Browsing by Author "Pulitzer, Melissa"

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    Evaluation of the Response of Unresectable Primary Cutaneous Melanoma to Immunotherapy Visualized With Reflectance Confocal Microscopy A Report of 2 Cases
    (2019) Navarrete Dechent, Cristián Patricio; Córdova, Miguel; Postow, Michael A.; Pulitzer, Melissa; Lezcano, Cecilia; Halpern, Allan C.; Rossi, Anthony M.
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    In vivo tumor immune microenvironment phenotypes correlate with inflammation and vasculature to predict immunotherapy response
    (2022) Sahu, Aditi; Kose, Kivanc; Kraehenbuehl, Lukas; Byers, Candice; Holland, Aliya; Tembo, Teguru; Santella, Anthony; Alfonso, Anabel; Li, Madison; Cordova, Miguel; Gill, Melissa; Fox, Christi; Gonzalez, Salvador; Kumar, Piyush; Wang, Amber Weiching; Kurtansky, Nicholas; Chandrani, Pratik; Yin, Shen; Mehta, Paras; Navarrete-Dechent, Cristian; Peterson, Gary; King, Kimeil; Dusza, Stephen; Yang, Ning; Liu, Shuaitong; Phillips, William; Guitera, Pascale; Rossi, Anthony; Halpern, Allan; Deng, Liang; Pulitzer, Melissa; Marghoob, Ashfaq; Chen, Chih-Shan Jason; Merghoub, Taha; Rajadhyaksha, Milind
    Response to immunotherapies can be variable and unpredictable. Pathology-based phenotyping of tumors into 'hot' and 'cold' is static, relying solely on T-cell infiltration in single-time single-site biopsies, resulting in suboptimal treatment response prediction. Dynamic vascular events (tumor angiogenesis, leukocyte trafficking) within tumor immune microenvironment (TiME) also influence anti-tumor immunity and treatment response. Here, we report dynamic cellular-level TiME phenotyping in vivo that combines inflammation profiles with vascular features through non-invasive reflectance confocal microscopic imaging. In skin cancer patients, we demonstrate three main TiME phenotypes that correlate with gene and protein expression, and response to toll-like receptor agonist immune-therapy. Notably, phenotypes with high inflammation associate with immunostimulatory signatures and those with high vasculature with angiogenic and endothelial anergy signatures. Moreover, phenotypes with high inflammation and low vasculature demonstrate the best treatment response. This non-invasive in vivo phenotyping approach integrating dynamic vasculature with inflammation serves as a reliable predictor of response to topical immune-therapy in patients.
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    Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study
    (2023) Navarrete-Dechent, Cristian; Cordova, Miguel; Aleissa, Saud; Liopyris, Konstantinos; Dusza, Stephen W.; Kose, Kivanc; Busam, Klaus J.; Hollman, Travis; Lezcano, Cecilia; Pulitzer, Melissa; Chen, Chih-Shan J.; Lee, Erica H.; Rossi, Anthony M.; Nehal, Kishwer S.
    Background: Lentigo maligna/lentigo maligna melanoma (LM/LMM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminarily studies have used reflectance confocal microscopy (RCM) to assess LM/LMM margins.
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    Perifollicular linear projections: A dermatoscopic criterion for the diagnosis of lentigo maligna on the face
    (2024) Navarrete-Dechent, Cristian; Jaimes, Natalia; Dusza, Stephen W.; Liopyris, Konstantinos; Marchetti, Michael A.; Cordova, Miguel; Oliviero, Margaret; Villaseca, Miguel A.; Pulitzer, Melissa; Busam, Klaus J.; Rossi, Anthony M.; Rabinovitz, Harold S.; Nehal, Kishwer S.; Scope, Alon; Marghoob, Ashfaq A.
    Background: Lentigo maligna (LM) can mimic benign, flat, pigmented lesions and can be challenging to diagnose. Objective: To describe a new dermatoscopic feature termed "perifollicular linear projections (PLP)"as a diagnostic criterion for LM on the face. Methods: Retrospective study on reflectance confocal microscopy and dermatoscopy images of flat facial pigmented lesions originating from 2 databases. PLP were defined as short, linear, pigmented projections emanating from hair follicles. Dermatoscopy readers were blinded to the final histopathologic diagnosis. Results: From 83 consecutive LMs, 21/83 (25.3%) displayed "bulging of hair follicles"on reflectance confocal microscopy and 18 of these 21 (85.7%), displayed PLP on dermatoscopy. From a database of 2873 consecutively imaged and biopsied lesions, 252 flat-pigmented facial lesions were included. PLP was seen in 47/76 melanomas (61.8%), compared with 7/176 lesions (3.9%) with other diagnosis (P \ .001). The sensitivity was 61.8% (95% CI, 49.9%-72.7%), specificity 96.0% (95% CI, 92.9%-98.4%). PLP was independently associated with LM diagnosis on multivariate analysis (OR 26.1 [95% CI, 9.6%-71.0]). Limitations: Retrospective study. Conclusion: PLP is a newly described dermatoscopic criterion that may add specificity and sensitivity to the early diagnosis of LM located on the face. We postulate that PLP constitutes an intermediary step in the LM progression model. ( J Am Acad Dermatol 2024;90:52-7.)
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    Treatment of Extramammary Paget Disease and the Role of Reflectance Confocal Microscopy: A Prospective Study
    (2021) Navarrete-Dechent, Cristian; Aleissa, Saud; Cordova, Miguel; Hibler, Brian P.; Erlendsson, Andres M.; Polansky, Max; Cordova, Frank; Lee, Erica H.; Busam, Klaus J.; Hollmann, Travis; Lezcano, Cecilia; Moy, Andrea; Pulitzer, Melissa; Leitao, Mario M., Jr.; Rossi, Anthony M.
    BACKGROUND Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE To evaluate the treatment of EMPD patients and the role of RCM. METHODS Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). Limitations Relatively small sample size. CONCLUSION Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD.