Kelsey Hirotsu, MD

All Publications

• Endocrine mucin-producing sweat gland carcinoma of the eyelid in an elderly male: A case report. American journal of ophthalmology case reports Ha, S. K., Woldetensaye, A., Brown, R. A., Hirotsu, K. E., Kinde, B. 2025; 40: 102471

  Abstract

  To report a rare case of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid, initially misdiagnosed as a chalazion.A 76-year-old South-Asian male presented with a 9-month history of a painless left upper eyelid lesion. Initial ophthalmic assessment suggested presence of a chalazion that did not resolve with medical management. Examination revealed a 5.5 × 5.5 mm mass at the central left eyelid margin. The lesion transilluminated and extended over the eyelid margin, with splayed lashes but no madarosis. Histopathological examination demonstrated cribriforming glandular epithelium with extracellular mucin and synaptophysin expression, confirming EMPSGC with associated mucinous carcinoma. The patient underwent successful Mohs micrographic surgery with oculoplastic reconstruction and with no evidence of recurrence at five-month follow-up.EMPSGC is an uncommon, low-grade adnexal neoplasm, often under-recognized due to its benign appearance. This case highlights the importance of considering EMPSGC in the differential diagnosis of persistent eyelid lesions, particularly those unresponsive to conservative treatment. Histopathologic evaluation is critical for early recognition and appropriate management of lesions.

  View details for DOI 10.1016/j.ajoc.2025.102471

  View details for PubMedID 41311661

  View details for PubMedCentralID PMC12648717

• Adjuvant radiation is associated with reduced risks of local recurrence and nodal metastasis in high-risk localized cutaneous squamous cell carcinoma: a retrospective multicenter cohort study. International journal of radiation oncology, biology, physics Ran, N. A., Granger, E. E., Brodland, D. G., Canueto, J., Carr, D. R., Carter, J. B., Carucci, J. A., Hirotsu, K. E., Lotter, W., Mangold, A. R., Girardi, F. M., Nijhawan, R., Shahwan, K. T., Srivastava, D., Vidimos, A. T., Willenbrink, T. J., Wysong, A., Schoenfeld, J. D., Margalit, D. N., Tishler, R. B., Gensheimer, M. F., Schaner, P. E., Koyfman, S. A., Ruiz, E. S. 2025

  Abstract

  BACKGROUND: High-risk cutaneous squamous cell carcinomas (HRCSCC) have an increased likelihood of poor outcomes following surgery. Adjuvant radiation therapy (ART) may decrease this risk; however, there is limited data on its efficacy.OBJECTIVE: To evaluate whether ART is associated with reduced risks of local recurrence, locoregional recurrence, nodal metastasis, and disease-specific death in localized, fully resected HRCSCC.METHODS: A retrospective, multicenter cohort study was conducted. Competing risk modeling was performed to evaluate ART, controlling for patient, tumor, and treatment factors.RESULTS: This study included 1,267 HRCSCC, of which 155 (12.2%) received ART. ART was associated with a 50% reduction in the risk of local recurrence (CHR=0.47; 95% CI: 0.23, 0.96; p=0.04), locoregional recurrence (CHR=0.47; 95% CI: 0.26, 0.83; p=0.01), and nodal metastasis (CHR=0.45; 95% CI: 0.21, 0.98; p=0.04). The effect on disease-specific death was small and not statistically significant (CHR=0.83; 95% CI: 0.35, 1.94; p=0.66). In modeling, ART decreased the estimated 5-year cumulative incidence of local recurrence from 11.9% (95% CI, 9.4%-14.0%) to 5.9% (2.8%-9.8%), of locoregional recurrence from 17.8% (15.1%-20.3%) to 9.0% (5.1%-13.6%), and of nodal metastasis from 9.5% (7.3%-11.2%) to 4.6% (1.7%-8.5%). A subset of HRCSCC at greatest risk of poor outcomes was identified and comprised of tumors that were Brigham and Women's Hospital (BWH) stage T3, BWH stage T2 tumors with three risk factors, and/or tumors with lymphovascular invasion. Among these 246 HRCSCC, 74 (30.1%) received ART, and ART was associated with a decreased risk of locoregional recurrence (CHR=0.48; 95% CI: 0.26, 0.89; p=0.02) and nodal metastasis (CHR=0.43; 95% CI: 0.19, 0.97; p=0.04). On modeling, this subgroup experienced greater absolute reductions in the estimated 5-year incidence of locoregional recurrence from 36.6% (95% CI, 30.0%-45.3%) to 20.0% (11.1%, 31.1%) and of nodal metastasis from 21.1% (17.4%-30.9%) to 9.6% (4.2%-18.1%).CONCLUSION: In this retrospective multicenter cohort of HRCSCC, adjuvant radiation was associated with reduced risks of local recurrence and nodal metastasis. Prospective studies are required to further characterize the effect of adjuvant radiation on HRCSCC.

  View details for DOI 10.1016/j.ijrobp.2025.10.007

  View details for PubMedID 41135709

• Risk of recurrence, metastasis, and death for cutaneous squamous cell carcinomas with solitary large caliber perineural invasion: A multicenter cohort study. Journal of the American Academy of Dermatology Ran, N. A., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Carr, D. R., Shahwan, K. T., Hirotsu, K. E., Carucci, J. A., Carter, J. B., Canueto, J., Muradas Girardi, F., Mangold, A. R., Nijhawan, R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Ruiz, E. 2025

  View details for DOI 10.1016/j.jaad.2025.10.054

  View details for PubMedID 41110720

• Patterns of Disease-Specific Death from Cutaneous Squamous Cell Carcinoma: A Multicenter Retrospective Cohort. Journal of the American Academy of Dermatology Gibson, F. T., Ran, N. A., Karn, E. E., Groover, M., Brodland, D. G., Canueto, J., Carr, D. R., Carter, J. B., Carucci, J. A., Hirotsu, K. E., Koyfman, S. A., Mangold, A. R., Girardi, F. M., Nijhawan, R. I., Shahwan, K. T., Srivastava, D., Vidimos, A. T., Willenbrink, T. J., Wysong, A., Zitelli, J. A., Ruiz, E. S. 2025

  View details for DOI 10.1016/j.jaad.2025.10.031

  View details for PubMedID 41076132

• Recurrent status is associated with poor outcomes in cutaneous squamous cell carcinoma. Journal of the European Academy of Dermatology and Venereology : JEADV Cardona-Machado, C., Ran, N. A., Granger, E. E., Brodland, D. G., Carr, D. R., Carter, J. B., Carucci, J. A., Hirotsu, K. E., Koyfman, S. A., Mangold, A. R., Muradas Girardi, F., Shahwan, K. T., Srivastava, D., Nijhawan, R. I., Vidimos, A. T., Willenbrink, T. J., Wysong, A., Ruiz, E. S., Canueto, J. 2025

  View details for DOI 10.1111/jdv.70090

  View details for PubMedID 41055138

• Performance of Staging Systems for Non-head and Neck Cutaneous Squamous Cell Carcinoma. American journal of clinical dermatology Voller, L. M., Hirotsu, K. E., Aasi, S. Z., Nikahd, M., Ruiz, E., Ran, N., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Shahwan, K. T., Carr, D. R. 2025

  Abstract

  BACKGROUND: Data are limited regarding the performance of staging systems for non-head and neck cutaneous squamous cell carcinomas (non-HNCSCCs).OBJECTIVE: The aim of this study was to evaluate the performance of the Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer 8th edition (AJCC8) staging system in predicting poor outcomes in non-HNCSCCs.PATIENTS AND METHODS: Demographics, tumor features and stages, and outcomes for non-HNCSCCs were collected retrospectively from 11 institutions in two countries. Poor outcomes included local recurrence, metastasis, and disease-specific death; major poor outcomes excluded local recurrence. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), concordance index (c-index), and 3-year cumulative incidence were calculated. Cumulative incidence function (CIF) plots were created.RESULTS: 9300 non-HNCSCCs were included. Ninety-five tumors (1%) resulted in major poor outcomes; 250 (2.7%) resulted in poor outcomes. The rate of local recurrence was 1.9%, and the rate of nodal metastasis was 0.74%. Major poor outcomes were predicted with sensitivities 0.48/0.49, specificities 0.98/0.96, PPVs 0.17/0.13, NPVs 0.99/0.99, and c-indices 0.73/0.74 for BWH/AJCC8. Poor outcomes were predicted with sensitivities 0.24/0.26, specificities 0.98/0.97, PPVs 0.22/0.17, NPVs 0.98/0.98, and c-indices 0.61/0.61 for BWH/AJCC8.CONCLUSIONS: Both systems performed similarly in predicting poor outcomes in non-HNCSCCs. Specificity and NPV were high, sensitivity and PPV were low, and c-indices were moderately high. As the c-indices were comparable to those seen in the HNCSCC literature, it is reasonable to use the BWH and AJCC8 staging systems for tumors located off the head and neck. However, further refinement of CSCC staging systems is needed to improve prognostication.

  View details for DOI 10.1007/s40257-025-00987-z

  View details for PubMedID 40996598

• Impact of Immunosuppression on Cutaneous Squamous Cell Carcinoma Outcomes. Journal of the American Academy of Dermatology Klein, J. C., Shahwan, K. T., Petric, U. B., Mallela, T., Voller, L., Ruiz, E., Ran, N., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Hirotsu, K., Carucci, J. A., Carter, J. B., Cañueto, J., Girardi, F. M., Mangold, A. R., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Lotter, W., Jeanselme, V., Nikahd, M., Nijhawan, R. I., Srivastava, D., Carr, D. R. 2025

  Abstract

  Immunosuppression is associated with a higher risk of developing cutaneous squamous cell carcinoma and more aggressive tumors, but its role as an independent predictor of poor outcomes remains unclear.To determine whether immunosuppression independently predicts poor outcomes in cutaneous squamous cell carcinoma.This was a retrospective cohort study with pooled data from 12 international centers. Demographics, immunosuppression status, tumor characteristics, treatment, and outcomes were collected. Univariable and multivariable marginal Fine and Gray competing risk analyses were performed. Subgroup multivariable analyses were performed on the organ transplant and chronic lymphocytic leukemia cohorts.A total of 11,930 patients with 18,760 tumors (14,766 in immunocompetent and 3,994 in immunosuppressed) were included. Immunosuppressed patients had a higher prevalence of high-risk tumor features and poor disease outcomes. On multivariable analysis, immunosuppression was independently associated with local recurrence, distant metastasis, disease-specific death, and major poor outcomes. Organ transplantation was predictive of local recurrence, distant metastasis, and disease-specific death, whereas chronic lymphocytic leukemia independently predicted local recurrence, disease-specific death, and major poor outcomes.Retrospective design, potential for data heterogeneity.Immunosuppression is an independent risk factor for major poor outcomes in cutaneous squamous cell carcinoma and should be included in risk nomograms.

  View details for DOI 10.1016/j.jaad.2025.09.042

  View details for PubMedID 40975132

• Dermatology Scheduling Triage of Transplant Patients and Transplant Candidates to Improve Early Diagnosis and Prevention of Skin Cancer: International Immunosuppression and Transplant Skin Cancer Collaborative Expert Consensus Recommendations. Transplant international : official journal of the European Society for Organ Transplantation Hirotsu, K. E., Crowe, L., Michalski-McNeely, B., Arron, S. T., Bibee, K., Bottomley, M. J., Carr, D. R., Carter, J. B., Christensen, S. R., Chung, C., Jambusaria, A., Ken, K. M., Loss, M. J., Paragh, G., Plasmeijer, E. I., Proby, C., Pugliano-Mauro, M., Shahwan, K. T., Whitley, M. J., Carroll, B. T. 2025; 38: 14711

  Abstract

  Solid organ transplant recipients (SOTRs) have a high risk of developing aggressive skin cancers. However, there are no standardized triage guidelines to assist dermatology clinics with scheduling new patients pre- or post-transplant. Dermatologic care of SOTRs requires multidisciplinary coordination, extensive assessment, tailored counseling, and longitudinal care. Specialized high-risk transplant clinics are designed to address this clinical need but are a limited resource. This triage algorithm aims to provide a practical framework for tertiary care centers or community practice clinics receiving pre- or post-transplant referrals for active concerning growths or routine skin cancer screening exams. In summary, our expert panel recommends SOTRs are seen within 1-2 weeks for evaluation of an active growth and triaged according to their risk factors for the initial post-transplant screening visit (6 months-2+ years post-transplant). Transplant candidates should be seen for pre-transplant evaluation within 1 month of the referral for a skin cancer screening exam, depending on the transplant team's timeline and dermatologist availability. Overall, dermatologists face numerous challenges in caring for transplant patients, and scheduling these patients in a timely manner according to the acuity of their needs will facilitate prevention and early diagnosis of skin cancer, thus improving transplant patient outcomes.

  View details for DOI 10.3389/ti.2025.14711

  View details for PubMedID 41018279

  View details for PubMedCentralID PMC12460180

• Risk factors for regional or distant metastatic disease in sebaceous carcinoma: a retrospective cohort study from the National Cancer Database. Journal of the American Academy of Dermatology Maloney, N. J., Zacher, N. C., Aasi, S. Z., Hirotsu, K. E., Zaba, L. C., Kibbi, N. 2025

  View details for DOI 10.1016/j.jaad.2025.09.007

  View details for PubMedID 40945747

• Validation of Current Staging Systems in HNCSCC: A Multinational Cohort Study. Head & neck Girardi, F. M., Wagner, V. P., Machado, C. D., Wysong, A., Ran, N. A., Granger, E. E., Koyfman, S. A., Vidimos, A. T., Carr, D. R., Shahwan, K. T., Hirotsu, K. E., Carucci, J. A., Carter, J. B., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Jambusaria-Pahlajani, A., Nijhawan, R. I., Ruiz, E. S., Canueto, J. 2025

  Abstract

  IMPORTANCE: Risk stratification of cutaneous squamous cell carcinoma (CSCC) is central to effective management. Despite advancements in the 8th edition of the American Joint Committee on Cancer (AJCC8) staging system, the distinctiveness of T-stages remains limited.OBJECTIVE: To evaluate the effectiveness of the Brigham and Women's Hospital (BWH) and the AJCC8 staging systems in predicting poor outcomes in head and neck (HN) CSCC.DESIGN: A retrospective, multinational cohort study of CSCCs diagnosed between January 10, 1991, and December 31, 2023.SETTING: Twelve centers across the United States (10), Spain (1), and Brazil (1).PARTICIPANTS: Patients with invasive CSCC who underwent curative-intent surgical treatment. Exclusions included cases of lip CSCC, cases with prior HN cancer with associated regional disease, patients with a history of chemotherapy/radiotherapy for other HN neoplasms, and recurrent primary tumors.EXPOSURE: Tumors were staged according to both the AJCC8 TNM staging system and the BWH tumor classification.MAIN OUTCOMES AND MEASURES: Local recurrence (LR), nodal recurrence (NR), distant recurrence (DR), and disease-specific death (DSD).RESULTS: A total of 9852 excised tumors from 3168 patients were included. The 2 systems had comparable monotonicity and homogeneity. Significant differences could be observed in 5-year cumulative incidence for DSD in both BWH and AJCC8, and also for LR in BWH. Higher T-stages exhibited similar curves regarding NR and DR for both AJCC8 and BWH staging systems. Overall, we observed high specificity and NPV, low sensitivity and PPV, and moderately high c-indices for both the BWH and AJCC8 staging systems in predicting the main outcomes for HNCSCC.CONCLUSION AND RELEVANCE: Current AJCC8 and BWH staging systems can accurately predict survival in HNCSCC, although there are still important characteristics to be addressed in future staging systems for better stratification according to the other main outcomes.

  View details for DOI 10.1002/hed.28259

  View details for PubMedID 40709408

• Satellitosis/in-transit metastasis in cutaneous squamous cell carcinoma: Risk factors and the prognostic significance. Journal of the American Academy of Dermatology Pahalyants, V., Jairath, N. K., Maas, D. E., Cheraghlou, S., Mandal, S., Friedman, S., Criscito, M. C., Lee, N., Doudican, N. A., Ruiz, E. S., Ran, N., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Carr, D. R., Shahwan, K. T., Hirotsu, K. E., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Carucci, J. A. 2025

  Abstract

  BACKGROUND: Satellitosis or in-transit metastasis (S-ITM) from cutaneous squamous cell carcinoma (cSCC) is associated with poor outcomes but is not included in current staging guidelines.OBJECTIVE: To determine risk factors and prognostic significance of S-ITM.METHODS: This cohort study included 8,901 patients with cSCC from 12 institutions (1998-2023). Risk factors for S-ITM were calculated using logistic regression. Outcomes were compared with 1:2 propensity score matched controls using a Fine-Gray subdistribution hazard model.RESULTS: Seventy-seven patients developed S-ITM. Increased patient age (OR 1.03, 95% CI 1.01-1.05, p<0.01), history of immunosuppression (OR 4.31, 95% CI 2.59-7.10, p<0.001), higher BWH stage (T2a OR 4.14, 95% CI 2.05-8.41; T2b OR 15.96, 95% CI 8.58-31.19; T3 OR 30.27, 95% CI 10.70-79.04, all p<0.001) and LVI (OR 4.57, 95% CI 1.80-10.38, p=0.001) were independent risk factors for S-ITM. S-ITM was associated with LR (SHR 2.40, 95% CI 1.43-4.04, p<0.001), NM (SHR 1.89 (95% CI .02-3.49, p=0.04), DM (SHR 4.41, 95% CI 1.45-13.27, p=0.01), and DSD (SHR 4.48, 95% CI 2.34-8.58, p<0.001).LIMITATIONS: Retrospective cohort study. The rarity of S-ITM may limit statistical power.CONCLUSION: Patients with cSCC and S-ITM are at higher risk for poor outcomes independent of patient, tumor, and treatment characteristics.

  View details for DOI 10.1016/j.jaad.2025.07.029

  View details for PubMedID 40683360

• Protocol for establishing a large, international, multicenter cutaneous squamous cell carcinoma database ARCHIVES OF DERMATOLOGICAL RESEARCH Hallak, D., Ruiz, E., Ran, N., Granger, E. E., Jambusaria-Pahlajani, A., Koyfman, S., Vidimos, A., Wysong, A., Hirotsu, K., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F., Mangold, A. R., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Srivastava, D., Nijhawan, R. I., Carr, D. R., Shahwan, K. T. 2025; 317 (1)

  View details for DOI 10.1007/s00403-025-04330-8

  View details for Web of Science ID 001526851400002

• Subclinical extension of cutaneous squamous cell carcinoma may predict poor outcomes in immunosuppressed patients treated with Mohs micrographic surgery: A retrospective cohort review. Journal of the American Academy of Dermatology Voller, L. M., Dominguez, J. L., Valencia, A., Maloney, N., Kibbi, N., Aasi, S. Z., Hirotsu, K. E. 2025

  View details for DOI 10.1016/j.jaad.2025.05.1448

  View details for PubMedID 40505738

• Lymphovascular invasion is an independent predictor of metastasis and disease-specific death in cutaneous squamous cell carcinoma: a multicenter retrospective study. Journal of the American Academy of Dermatology Hirotsu, K. E., Aasi, S. Z., Samson, K. K., Zheng, C., Nazaroff, J. R., Voller, L. M., Ruiz, E. S., Ran, N. A., Granger, E. E., Koyfman, S. A., Vidimos, A. T., Carr, D. R., Shahwan, K. T., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Wysong, A. 2025

  Abstract

  BACKGROUND: Lymphovascular invasion (LVI) is regarded as a high-risk feature of cutaneous squamous cell carcinoma (CSCC) but is currently absent from CSCC staging systems.OBJECTIVE: To assess whether LVI serves as an independent predictor of major poor outcomes in CSCC.METHODS: Twelve centers contributed to a multinational CSCC database. Clinical and pathologic risk factors, treatment, and patient outcomes were retrospectively collected. CSCCs were stratified based on LVI status. Tumors that developed major poor outcomes defined as nodal metastasis, in-transit metastasis, distant metastasis, and disease-specific death were identified.RESULTS: A total of 23,166 CSCCs were identified, 179 were LVI+ tumors (0.8%). LVI+ tumors had a higher cumulative incidence of major poor outcomes than those without LVI (33.5% vs. 3.2% at 3 years; overall cumulative incidence function p < 0.001). In an adjusted analysis, LVI+ tumors had an 82% increase in the rate of developing major poor outcomes when compared to LVI- tumors (subdistribution hazard ratio (SHR) = 1.82; p = 0.002). Notably, LVI+ low-stage BWH tumors (T1 or T2a) had a greater cumulative incidence of major poor outcomes compared to LVI- BWH low-stage tumors (20.7% vs. 1.61% at 3 years, overall cumulative incidence function p < 0.001).LIMITATIONS: Retrospective study design CONCLUSION: The presence of LVI in CSCC is a high-risk feature that is an independent predictor of metastasis and disease-specific death in both low and high BWH stage tumors.

  View details for DOI 10.1016/j.jaad.2025.04.029

  View details for PubMedID 40253009

• A multicenter validation study of Mohs micrographic surgery vs wide local excision in primary high-stage cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology Wang, D. M., Ran, N. A., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Carr, D. R., Shahwan, K. T., Hirotsu, K. E., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Nijhawan, R. I., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Ruiz, E. S. 2025

  View details for DOI 10.1016/j.jaad.2025.04.010

  View details for PubMedID 40210096

• Risk Factor Number and Recurrence, Metastasis, and Disease-Related Death in Cutaneous Squamous Cell Carcinoma. JAMA dermatology Ran, N. A., Granger, E. E., Brodland, D. G., Canueto, J., Carr, D. R., Carter, J. B., Carucci, J. A., Hirotsu, K. E., Koyfman, S. A., Mangold, A. R., Girardi, F. M., Shahwan, K. T., Srivastava, D., Vidimos, A. T., Willenbrink, T. J., Wysong, A., Ruiz, E. S. 2025

  Abstract

  Importance: Cutaneous squamous cell carcinoma (CSCC) risk stratification is central to management, and physicians rely on tumor staging systems to estimate risk. The Brigham and Women's Hospital (BWH) T staging system predicts risk based on 4 tumor risk factors (RFs). However, stage is not precisely associated with the number of RFs, as BWH stage T2b includes CSCCs with 2 and 3 RFs.Objective: To determine how RF number is associated with the risk of recurrence, metastasis, and disease-related death.Design, Setting, and Participants: This retrospective multination cohort study of CSCCs diagnosed between October 1, 1991, and July 19, 2023, was conducted at 12 centers in the US (10), Spain (1), and Brazil (1). Invasive CSCCs with confirmed negative margins longer than 14 days were included. Tumors were excluded if they were metastatic at presentation or received adjuvant therapy. Data were analyzed from October 2023 to August 2024.Interventions or Exposures: CSCCs were stratified by the number of the following RFs (0, 1, 2, 3, or 4): a diameter of 2 cm or larger, poorly differentiated histology, tumor extension beyond subcutaneous fat, and large caliber nerve invasion.Main Outcomes and Measures: Five-year cumulative incidences of local recurrence, nodal metastasis, distant metastasis, and disease-specific death.Results: A total of 16 844 CSCCs were included (5978 female individuals [35.5%]; median [IQR] age, 73.9 [65.7-81.8] years), with 0 (12 657 [75.1%]), 1 (2892 [17.2%]), 2 (1015 [6.0%]), 3 (225 [1.3%]) or 4 (55 [0.3%]) RFs. Median (IQ) follow up time was 33.6 (14.5-60.3) months. For local recurrence, the risk increased as the number of RF increased from 0 (1.7%; 95% CI, 1.5%-2.0%) to 1 (5.0%; 95% CI, 4.1%-5.9%) to 2 (8.8%; 95% CI, 7.0%-11.0%) to 3 (16.0%; 95% CI, 11.0%-22.0%) to 4 (33.0%; 95% CI, 19.0%-47.0%; P<.001 for between-group differences). This increase was also observed for nodal metastasis (0.6% [95% CI, 0.4%-0.7%] vs 3.6% [95% CI, 2.9%-4.4%] vs 11.0% [95% CI, 9.2%-13.0%] vs 20.0% [95% CI, 15.0%-26.0%] vs 28.0% [95% CI, 15.0%-42.0%], respectively; P<.001), distant metastasis (0.2% [95% CI, 0.1%-0.3%] vs 1.1% [95% CI, 0.7%-1.6%] vs 2.3% [95% CI, 1.4%-3.4%] vs 7.9% [95% CI, 4.6%-12.0%] vs 8.4% [95% CI, 2.6%-19.0%], respectively; P<.001), and disease-specific death (0.3% [95% CI, 0.2%-0.4%] vs 1.9% [95% CI, 1.4%-2.7%] vs 5.4% [95% CI, 4.0%-7.0%] vs 11.0% [95% CI, 6.7%-16.0%] vs 25% [95% CI, 12%-39%], respectively; P<.001). CSCCs with 3 RFs had higher cumulative incidences of local recurrence (1.6-fold), nodal metastasis (1.9-fold), distant metastasis (4.3-fold), and disease-specific death (1.9-fold) compared with those with 2 RFs.Conclusions and Relevance: The results of this cohort study suggest that the number of RFs is an indicator of risk, and among BWH T2b tumors, those with 3 RFs represent a higher risk subset.

  View details for DOI 10.1001/jamadermatol.2025.0128

  View details for PubMedID 40105853

• riSCC: A personalized risk model for the development of poor outcomes in cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology Jambusaria-Pahlajani, A., Jeanselme, V., Wang, D. M., Ran, N. A., Granger, E. E., Canueto, J., Brodland, D. G., Carr, D. R., Carter, J. B., Carucci, J. A., Hirotsu, K. E., Karn, E. E., Koyfman, S. A., Mangold, A. R., Muradas Girardi, F., Shahwan, K. T., Srivastava, D., Vidimos, A. T., Willenbrink, T. J., Wysong, A., Lotter, W., Ruiz, E. S. 2025

  Abstract

  BACKGROUND: Cutaneous squamous cell carcinoma (CSCC) is a prevalent disease for which improved risk stratification strategies are needed.OBJECTIVE: To develop a novel prognostic model (herein "riSCC") for CSCC and compare riSCC performance to Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer Staging 8th Edition (AJCC8) T staging systems.METHODS: Retrospective 12-center, multinational cohort study of CSCCs from 1991 to 2023. Clinical and pathologic risk factors, treatments, and outcomes were collected. Fine-Gray model was employed for each outcome with inverse probability of treatment weighting. A final model was trained for prospective use and estimation of hazard ratios.RESULTS: 23,166 localized CSCC tumors were included. riSCC prognostic model performed superiorly to American Joint Committee on Cancer 8th edition and Brigham and Women's Hospital T staging for all outcomes. At five years, the C-index for riSCC ranged from 0.74 for LR to 0.87 for DSD.LIMITATIONS: Retrospective study design CONCLUSION: riSCC prognostic model offers fine-grained risk estimates and improved stratification for important CSCC outcomes compared to T staging systems.

  View details for DOI 10.1016/j.jaad.2025.02.076

  View details for PubMedID 40024391

• Identifying the Impact of Minor Risk Factors in Brigham and Women's Hospital Stage T1 Cutaneous Squamous Cell Carcinomas on Risk of Poor Outcomes: A Retrospective Cohort Study. Journal of the American Academy of Dermatology Shahwan, K. T., Walker, T. D., Tan, A., Ruiz, E., Ran, N., Granger, E. E., Koyfman, S., Vidimos, A., Wysong, A., Hirotsu, K. E., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Carr, D. R. 2025

  Abstract

  BACKGROUND: While Brigham and Women's Hospital (BWH) T1 cutaneous squamous cell carcinomas (CSCCs) are overall low risk, a small subset develop poor outcomes.OBJECTIVE: To evaluate the impact of minor risk factors on poor outcomes in T1 tumors.METHODS: Data was collected retrospectively from 11 centers. Univariable and multivariable regression analyses were performed evaluating the impact of minor risk factors (moderate differentiation, diameter 1-2 centimeters, fat invasion, and small-caliber perineural invasion [PNI]) on poor outcomes. Cumulative incidence function (CIF) plots were created for time to poor outcomes by number of minor risk factors.RESULTS: 15,481 BWH T1 tumors were included, of which 90 (0.58%) developed major poor outcomes and 332 (2.1%) developed any poor outcome. Minor risk factors that were significant on multivariable analysis included moderate differentiation, diameter, and subcutaneous fat invasion. CIF plots demonstrated an increased risk of poor outcomes with presence of multiple minor risk factors; the risk of metastasis and major poor outcomes exceeded 5% in tumors with 3 minor risk factors.LIMITATIONS: Retrospective design, limited number of major poor outcomes.CONCLUSION: T1 tumors with multiple minor risk factors may be eligible for closer surveillance. Future staging systems should consider incorporating both major and minor risk factors.

  View details for DOI 10.1016/j.jaad.2025.02.052

  View details for PubMedID 40010504

• 5-fluorouracil 5% cream for squamous cell carcinoma in situ: Factors impacting treatment response. Journal of the American Academy of Dermatology Lin, C. P., Kibbi, N., Bandali, T., Hirotsu, K., Aasi, S. Z. 2024

  Abstract

  BACKGROUND: Complete clinical response (CCR) rates for squamous cell carcinoma in situ (SCCis) treated with 5-fluorouracil (5-FU) 5% cream range from 27-85%. Factors associated with CCR are not well-established.METHODS: Retrospective review of biopsy-proven primary SCCis diagnosed between 5/1/2019-4/30/2020 and treated with 5-FU 5% cream. Disease status at follow-up was recorded, with treatment failure defined as persistent or recurrent disease.RESULTS: The study included 149 SCCis cases, including 33.6% (50/149) arising in the context of immunosuppression. Eighteen cases failed treatment (10 persistent disease, 8 recurrent disease). By tumor size, CCR was noted in 128/144 (88.9%) tumors measuring <2 centimeters in diameter and 3/5 tumors ≥2 centimeters (60.0%, p=0.051). By treatment duration, CCR was observed in 4/7 (57.1%) tumors treated for <2 weeks, 72/83 (86.7%), tumors treated for 2 to <4 weeks, and 55/59 (93.2%) tumors treated for ≥4 weeks (p=0.019). On multivariate analysis, treatment failure was significantly associated with shorter treatment durations (OR 0.26; p=0.007) and increasing tumor size (OR 2.40; p=0.037).CONCLUSIONS: Shorter treatment duration and larger lesion size were significantly associated with failure of 5-FU in SCCis. Immunosuppression and anatomic location were not significant factors, supporting 5-FU use for SCCis in the immunosuppressed population and highlighting its versatility irrespective of anatomic location.

  View details for DOI 10.1016/j.jaad.2024.10.066

  View details for PubMedID 39521136

• Most cutaneous squamous cell carcinoma recurrences occur in the first three years after diagnosis: A multicenter retrospective cohort study. Journal of the American Academy of Dermatology Granger, E. E., Ran, N. A., Groover, M. K., Koyfman, S. A., Vidimos, A. T., Wysong, A., Carr, D. R., Shahwan, K. T., Hirotsu, K. E., Carucci, J. A., Carter, J. B., Canueto, J., Girardi, F. M., Mangold, A. R., Srivastava, D., Brodland, D. G., Zitelli, J. A., Willenbrink, T. J., Ruiz, E. S. 2024

  View details for DOI 10.1016/j.jaad.2024.06.072

  View details for PubMedID 38971189

• Histopathologic Characterization of Incidental Lesions Encountered During Mohs Micrographic Surgery With MART-1 Immunohistochemistry. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Hirotsu, K. E., Kibbi, N., Rieger, K. E., Aasi, S. Z. 2023

  Abstract

  As the use of melanoma antigen recognized by T cells (MART-1) immunohistochemistry (IHC) with Mohs surgery increases for the treatment of melanoma in situ and invasive melanoma, surgeons should be aware of MART-1 staining patterns of incidental lesions often encountered on frozen sections. Lack of this knowledge can lead to unnecessary additional surgery, increased health care costs, and loss of valuable laboratory staff time and resources.To characterize the histopathologic features of incidental lesions encountered during Mohs surgery for melanoma. To review key diagnostic and differentiating features on hematoxylin and eosin staining (H&E) and MART-1 IHC of these lesions.A comprehensive review of frozen-section histopathology slides from Mohs cases with MART-1 IHC at our institution was conducted from 2021 to 2023.Incidental benign and malignant lesions were identified and characterized on H&E frozen sections and MART-1 IHC. Although such entities can share MART-1 staining characteristics with melanoma in situ or melanoma, distinguishing characteristics on H&E and lack of histopathologic criteria for melanoma on MART-1 IHC can be used to distinguish these incidental lesions from melanoma.Staining of frozen sections for Mohs micrographic surgery with H&E and MART-1 IHC together can differentiate common incidental benign and malignant cutaneous lesions from melanoma.

  View details for DOI 10.1097/DSS.0000000000004048

  View details for PubMedID 38064448

• Association of histopathological grade with stage and survival in sebaceous carcinoma: a retrospective cohort study in the National Cancer Database. Journal of the American Academy of Dermatology Maloney, N. J., Zacher, N. C., Aasi, S. Z., Hirotsu, K. E., Zaba, L. C., Kibbi, N. 2023

  View details for DOI 10.1016/j.jaad.2023.07.1013

  View details for PubMedID 37532139

• Online risk calculator and nomogram for predicting sentinel lymph node positivity in Merkel Cell Carcinoma. Journal of the American Academy of Dermatology Maloney, N. J., Aasi, S. Z., Kibbi, N., Hirotsu, K. E., Zaba, L. C. 2023

  View details for DOI 10.1016/j.jaad.2023.05.042

  View details for PubMedID 37244414

• Comparison of clinicopathologic features, survival, and demographics in sebaceous carcinoma patients with and without Muir-Torre syndrome. Journal of the American Academy of Dermatology Maloney, N. J., Zacher, N. C., Hirotsu, K. E., Rajan, N., Aasi, S. Z., Kibbi, N. 2023

  Abstract

  Visceral malignancies in patients with Lynch syndrome behave less aggressively than in those without Lynch syndrome. The behavior of sebaceous carcinoma (SC) in Muir-Torre syndrome (MTS), a variant of Lynch syndrome, is incompletely investigated.Investigate features and survival of SC patients with and without MTS.Retrospective cohort study in the Surveillance, Epidemiology, and End Results 17 database from 2000-2019 of patients with SC. Patients were classified as MTS or non-MTS cases based on a threshold score of 2 on the Mayo MTS Risk Score.We identified 105 (2.8%) MTS cases and 3677 (97.2%) non-MTS cases. On univariate analysis, MTS patients were younger, had a higher proportion of tumors outside the head/neck, and had fewer high-grade tumors. On Kaplan-Meier analysis, MTS patients trended toward having better SC-specific survival. On multivariate Cox proportional hazards analysis adjusting for other covariates, MTS status was an independent predictor of worse overall survival. However, there was no association between MTS status and SC-specific survival.Given relatively high disease-specific survival in SC, our study may have been underpowered to detect a difference on Kaplan-Meier analysis.Our study suggests SC does not behave more aggressively in patients with MTS.

  View details for DOI 10.1016/j.jaad.2023.03.032

  View details for PubMedID 37003478

• Positive surgical margins in sebaceous carcinoma: risk factors and prognostic impact. Journal of the American Academy of Dermatology Maloney, N. J., Aasi, S. Z., Hirotsu, K. E., Zaba, L. C., Kibbi, N. 2023

  View details for DOI 10.1016/j.jaad.2023.01.049

  View details for PubMedID 36907557

• Acanthosis nigricans in the setting of severe pulmonary disease exacerbated by COVID-19 infection. JAAD case reports Hirotsu, K. E., Chiang, A., Bahrani, E., Cloutier, J. M., Rieger, K. E., Kwong, B. Y., Aleshin, M. 2022

  View details for DOI 10.1016/j.jdcr.2022.04.017

  View details for PubMedID 35529073

• Histologic subtype of cutaneous immune-related adverse events predicts overall survival in patients receiving immune checkpoint inhibitors. Journal of the American Academy of Dermatology Hirotsu, K. E., Scott, M. K., Marquez, C., Tran, A. T., Rieger, K. E., Novoa, R. A., Robinson, W. H., Kwong, B. Y., Zaba, L. C. 2021

  View details for DOI 10.1016/j.jaad.2021.11.050

  View details for PubMedID 34875301

• Complete remission from intralesional talimogene laherparepvec for regionally advanced Merkel cell carcinoma in an immunocompromised solid organ transplant patient. JAAD case reports Hirotsu, K. E., Hua, V., Tran, A. T., Morris, L., Reddy, S. A., Kwong, B. Y., Zaba, L. C. 2021; 13: 144-146

  View details for DOI 10.1016/j.jdcr.2021.05.005

  View details for PubMedID 34195326

• Clinical Characterization of Mogamulizumab-Associated Rash During Treatment of Mycosis Fungoides or Sezary Syndrome. JAMA dermatology Hirotsu, K. E., Neal, T. M., Khodadoust, M. S., Wang, J. Y., Rieger, K. E., Strelo, J., Hong, E., Kim, Y. H., Kwong, B. Y. 2021

  Abstract

  Importance: Mogamulizumab is a monoclonal antibody against CCR4 approved for treatment for mycosis fungoides (MF) and Sezary syndrome (SS). Mogamulizumab-associated rash (MAR) is difficult to differentiate from cutaneous MF or SS, which can lead to unnecessary discontinuation of drug use because of concern for severe drug reaction or incorrect presumption of disease relapse or progression in the skin.Objective: To examine the most common clinical presentations of MAR in patients with MF or SS and the diagnostic and management challenges.Design, Setting, and Participants: This retrospective case series assessed patients from a multidisciplinary cutaneous lymphoma clinic and supportive oncodermatology clinic at a major academic referral center who had a diagnosis of MF or SS and received mogamulizumab from January 1, 2013, to January 1, 2020. Treatment was followed by new or worsening rash with skin biopsy results compatible with drug eruption determined by clinicopathologic correlation and molecular testing to exclude active malignant disease.Exposures: At least 1 dose of mogamulizumab.Main Outcomes and Measures: Mogamulizumab-associated rash was characterized by clinical features, including time to onset, clinical presentation, histopathologic features, and management approach.Results: The study included 19 patients with MF or SS who developed MAR (median age, 65 years; age range, 38-82 years; 10 [52.6%] male). Median time to MAR onset was 119 days (range, 56 days to 3.8 years). Patients with MAR exhibited 4 predominant clinical presentations: (1) folliculotropic MF-like scalp plaques with alopecia, (2) papules and/or plaques, (3) photoaccentuated dermatitis, and (4) morbilliform or erythrodermic dermatitis. The most common anatomical region involved was the head and neck, including the scalp. Histopathologic findings were variable and did not correspond to primary clinical morphologic findings. Immunohistochemistry and T-cell clonality ancillary testing were helpful to distinguish MAR from disease. Most patients with MAR (14 of 19) discontinued mogamulizumab treatment; however, no life-threatening severe cutaneous adverse drug reactions occurred, and the decision for drug therapy cessation was usually multifactorial. Four patients were treated again with mogamulizumab with no life-threatening drug-related events. Approaches to management of MAR include topical corticosteroids, systemic corticosteroids, and/or methotrexate.Conclusions and Relevance: This case series found that mogamulizumab-associated rash had a heterogeneous clinical presentation with variable and delayed onset in patients with MF or SS. Mogamulizumab-associated rash exhibited a predilection for the head and neck and was difficult to clinically distinguish from relapse or progression of disease. Recognition of the most common clinical presentations can help prevent unnecessary discontinuation of mogamulizumab treatment. The presence of MAR does not necessitate permanent discontinuation of or avoidance of retreatment with mogamulizumab.

  View details for DOI 10.1001/jamadermatol.2021.0877

  View details for PubMedID 33881447

• An ulcerated violaceous nodule on the thigh. JAAD case reports Hirotsu, K. E., Kumar, A. M., Rieger, K. E., Chen, J. K. 2021; 9: 61–63

  View details for DOI 10.1016/j.jdcr.2021.01.011

  View details for PubMedID 33665278

• Histopathologic Characterization of Mogamulizumab-associated Rash. The American journal of surgical pathology Wang, J. Y., Hirotsu, K. E., Neal, T. M., Raghavan, S. S., Kwong, B. Y., Khodadoust, M. S., Brown, R. A., Novoa, R. A., Kim, Y. H., Rieger, K. E. 2020

  Abstract

  Rash is one of the most common adverse events observed with mogamulizumab, an anti-C-C chemokine receptor 4 monoclonal antibody approved for previously treated mycosis fungoides (MF) and Sezary syndrome (SS). Given the nonspecific clinical presentations of this rash, histopathologic distinction from MF/SS is critical for informing clinical management. We performed a comprehensive characterization of the histopathologic findings in mogamulizumab-associated rash (MAR) with the integration of high-throughput sequencing of T-cell receptor (TCR) genes. Fifty-two biopsy specimens from 19 patients were evaluated retrospectively. Three major histologic reaction patterns were identified: spongiotic/psoriasiform dermatitis (33/52), interface dermatitis (11/52), and granulomatous dermatitis (8/52). Almost half of the specimens (21/52) showed at least 2 of these reaction patterns concurrently. Dermal eosinophils were not a consistent feature, being present in only half (27/52) of specimens and prominent in only 3. Features mimicking MF/SS, including lymphocyte exocytosis, lamellar fibroplasia, and adnexal involvement, were commonly seen but tended to be focal and mild. In 38/43 specimens with available immunohistochemistry, intraepidermal lymphocytes demonstrated a CD4:CD8 ratio ≤1 : 1. Low background levels of the patient's previously identified MF/SS-associated TCR sequence(s) were demonstrated in 20/46 specimens analyzed by high-throughput sequencing of TCR. We conclude that MAR may demonstrate diverse histologic features. Findings that may distinguish MAR from MF/SS include the inverted or normalized CD4:CD8 ratio within intraepidermal lymphocytes and demonstration of absent or nondominant levels of disease-associated TCR sequences. Correlation with the clinical findings and immunohistochemical and molecular characterization of the patient's MF/SS before mogamulizumab, when possible, may facilitate recognition of MAR.

  View details for DOI 10.1097/PAS.0000000000001587

  View details for PubMedID 32976123

• Clinicopathologic characterization of enfortumab vedotin-associated cutaneous toxicity in patients with urothelial carcinoma. Journal of the American Academy of Dermatology Hirotsu, K. E., Rana, J. n., Wang, J. Y., Raghavan, S. S., Rieger, K. E., Srinivas, S. n., Fan, A. C., Kwong, B. Y., Novoa, R. A., Zaba, L. n. 2020

  View details for DOI 10.1016/j.jaad.2020.11.067

  View details for PubMedID 33301805

• Treatment of Hypertrophic Granulation Tissue: A Literature Review. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Hirotsu, K., Kannan, S., Brian Jiang, S. I. 2019

  Abstract

  BACKGROUND: Hypertrophic granulation tissue (HGT) is an uncommon but a frustrating complication of wound healing. Given its low prevalence and often refractory nature, many treatment options have been explored.OBJECTIVE: No comprehensive review exists on HGT management in dermatology literature; thus, the authors hope to compile a review of available treatments.MATERIALS AND METHODS: An exhaustive key word search of 3 databases was performed for treatment of HGT. Results from these reports were summarized in this review.RESULTS: Methods of treatment included silver nitrate, topical steroids (n = 11), intralesional steroids (n = 55), steroid tape (n = 25), surgical removal, polyurethane foam dressing (n = 32), and pulsed-dye laser (n = 13).CONCLUSION: With all treatment methods, the cases and studies reported varying degrees of successful treatment with HGT reduction. Given the lack of published literature, it remains unknown whether the initial injury preceding HGT formation determines treatment modality success. For HGT refractory to silver nitrate, choice of treatment depends on accessibility, ease of use, cost, and location of the wound. Intralesional and topical steroids should both be considered. Polyurethane foam can be considered an adjunct treatment. If resources allow, laser treatment should also be considered.

  View details for DOI 10.1097/DSS.0000000000002059

  View details for PubMedID 31403535

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption JAMA DERMATOLOGY Hirotsu, K., Dang, T. M., Li, S., Neal, J. W., Pugliese, S., Subramanian, A., Kwong, B. Y. 2019; 155 (7): 848–50

  View details for DOI 10.1001/jamadermatol.2019.0063

  View details for Web of Science ID 000482127300016

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption. JAMA dermatology Hirotsu, K. n., Dang, T. M., Li, S. n., Neal, J. W., Pugliese, S. n., Subramanian, A. n., Kwong, B. Y. 2019

  View details for PubMedID 31017625

• Cardiotoxicity associated with immune checkpoint inhibitors in cutaneous oncology. Journal of the American Academy of Dermatology Tabata, M. M., Choi, S. n., Hirotsu, K. n., Kwong, B. n., Soleymani, T. n. 2019

  View details for DOI 10.1016/j.jaad.2019.08.033

  View details for PubMedID 31437546

• Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair VASCULAR AND ENDOVASCULAR SURGERY Ullery, B. W., Suh, G., Hirotsu, K., Zhu, D., Lee, J. T., Dake, M. D., Fleischmann, D., Cheng, C. P. 2018; 52 (3): 173–80

  Abstract

  To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair.Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention.The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P < .005) and lower than both the left subclavian and brachiocephalic branch angles postintervention ( P < .05). From pre- to postoperative, no significant change in branch angle was found in any of the great vessels. Maximum curvature change of the stented lumen from pre- to postprocedure was greater than those of the ascending aorta and aortic arch ( P < .05).Thoracic endovascular aortic repair results in relative straightening of the stented aortic region and also accentuates the native curvature of the ascending aorta when the endograft has a more proximal landing zone. Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.

