would allow prediction of nodal involvement. There was an increased risk of occult lymph node metastases with increasing thickness of the primary lesions. While this trend was not found to be statistically significant, no occult lymph node metastases were found for lesions less than 1.0 mm in thickness. Significant features included mitotic figures, 'prognostic index,' and plasma cells within the infiltrate. A multiple logistic regression analysis identified three groups of patients with low, medium, and high risk of occult metastases, based on thickness, location, and plasma cells. The correlation between plasma cells and the incidence of metastases in lymph nodes might represent an immunologic phenomenon
— id: 25133, year: 1984, vol: 6 Suppl, page: 35, stat: Journal Article,

HUMAN-TUMOR CLONOGENIC-ASSAY - CHEMOSENSITIVITY TESTING IN SOFT AGAR AND CLINICAL CORRELATION IN MALIGNANT-MELANOMA
CUMPS, E; BOWEN, J; HARRIS, M; ROSES, D; GOLOMB, F; VALENTINE, F; MUGGIA, F; LEVIN, M
1983 ;31(2):A405-A405, Clinical research
— id: 40682, year: 1983, vol: 31, page: A405, 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,

BIOPSY AND SURGICAL-MANAGEMENT OF MALIGNANT-MELANOMA
HARRIS, MN; ROSES, DF
1983 ;9(8):663-663, Journal of dermatologic surgery & oncology
— id: 40648, year: 1983, vol: 9, page: 663, 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,

Carcinoma of the thyroglossal duct
Roses DF; Snively SL; Phelps RG; Cohen N; Blum M
1983 Feb;145(2):266-269, American journal of surgery
Seven patients with carcinoma in a thyroglossal duct cyst have received treatment over a 15 year period. Findings in all of these patients reflect the likelihood of carcinoma arising within thyroglossal duct tissue. In each patient there was sufficient histologic evidence of the presence of a thyroglossal duct cyst and carcinoma arising within an intimate admixture of normal thyroid tissue in the cyst wall. In the absence of a history of irradiation and with separation of the carcinoma from the pyramidal lobe of the thyroid, excision of the thyroglossal cyst alone by traditional means seems appropriate. Our experience as well as a review of reported cases to date indicate that distant metastases are extremely rare and the prognosis excellent
— id: 25108, year: 1983, vol: 145, page: 266, stat: Journal Article,

Diagnosis and management of cutaneous malignant melanoma
Roses, Daniel F.; Harris, Matthew N.; Ackerman, A. Bernard
Philadelphia : Saunders, c1983,
— id: 226, year: 1983, vol: , page: , stat: ,

Thyroglossal duct carcinoma
Blum M; Roses DF; Cohen C
1982 Aug 27;248(8):924-924, JAMA
— id: 25109, year: 1982, vol: 248, page: 924, stat: Journal Article,

Changing concepts and advances in the mangement of soft tissue sarcomas
Blum RH; Roses DF; Newall J
1982 ;6:6-6, Cancer report (NYU School of Medicine)
— id: 25217, year: 1982, vol: 6, page: 6, 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,

Pathologic predictors of recurrence in stage 1 (TINOMO) breast cancer
Roses DF; Bell DA; Flotte TJ; Taylor R; Ratech H; Dubin N
1982 Dec;78(6):817-820, American journal of clinical pathology
A group of 122 consecutively treated pathologic Stage 1 (TINOMO) patients with cancer of the breast were studied to define histopathologic predictors of recurrence. Lymphatic invasion was the most significant predictor of recurrence; recurrence was present in 32% (8/25) of patients who had lymphatic invasion and in 10.3% (10/97) of patients who did not (P = 0.006). Histologic type was also predictive of recurrent disease. Eighteen per cent (18/101) of patients with invasive ductal or lobular carcinoma developed recurrent disease, while none of the group of 21 patients with medullary carcinoma, tubular carcinoma, colloid carcinoma, Paget's disease, and intraductal carcinoma with minimal invasion suffered a recurrence (P = 0.036). Vascular invasion, grade of malignancy, cellularity, presence or absence of circumscription, cellular infiltrate, fibroblastic response, neural invasion, and necrosis were not significant predictors of recurrence. Multiple logistic regression analysis of patients with invasive ductal or lobular carcinoma confirmed the results for individual factors, that only patients with lymphatic invasion were at higher risk of recurrence
— id: 25145, year: 1982, vol: 78, page: 817, stat: Journal Article,

Malignant melanoma margins
Roses DF; Harris MN; Gumport SL; Ackerman AB
1982 Aug 12;307(7):439-441, New England journal of medicine
— id: 107001, year: 1982, vol: 307, page: 439, stat: Journal Article,

Primary melanoma thickness correlated with regional lymph node metastases
Roses DF; Harris MN; Hidalgo D; Valensi QJ; Dubin N
1982 Jul;117(7):921-923, Archives of Surgery (Chicago)
We studied 119 patients with stage I primary cutaneous malignant melanoma, who were undergoing regional lymph node dissection, to determine the relationship of lymph node metastases to thickness of the primary lesion. The lymph nodes in the dissection specimen were each evaluated by serial sections. None of the patients with lesions less than 1.0 mm thick had nodal micrometastases. When lesions exceeded 1.0 mm in thickness, there was no appreciable increase in the incidence of nodal metastases until a thickness greater than 4.0 mm was reached, in which cases the incidence of metastases was 50%. Predictive variables were determined by multiple logistic regression analysis. Only lesions that were at least 4.0 mm thick and were not located on the upper extremities were significant predictors of lymph node metastases; within this category there was a 64% incidence of lymph node metastases
— id: 25135, year: 1982, vol: 117, page: 921, stat: Journal Article,

PROPER BIOPSY OF A LESION SUSPECT OF BEING A MALIGNANT-MELANOMA
ROSES, DF
1982 ;4(5):475-476, American journal of dermatopathology
— id: 50529, year: 1982, vol: 4, page: 475, stat: Journal Article,

A prognostic model for clinical stage I melanoma of the lower extremity. Location on foot as independent risk factor for recurrent disease
Day CL Jr; Sober AJ; Kopf AW; Lew RA; Mihm MC Jr; Golomb FM; Hennessey P; Harris MN; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Fitzpatrick TB; Postel A
1981 May;89(5):599-603, Surgery
Thirteen variables were studied to determine their usefulness in predicting recurrent disease in 158 patients with stage I melanoma of the lower extremity. A Cox proportional hazards analysis demonstrated that three variables were independent risk factors for recurrent disease in these patients: (1) thickness, in millimeters, of the primary tumor (P = 0.000009), (2) primary tumor location on the foot (P = 0.0003), and (3) the number of mitoses/mm2 (P = 0.0244). Life-table analyses of patient subgroups defined by different combinations of these three variables demonstrated that thick (greater than or equal to 3.0 mm) melanomas of the foot were associated with recurrent disease much more frequently than tumors of similar thickness located on the thigh or calf. These data provide guidelines that can be used to evaluate results of surgical and/or adjuvant therapy studies for patients with melanoma of the lower extremity
— id: 25111, year: 1981, vol: 89, page: 599, stat: Journal Article,

A prognostic model for clinical stage I melanoma of the trunk. Location near the midline is not an independent risk factor for recurrent disease
Day CL Jr; Sober AJ; Kopf AW; Lew RA; Mihm MC Jr; Golomb FM; Postel A; Hennessey P; Harris MN; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Fitzpatrick TB
1981 Aug;142(2):247-251, American journal of surgery
Fifteen variables were studied for their usefulness in predicting recurrent disease in 254 patients with clinical stage I melanoma of the trunk. Thickness of the primary tumor correctly predicted outcome with an accuracy of 90 percent or greater in 176 patients with melanoma primaries with a thickness of less than 1.70 mm or 5.5 mm or greater. No other variables significantly increased predictive accuracy over these ranges of thickness. A Cox proportional hazards analysis of the remaining 78 patients with primary tumors 1.70 to 5.49 mm thick demonstrated that the following four variables functioned as independent risk factors for recurrent disease: (1) thickness of the primary tumor (p = 0.0005), (2) mitoses/mm2 greater than 6 (p = 0.006), (3) a nearly absent or minimal lymphocyte response at the base of the tumor (p = 0.009), and (4) location on the upper trunk (p = 0.03). Trunk lesions located near the midline did not have a worse prognosis than more lateral melanomas of similar thickness
— id: 25110, year: 1981, vol: 142, page: 247, stat: Journal Article,

A prognostic model for clinical stage I melanoma of the upper extremity. The importance of anatomic subsites in predicting recurrent disease
Day CL Jr; Sober AJ; Kopf AW; Lew RA; Mihm MC Jr; Hennessey P; Golomb FM; Harris MN; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Postel A; Grier WR; Mintzis MN; Fitzpatrick TB
1981 Apr;193(4):436-440, Annals of surgery
Thirteen variables were studied for their relative usefulness in predicting recurrent disease in 107 patients with clinical Stage I melanoma of the upper extremity. After a mean follow-up period of 54 months, the only patents who have had recurrent disease to date are those who primary lesions were located either on the hand or posterior upper arm. The five-year disease-free survival role for 44 patients with melanoma at these sites was 68%. None of 63 patients with melanoma located on the forearm of anterior upper arm have had recurrent disease (i.e., the five-year, disease-free survival rate was 100% (p = 0.00004), compared with the hand or posterior arm group). A Cox proportional hazards (multivariate) analysis demonstrated that two primary tumor histologic variable, thickness in millimeters and ulceration, interacted to produce the best prognostic model for those 44 patients with melanoma of the hand or posterior upper arm. Twenty-one patients with primary lesions at these sites had primary tumors less than 2.25 mm in thickness and no evidence of ulceration histologically. Their five-year, disease-free survival role was 95%. For the remaining 23 patients with primary tumors on the hand or posterior upper arm who had either histologic evidence of ulceration or primary tumors greater than or equal to 2.25 mm, the five-year disease-free survival rate was 37% (p = 0.002, compared with group nonulcerated, thin lesions). The excellent survival rate for patients with melanomas on the forearm or anterior upper arm was not completely explained by pathologic stage, by primary tumor thickness, or by histologic ulceration of the primary tumor
— id: 25112, year: 1981, vol: 193, page: 436, stat: Journal Article,

The diagnosis and management of common skin cancers
Gumport SL; Harris MN; Roses DF; Kopf AW
1981 Mar-Apr;31(2):79-90, CA: a cancer journal for clinicians
— id: 25120, year: 1981, vol: 31, page: 79, stat: Journal Article,

Mixed parathyroid-thymic cyst
Harris MN; Basuk R; Roses DF; Rabinowitz M; Feiner HD
1981 Oct;81(11):1657-1659, New York state journal of medicine
— id: 25106, year: 1981, vol: 81, page: 1657, stat: Journal Article,

Management of head and neck melanoma
Harris MN; Roses DF
Head and neck surgery Mt. Kisco, NY : Futura Publishing, 1981,
— id: 2719, year: 1981, vol: , page: ?, stat: Chapter,

Carcinoma of the breast metastatic to the skin and simulating malignant melanoma
Jacoby R; Roses DF; Valensi Q
Pathology of malignant melanoma New York : Masson Publishing, 1981,
— id: 2715, year: 1981, vol: , page: 263, stat: Chapter,

Benign breast conditions
Roses DF; Harris MN
1981 ;17(11):114-127, Hospital medicine
Discussion of benign breast disease, including signs, symptoms, diagnosis, and suggested treatment, is presented. Helpful means for distinguishing between benign and malignant breast disease include biopsy, patient and family history, age, frequency of pregnancies, and timing of menstruation in relation to examination. The presence of a mass during examination, along with changes in size or firmness of one breast, skin changes, nipple discharge, or changes in nipple epithelium, may provide information helpful to establishing diagnostic procedure. Fibrocystic disease ranging from epithelium-lined cyst to sclerosing adenosis presents with symptoms of breast discomfort. Histopathological changes include hyperplasia of duct epithelium, duct papillomatosis, and blunt duct adenosis. Treatment includes aspiration and re-examination or possibly mammography. When mammography is insufficient to distinguish from carcinoma, a biopsy is indicated. Mammary duct ectasia is characterized by a yellowish-brown discharge, thickening of the duct wall, and shortening and retraction of the nipple. Ductal excision is indicated; excisional biopsy should be performed if a mass is present. Intraductal papilloma presents with bloody nipple and should be further evaluated by biopsy and possibly mammography. Fat necrosis can sometimes mimic cancer; biopsy and mammography may be needed for definitive diagnosis. Fibroadenomas are solid, rubbery, movable lesions. Re-examination during another part of the menstrual cycle and excisional biopsy are indicated for diagnosis. Accurate diagnosis and patient reassurance are necessary when dealing with benign breast disease
— id: 25188, year: 1981, vol: 17, page: 114, stat: Journal Article,

Wide and deep excision for malignant melanoma
Roses DF; Harris MN; Casson P; Gumport SL
Pathology of malignant melanoma New York : Masson Publishing, 1981,
— id: 2716, year: 1981, vol: , page: 363, stat: Chapter,

Surgical management for malignant melanoma of the trunk
Roses DF; Harris MN; Gumport SL
1981 Mar;116(3):315-317, Archives of Surgery (Chicago)
A group of 525 patients with primary cutaneous malignant melanoma of the trunk was treated by a uniform surgical approach that included regional lymph node dissection for selected patients; 266 (50.6%) had regional lymph node dissections in addition to wide and deep excision, all with primary lesions extending below the superficial papillary dermis. Of 171 patients treated over five years ago, 130 had histologically negative nodes; 94 (72%) are alive with no evidence of disease (NED). Of 41 with histologically positive nodes, 12 (29%) are alive with NED. A comparison of the 21 patients with clinically occult micrometastases shows eight (38%) alive with NED, whereas four of 20 (20%) with clinically demonstrable as well as histologically proven nodal metastases are alive with NED. Though there may be a modest benefit to lymph node dissection for microscopic rather than gross nodal metastases for invasive melanoma of the trunk, for most such patients melanoma in regional nodes indicates the presence of systemic metastatic disease
— id: 25119, year: 1981, vol: 116, page: 315, stat: Journal Article,

Regional lymph node dissection for malignant melanoma of the extremities
Roses DF; Harris MN; Gumport SL; Michelassi F; Coffey JA; Dubin N
1981 Jun;89(6):654-659, Surgery
Seven hundred thirty-nine patients with malignant melanoma of the extremities were treated with a uniform surgical approach that included wide and deep excision of the primary site and regional node dissection therapeutically and electively for invasive lesions (Clark's levels III, IV, and V). Of the 490 patients who underwent lymph node dissections, follow-up was available for 457 (93%). Life-table comparison of 362 patients with histologically negative nodes to 95 with histologically proved lymph node metastases yielded statistically significant differences in survival (P less than 0.001). Five-year cumulative survival rates were 91% in the group without and 48% in the group with nodal metastases. Among histologically positive patients, differences in life-table survival curves for the 60 clinically negative patients compared to the 35 clinically positive patients were also statistically significant (P = 0.004); 5-year cumulative survival rates were 57% for the former group and 33% for the latter. Although there appears to be an advantage to regional lymph node dissection for micrometastases as opposed to gross nodal involvement, for the majority of patients metastatic melanoma in these nodes is the major indicator of systemic disease
— id: 25118, year: 1981, vol: 89, page: 654, stat: Journal Article,

Total mastectomy with complete axillary dissection
Roses DF; Harris MN; Potter DA; Gumport SL
1981 Jul;194(1):4-8, Annals of surgery
A technique for total mastectomy with complete axillary dissection, which uses division of the insertion of the sternal portion of the pectoralis major muscle, preservation of its innervation, reconstruction after completion of the dissection and resection of the pectoralis minor muscle has been evaluated for 115 consecutive procedures. This modification facilitates a thorough axillary dissection, while preserving the cosmetic and functional benefits of the Patey operation
— id: 25117, year: 1981, vol: 194, page: 4, stat: Journal Article,

Biopsy for microcalcification detected by mammography
Roses DF; Harris MN; Gorstein F; Gumport SL
1980 Mar;87(3):248-252, Surgery
Fifty-two patients who were biopsied because of the presence of clustered microcalcifications on mammography, in the absence of any definable mass on x-ray or physical examination, were studied. Localization of the microcalcifications was obtained by measuring the area in relation to the vertical and horizontal axes from the nipple on both lateral and cephalocaudad views. Specimen radiography was obtained to ensure that the area with microcalcifications had been included in the specimen. Carcinoma was found in 17 instances (33%). In four (24%) the detected microcalcifications corresponded to fibrocystic disease, with carcinoma being found only in adjacent tissue with little or no calcifications. Precise localization and removal of only the area containing calcifications without excision of a generous margin of surrounding tissue may result in the exclusion of an adjacent carcinoma
— id: 25122, year: 1980, vol: 87, page: 248, stat: Journal Article,

