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Risk factors for local recurrence of primary cutaneous squamous cell carcinomas. Treatment by microscopically controlled excision

Dzubow LM; Rigel DS; Robins P
Four hundred fourteen primary cutaneous squamous cell carcinomas were treated by microscopically controlled excision. A five-year mortality-table adjusted cure rate of 93.3% was achieved. The following six parameters were analyzed for correlation with the local recurrence rate: sex, age, lesion diameter, history of previous therapy, anatomic site, and number of stages of Mohs' surgery required for treatment. Only the number of stages correlated significantly with the recurrence rate. However, subpopulations at high risk for recurrent disease could be identified. These consisted of male patients younger than 60 years of age, male patients requiring five or more stages of Mohs' surgery, and patients of either sex with carcinoma of the lower extremity. Modifications of microscopically controlled excision may be warranted in selected patients
PMID: 7138046
ISSN: 0003-987x
CID: 16861

"Small" melanomas: relation of prognostic variables to diameter of primary superficial spreading melanomas

Kopf AW; Rodriguez-Sains RS; Rigel DS; Friedman RJ; Bart RS; Grier WR; Mintzis MM; Postel AH
In a consecutive series of 648 superficial spreading melanomas a significantly better 5-year disease-free survival rate was observed for patients whose primary tumors were 14 mm or less in diameter when compared with those 15 mm or larger in diameter. Other distinguishing features of the group of 'smaller' superficial spreading melanomas were that they occurred in younger patients; were of shorter durations; were more common in women; occurred disproportionately on the lower limbs; were less elevated; tended to be round in shape; were thinner (Breslow); penetrated less deeply (Clark levels); showed less histologic regression; and developed fewer metastases. Based on these findings it is recommended that educational programs be undertaken for the medical profession and for the public to promote early diagnosis and prompt treatment of superficial spreading melanomas when they are small in diameter and more often curable. A color atlas of 'small' melanomas is presented
PMID: 7130508
ISSN: 0148-0812
CID: 16627

The rising incidence and mortality rate of malignant melanoma

Kopf AW; Rigel DS; Friedman RJ
PMID: 7130506
ISSN: 0148-0812
CID: 16862

Is it time for a computer in your practice? III: Types of computer systems for medical offices

Rigel DS
The three basic types of medical-office computer systems have been described along with their basic advantages and disadvantages. A fourth option, that of keeping your current manual office system, may be a valid alternative. The next article of this series will discuss a method for evaluating the suitability of any computer system for your needs and will describe how to select the 'best' one for you
PMID: 7119252
ISSN: 0148-0812
CID: 16863

Is it time for a computer in your practice? II. What tasks your computer can perform

Rigel DS
In this article, the potential benefits of an office computer system have been detailed. As computer costs and sizes decrease, and computing capabilities increase, even more benefits will be had in the future. Of course, not all of these benefits are applicable to all practices. Equally important to note are the many problems associated with installation and use of computer systems, and these must be taken into account before an intelligent decision can be made as to whether its acquisition would benefit your practice. Helping the physician to weigh the benefits of an office computer system against its costs and potential problems will be the subject of the next article in this series
PMID: 7069043
ISSN: 0148-0812
CID: 16864

THE DERMATOPATHOLOGIST SINE AL [Editorial]

Kopf, AW; Rigel, DS
ISI:A1982PL82600002
ISSN: 0193-1091
CID: 30519

MICROSCOPIC SATELLITES ARE HIGHLY PREDICTIVE OF LYMPH-NODE METASTASES IN CLINICAL STAGE-I MELANOMA [Meeting Abstract]

Harrist, TJ; Rigel, D; Day, CL; Sober, AJ; Lew, RA; Harris, MN; Kopf, AW; Fitzpatrick, TB; Mihm, MC
ISI:A1982MX79100134
ISSN: 0023-6837
CID: 30586

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
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%)
PMCID:1352402
PMID: 7055383
ISSN: 0003-4932
CID: 16628

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
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
PMCID:1352401
PMID: 7055382
ISSN: 0003-4932
CID: 16629

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
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
PMCID:1352400
PMID: 7055381
ISSN: 0003-4932
CID: 16630