  View details for PubMedID 29400263

• Promoting sunscreen use and sun-protective practices in NCAA athletes: Impact of SUNSPORT educational intervention for student-athletes, athletic trainers, and coaches JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Ally, M. S., Swetter, S. M., Hirotsu, K. E., Gordon, J., Kim, D., Wysong, A., Donnelly, L., Li, S., Nord, K. M. 2018; 78 (2): 289-+

  Abstract

  Student-athletes (SAs) have an increased skin cancer risk on account of significant ultraviolet exposure; however, their sun-protective practices are suboptimal. A novel program, Stanford University Network for Sun Protection, Outreach, Research, and Teamwork (SUNSPORT), was designed to target SAs, coaches, and athletic trainers (ATs).To measure the impact of educational intervention on sun protection beliefs and practices of SAs.A survey of sun protection beliefs and practices was administered to National Collegiate Athletic Association athletes before and after intervention. SUNSPORT dermatologists educated SAs, coaches, and ATs regarding skin cancer risk and prevention methods. The main outcome was frequency of sunscreen use by SAs before versus after intervention.A total of 846 National Collegiate Athletic Association athletes were surveyed between September 23, 2012, and September 20, 2015. After intervention, significant increases were observed in sunscreen use 4 or more days per week by SAs (from 26% to 39% [P = .02]), SAs spoken to by their coach about sun safety (from 26% to 57% [P = .0001]), and SA recognition of higher skin cancer risk (from 54% to 67% [P = .04]).Intervention in only 1 West Coast university and no paired data.Following the SUNSPORT intervention, SAs were significantly more likely to use sunscreen, especially if encouraged by their coach. This study emphasizes that education directed to SAs, ATs, and coaches can improve sun-protective practices in SAs.

  View details for PubMedID 28993006

• Changes in Geometry and Cardiac Deformation of the Thoracic Aorta after Thoracic Endovascular Aortic Repair Hirotsu, K., Suh, G., Lee, J. T., Dake, M. D., Fleischmann, D., Cheng, C. P. ELSEVIER SCIENCE INC. 2018: 83–89

  View details for DOI 10.1016/j.avsg.2017.07.033

  View details for Web of Science ID 000418233100011

• Changes in Geometry and Cardiac Deformation of the Thoracic Aorta after Thoracic Endovascular Aortic Repair. Annals of vascular surgery Hirotsu, K., Suh, G., Lee, J. T., Dake, M. D., Fleischmann, D., Cheng, C. P. 2017

  Abstract

  BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has dramatically expanded treatment options for patients with thoracic aortic pathology. The interaction between endografts and the dynamic anatomy of the thoracic aorta is not well characterized for repetitive physiologic stressors and subsequent issues related to long-term durability. Through three-dimensional (3D) modeling we sought to quantify cardiac-induced aortic deformation before and after TEVAR to assess the impact of endografts on dynamic aortic anatomy.METHODS: Eight patients with acute (n=4) or chronic (n=3) type B dissections, or chronic arch aneurysm (n=1), underwent TEVAR with a single (n=5) or multiple (n=3) Gore C-TAG(s). Cardiac-resolved thoracic CT images were acquired pre- and post-TEVAR. 3D models of thoracic aorta and branch vessels were constructed in systole and diastole. Axial length, mean, and peak curvature of the ascending aorta, arch, and stented lumens were computed from the aortic lumen centerline, delineated with branch vessel landmarks. Cardiac-induced deformation was computed from mid-diastole to end-systole.RESULTS: Pre-TEVAR, there were no significant cardiac-induced changes for aortic axial length or mean curvature. Post-TEVAR, the ascending aorta increased in axial length (2.7±3.1%, P<0.05) and decreased in mean curvature (0.38±0.05 0.36±0.05cm-1, P<0.05) from diastole to systole. From pre- to post-TEVAR, axial length change increased in the ascending aorta (P<0.02), mean curvature decreased in the arch and stented aorta (P<0.03), and peak curvature decreased in the stented aorta (P<0.05).CONCLUSIONS: TEVAR for a range of indications not only causes direct geometric changes to the stented aorta but also results in dynamic changes to the ascending and stented aorta. In our cohort, endograft placement straightens the stented aorta and mutes cardiac-induced bending due to longitudinal stiffness. This is compensated by greater length and curvature changes from diastole to systole in the ascending aorta, relative to pre-TEVAR.

  View details for PubMedID 28887263

• Localized bullous pemphigoid in a melanoma patient with dual exposure to PD-1 checkpoint inhibition and radiation therapy. JAAD case reports Hirotsu, K. n., Chiou, A. S., Chiang, A. n., Kim, J. n., Kwong, B. Y., Pugliese, S. n. 2017; 3 (5): 404–6

  View details for PubMedID 28884139

• Volumetric analysis demonstrates that true and false lumen remodeling persists for 12 months after thoracic endovascular aortic repair JOURNAL OF VASCULAR SURGERY CASES AND INNOVATIVE TECHNIQUES Suh, G., Hirotsu, K., Beygui, R. E., Dake, M. D., Fleischmann, D., Cheng, C. P. 2016; 2 (3): 101–4

  View details for DOI 10.1016/j.jvscit.2016.05.001

  View details for Web of Science ID 000438436000012

• Volumetric analysis demonstrates that true and false lumen remodeling persists for 12 months after thoracic endovascular aortic repair. Journal of vascular surgery cases and innovative techniques Suh, G. Y., Hirotsu, K., Beygui, R. E., Dake, M. D., Fleischmann, D., Cheng, C. P. 2016; 2 (3): 101-104

  Abstract

  A 62-year-old man underwent an elephant trunk procedure followed by thoracic endovascular aortic repair (TEVAR). Computed tomography angiography-based models were built to quantify volume of the whole aorta and true and false lumens preoperatively, before TEVAR, after TEVAR, and at follow-up at 3, 6, and 12 months. With TEVAR, descending aortic true lumen volume increased by 54%, then increased additionally by 60% during 12 months. The descending aortic false lumen volume regressed continuously for 12 months following TEVAR, with the most rapid rate from 6 to 12 months at 16 cm3/month. TEVAR immediately increased true lumen volume and continued to remodel the true and false lumens throughout the following 12 months.

  View details for DOI 10.1016/j.jvscit.2016.05.001

  View details for PubMedID 38827208

  View details for PubMedCentralID PMC11140378

• Geometric analysis of thoracic aorta and arch branches before and after TEVAR Suh, G., Hirotsu, K., Zhu, Y. D., Lee, J., Dake, M., Fleischmann, D., Cheng, C. ELSEVIER SCIENCE INC. 2015: B129

  View details for DOI 10.1016/j.jacc.2015.08.340

  View details for Web of Science ID 000363329000283