Selective surgical management of cutaneous melanoma of the head and neck
Roses DF; Harris MN; Grunberger I; Gumport SL
1980 Nov;192(5):629-632, Annals of surgery
A series of 206 patients with cutaneous melanoma of the head and neck has been studied. Ninety patients had a regional lymph node dissections performed. Seventeen lymph node dissections were done therapeutically and 73 were done electively. Thirty-one patients had histologically positive lymph nodes and, of these, 30 patients have been followed to the present time or death. Twenty-nine of these patients (97%) have developed systemic melanoma. Twenty-six patients have died and three are alive with disease. No patient had local recurrence alone while four had local recurrence synchronously with systemic metastases. This contrasts with 29 patients followed for greater than five years with histologically negative nodes, 27 (93.1%) of whom are alive with no evidence of recurrent disease. Regional node metastases with melanoma of the head and neck is an almost certain indication of systemic disease. A selective surgical approach to invasive melanoma in this region is proposed based on the observation in the 31 patients who had radical neck dissections with histologically positive nodes. The metastases always involved the nodal group adjacent to the primary site. This selective approach should allow optimal local control and accurate pathologic staging while limiting the extent of the surgery
— id: 25121, year: 1980, vol: 192, page: 629, stat: Journal Article,

Prognosis for invasive melanoma
Nolan K; Roses DF
1979 ;19(11):103-103, Consultant
The case history of a 29-yr-old woman with a mole of 4-5 yr duration on the anterior chest wall is briefly described. The woman was 5 mo pregnant, and the mole had recently become darker, larger, and sensitive to touch. A superficial spreading melanoma invasive to Clark's level III, 1 mm, was excised. Two wk later, wide, local excision of the melanoma site was performed, and no residual melanoma cells were found. Recommendations for follow-up treatment and prognosis are made by a consultant
— id: 25186, year: 1979, vol: 19, page: 103, stat: Journal Article,

Assessment of biopsy techniques and histopathologic interpretations of primary cutaneous malignant melanoma
Roses DF; Ackerman AB; Harris MN; Weinhouse GR; Gumport SL
1979 Mar;189(3):294-297, Annals of surgery
The biopsy techniques utilized for diagnosis in 1,161 patients with primary cutaneous malignant melanoma treated at the New York University Medical Center were reviewed. Eight hundred sixty-four (74%) biopsies were of the excisional type and 269 (23%) were incisional. Twenty-eight biopsies (3%) could not be assessed. Two hundred fifty-two consecutive patients referred for treatment of malignant melanoma to the authors for the last three years were studied to determine whether standard techniques of biopsy and uniform criteria for histopathologic diagnosis and staging were being utilized. One hundred forty-nine of these patients (59%) had total excisional biopsies of their lesions and 103 (41%) had incisional biopsies. Of the latter group, 66 (64%) were for lesions less than 2 cm in diameter and were situated in areas other than the face. The biopsy specimens obtained from 123 patients were reviewed by at least one other pathologist as well as our own (A.B.A.). For these 123 patients a difference of histologic diagnosis between pathologists occurred in 11 (9%). In 58 (47%) there was a discrepancy in assignment of Clark levels or a failure to assess Clark levels. Tumor thicknesses as measured by Breslow were read in only 22 (18%) of these 123 patients. The inadequacies of many of the biopsy specimens and discrepancies in histopathologic interpretation indicate that acceptable biopsy techniques and reproducible diagnostic criteria have not yet been generally adapted for primary cutaneous malignant melanomas
— id: 25123, year: 1979, vol: 189, page: 294, stat: Journal Article,

