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Browsing by Author "Chen, Steven T."
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Item Personal history of keratinocyte carcinoma is associated with reduced risk of death from invasive melanoma in men(Elsevier, 2018-05-01) Song, Fengju; Chen, Steven T.; Li, Xin; Han, Jiali; Epidemiology, School of Public HealthBackground Previous studies have found an increased risk for invasive cutaneous melanoma (CM) among those with a history of keratinocyte carcinoma (KC). Objective The aim of this study was to evaluate the risk of CM death after KC. Methods The study was based on the Health Professionals Follow-up Study. A Cox proportional hazards model was used to examine the hazard ratio (HR) of death due to CM associated with personal history of KC among the entire study population (primary analysis) and among participants with invasive CM (secondary analysis), respectively. Results We documented a total of 908 participants with invasive CM over a total of 0.7 million person-years of follow-up. Among all participants, the risk for development of either lethal or nonlethal invasive CM increased for those with a history of KC. The risk for death due to melanoma based on KC history was not significantly increased, with an HR of 1.53 (95% confidence interval, 0.95-2.46). In the case-only analysis, those with a history of KC had a significantly lower risk for death due to melanoma than those with no such history (HR, 0.60; 95% confidence interval, 0.35-0.94). Limitations Because the population covered by the Health Professionals Follow-up Study consists exclusively of male health professionals, the results of this study may not be extended to the entire population. Conclusion Personal history of KC is associated with a decreased risk for melanoma-specific death among male patients with invasive CM.Item Personal history of non-melanoma skin cancer diagnosis and death from melanoma in women(Wiley, 2018) Chen, Steven T.; Li, Xin; Han, Jiali; Epidemiology, School of Public HealthMelanoma incidence is increasing. We evaluated risk of melanoma death after diagnosis of non-melanoma skin cancer (NMSC). We followed 77,288 female American nurses from the Nurses’ Health Study from 1986 to 2012. We used Cox proportional hazards models to determine the hazard ratio (HR) of lethal and non-lethal melanoma diagnosis and melanoma death, according to personal NMSC history. Among melanoma cases, we examined the HR of melanoma death and the odds ratio (OR) of melanoma with a Breslow thickness ≥0.8 mm or Clark's levels of IV and V according to history of NMSC. We documented 930 melanoma cases without NMSC history and 615 melanoma cases with NMSC history over 1.8 million person-years. The multivariate-adjusted HR (95% confidence interval) of melanoma death associated with personal history of NMSC was 2.89 (1.85–4.50). Women with history of NMSC were more likely to develop non-lethal melanoma than lethal melanoma (HR (95% CI): 2.31 (2.05–2.60) vs. 1.74 (1.05–2.87)). Among melanoma cases, women with history of NMSC had a non-significant decreased risk of melanoma deaths (0.87 (0.55–1.37)), Breslow thickness ≥0.8 mm (0.85 (0.59–1.21)) and Clark's levels IV and V (0.81(0.52–1.24)). Women with NMSC history were less likely to be diagnosed with a lethal melanoma than a non-lethal melanoma, but overall rate of melanoma diagnosis was increased in both subtypes, leading to the increased risk of melanoma death. Our findings suggest the continued need for dermatologic screening for patients after NMSC diagnosis, given increased melanoma risk. Early detection among NMSC patients may decrease deaths from melanoma.Item Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults(Elsevier, 2020-06) Seminario-Vidal, Lucia; Kroshinsky, Daniela; Malachowski, Stephen J.; Sun, James; Markova, Alina; Beachkofsky, Thomas M.; Kaffenberger, Benjamin H.; Ergen, Elizabeth N.; Mauskar, Melissa; Bridges, Alina; Calhoun, Cody; Cardones, Adela R.; Chen, Steven T.; Chodosh, James; Cotliar, Jonathan; Davis, Mark D. P.; DeNiro, Katherine L.; Dominguez, Arturo R.; Eljure-Téllez, Juliana; Femia, Alisa; Fox, Lindy P.; Guda, Anisha; Mitchell, Caroline; Mostaghimi, Arash; Ortega-Loayza, Alex G.; Owen, Cindy; Pasieka, Helena; Rahnama-Moghadam, Sahand; Saeed, Hajirah N.; Saunderson, Rebecca B.; Shanbhag, Swapna; Sharon, Victoria R.; Strowd, Lindsay; Venkatesh, Samantha; Wanat, Karolyn A.; Wetter, David A.; Worswick, Scott; Micheletti, Robert G.; Dermatology, School of MedicineStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.Item Taking a “step” toward diversity in dermatology: De-emphasizing USMLE Step 1 scores in residency applications(Elsevier, 2020-03-05) Isaq, Nasro A.; Bowers, Sacharitha; Chen, Steven T.; Medicine, School of Medicine