Malignant melanoma. Delayed hypersensitivity skin testing
Roses DF; Campion JF; Harris MN; Gumport SL
1979 Jan;114(1):35-38, Archives of Surgery (Chicago)
One hundred eighty-two patients undergoing initial surgical therapy for primary malignant melanoma were evaluated for delayed hypersensitivity using a battery of recall antigens prior to surgery. Fifty-six patients were also sensitized with 2, 4-dinitrochlorobenzene. All tumors were classified by Clark-Mihm levels and the patients were clinically staged. They were followed up for an average period of 55 months. There was no significant difference in the ability of patients with varied Clark-Mihm level lesions to mount a delayed hypersensitivity response to the recall battery or to 2, 4-dinitrochlorobenzene. Thirteen stage I melanoma patients in whom recurrence developed at a distant site exhibited no difference in immune responsiveness when compared to 148 patients in whom recurrence did not develop when both groups were tested with recall antigens. No difference was noted in patients with stage II disease in whom recurrence developed, as measured by reaction to these same antigens. Twelve patients demonstrated anergy to recall antigens, in none of whom has recurrence developed to date. Fifty-six patients who were tested with 2, 4-dinitrochlorobenzene showed no difference in reactivity with tumors classified at any of the Clark-Mihm levels. Anergy demonstrated by delayed hypersensitivity skin testing appears to reflect increasing tumor burden, rather than a preexisting deficiency that can be used to predict patients at high risk for the development of recurrent disease
— id: 25124, year: 1979, vol: 114, page: 35, stat: Journal Article,

Cutaneous melanoma of the breast
Roses DF; Harris MN; Stern JS; Gumport SL
1979 Jan;189(1):112-115, Annals of surgery
A series of 21 patients treated surgically for primary melanoma of the skin of the breast has been studied. Melanomas in this location accounted for 1.8% of a total of 1,140 patients with primary clinical Stage I and Stage II melanomas treated during a 28 year period. Wide excision with axillary lymph node dissection in selected instances has resulted in no mortality and no local recurrence to date. This approach allowed the preservation of a major portion of the breast in eight female patients. It is emphasized that melanoma is a cutaneous lesion and considerations applying to lymphatic dissemination of parenchymal disease of the breast need not apply
— id: 25125, year: 1979, vol: 189, page: 112, stat: Journal Article,

SESQUICENTENNIAL OF BILLROTH,THEODORE
ROSES, DF
1979 ;138(5):704-709, American journal of surgery
— id: 50174, year: 1979, vol: 138, page: 704, stat: Journal Article,

Lymph-node dissection in melanoma
Dubin N; Pasternack BS; Roses DF; Harris MN; Gumport SL
1978 Jan 26;298(4):222-224, New England journal of medicine
— id: 107000, year: 1978, vol: 298, page: 222, stat: Journal Article,

Major vascular reconstruction for limb salvage in patients with soft tissue and skeletal sarcomas of the extremities
Imparato AM; Roses DF; Francis KC; Lewis MM
1978 Dec;147(6):891-896, Surgery, gynecology & obstetrics
Thirteen patients with sarcomas of the extremities have been treated with radical en bloc resection requiring vascular reconstruction as initial treatment. In one instance, vascular reconstruction failed. Eight patients are currently alive and free of disease. There were two instances of a local recurrence. Each of the remaining five patients who died had distant metastases develop, none of whom had a local recurrence. Vascular reconstruction with prosthetic bone replacement, when indicated, offers an alternative approach to the treatment of tumors which, because of attachment to major vascular structures, might be considered for radical amputation
— id: 25136, year: 1978, vol: 147, page: 891, stat: Journal Article,

Selective surgical management of operable breast cancer
Gumport SL; Harris MN; Roses DF
1977 ;1:1-1, Cancer report (NYU School of Medicine)
— id: 25216, year: 1977, vol: 1, page: 1, stat: Journal Article,

Total mastectomy with axillary dissection. A modified radical mastectomy
Roses DF; Harris MN; Gumport SL
1977 Nov;134(5):674-677, American journal of surgery
A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation
— id: 25126, year: 1977, vol: 134, page: 674, stat: Journal Article,

Perforated diverticula of the jejunum and lleum
Roses DF; Gouge TH; Scher KS; Ranson JH
1976 Nov;132(5):649-652, American journal of surgery
Over a ten year period, four patients with inflammation or perforation of non-Meckelian, small intestinal diverticula were treated on the surgical services of Bellevue Hospital. This entity remains uncommon but may be increasing in incidence. The patients presented with a short history of severe abdominal pain, usually accompanied by nausea and vomiting. Each patient also gave a longer preceding history of less well defined abdominal symptoms. The pathogenesis of the small intestinal diverticula is uncertain but may be related to disturbed muscular peristalsis in the small bowel analogous to the changes implicated in esophageal and colonic diverticular disease. The diverticulum may be difficult to demonstrate at operation, and careful exploration for this possibility should be carried out at the time of operation for peritonitis of obscure origin. Segmental resection and end-to-end anastomosis is the treatment of choice
— id: 25114, year: 1976, vol: 132, page: 649, stat: Journal Article,

Melanoma of the head and neck
Harris MN; Roses DF; Culliford AT; Gumport SL
1975 Jul;182(1):86-91, Annals of surgery
A series of 94 patients with cutaneous malignant melanoma of the head and neck region has been studied. Fifty-three of the patients had regional lymph node dissections performed and the results in 37 performed more than 5 years ago are presented. The policy of elective lymph node dissection for invasive melanoma of the head and neck is strongly endorsed, although not proven by the data presented in this limited series. Whenever possible, a total excisional biopsy should be performed to establish the diagnosis. It is recommended that all melanomas be classified by the method of Clark and Mihm and that the level of invasion also be determined. There is an appreciable error in the clinical evaluation of lymph nodes for metastases. In general, it is suggested that elective regional lymph node dissections be performed for invasive melanoma (levels III, IV and V). The literature pertaining to cutaneous melanoma of the head and neck has been reviewed and surgical and pathological problems peculiar to lesions of this region are emphasized
— id: 25127, year: 1975, vol: 182, page: 86, stat: Journal Article,

Objective early identification of severe acute pancreatitis
Ranson JH; Rifkind KM; Roses DF; Fink SD; Eng K; Localio SA
1974 Jun;61(6):443-451, American journal of gastroenterology
— id: 19517, year: 1974, vol: 61, page: 443, stat: Journal Article,

Prognostic signs and the role of operative management in acute pancreatitis
Ranson JH; Rifkind KM; Roses DF; Fink SD; Eng K; Spencer FC
1974 Jul;139(1):69-81, Surgery, gynecology & obstetrics
— id: 19516, year: 1974, vol: 139, page: 69, stat: Journal Article,

Respiratory complications in acute pancreatitis
Ranson JH; Turner JW; Roses DF; Rifkind KM; Spencer FC
1974 May;179(5):557-566, Annals of surgery
— id: 19583, year: 1974, vol: 179, page: 557, stat: Journal Article,

Angiography as diagnostic aid in splenic trauma
Roses DF
1974 Sep;74(10):1808-1809, New York state journal of medicine
— id: 25144, year: 1974, vol: 74, page: 1808, stat: Journal Article,

Bacterial endocarditis associated with colorectal carcinoma
Roses DF; Richman H; Localio SA
1974 Feb;179(2):190-191, Annals of surgery
— id: 25139, year: 1974, vol: 179, page: 190, stat: Journal Article,

Febrile responses associated with cardiac surgery. Relationships to the postpericardiotomy syndrome and to altered host immunologic reactivity
Roses DF; Rose MR; Rapaport FT
1974 Feb;67(2):251-257, Journal of thoracic & cardiovascular surgery
— id: 25140, year: 1974, vol: 67, page: 251, stat: Journal Article,

Early respiratory insufficiency in acute pancreatitis
Ranson JH; Roses DF; Fink SD
1973 Jul;178(1):75-79, Annals of surgery
— id: 19518, year: 1973, vol: 178, page: 75, stat: Journal Article,

Intravenous techniques
Roses DF; Bernard RW; Stahl WM
1973 ;8:7-7, Surgery digest
— id: 25208, year: 1973, vol: 8, page: 7, stat: Journal Article,

White graft reaction after streptococcal and staphylococcal infection in man
Roses DF; Zabriskie JB; Rapaport FT
1973 Mar;5(1):487-489, Transplantation proceedings
— id: 25142, year: 1973, vol: 5, page: 487, stat: Journal Article,