Bio

Bio


Sumaira Z. Aasi, M.D., is a Professor of Dermatology and Director of Mohs and Dermatologic Surgery. Dr. Aasi completed a fellowship in Mohs micrographic surgery and cutaneous oncology at Yale University where she was on faculty and served as Associate Chief. Dr. Aasi helped train fellows in Mohs and Micrographic Surgery for over ten years. She has served on the Board of Directors of the American College of Mohs Surgery. Her clinical interests include management of high risk nonmelanoma skin cancers, Mohs histopathology, and reconstructive surgery.

Clinical Focus


  • Cancer > Cutaneous (Dermatologic) Oncology
  • Dermatologic Surgery
  • Mohs Micrographic Surgery
  • Melanoma and Skin Cancer
  • Skin oncology in transplant patients
  • Laser Surgery
  • Dermatology

Academic Appointments


Honors & Awards


  • Distinguished Service Award, American College of Mohs Surgery (2013)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2011)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2010)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2009)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2008)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2007)
  • Connecticut Magazine Top Doctors, Connecticut Magazine (2006)
  • Cutting Edge Research Grant Award, American Society of Dermatologic Surgery` (2003)

Professional Education


  • Fellowship:Yale Micrographic and Dermatologic Fellowship (2002) CT
  • Residency:Northwestern University Dermatology Residency (2001) IL
  • Internship:University of Chicago Medical Center Internal Medicine Residency (1998) IL
  • Board Certification: Dermatology, American Board of Dermatology (2001)
  • Medical Education:Northwestern University Feinberg School of Medicine (1997) IL

Research & Scholarship

Current Research and Scholarly Interests


High risk squamous cell carcinoma; frozen histopathology; reconstructive surgery.

Clinical Trials


  • A Study of Vismodegib With Surgery in Participants With Previously Untreated Basal Cell Carcinoma Not Recruiting

    This randomized, double-blind, placebo-controlled study will assess the efficacy and safety of vismodegib with surgery in participants with basal cell carcinoma.

    Stanford is currently not accepting patients for this trial. For more information, please contact Irene Bailey-Healy, 408-892-7261.

    View full details

  • Analysis of Cutaneous and Hematologic Disorders by High-Throughput Nucleic Acid Sequencing Not Recruiting

    The goal of this study is to identify genetic changes associated with the initiation, progression, and treatment response of response of cutaneous and hematologic disorders using recently developed high-throughput sequencing technologies. The improved understanding of the genetic changes associated with cutaneous and hematologic disorders may lead to improved diagnostic, prognostic and therapeutic options for these disorders.

    Stanford is currently not accepting patients for this trial. For more information, please contact Alexander Ungewickell, 650-723-6661.

    View full details

  • Vismodegib in Treating Patients With Basal Cell Carcinoma (BCC) Not Recruiting

    The purpose of this study is to learn about the effect of vismodegib on sporadic basal cell carcinoma (BCCs) prior to surgical removal.

    Stanford is currently not accepting patients for this trial. For more information, please contact Irene Bailey, 650-721-7149.

    View full details

Teaching

2018-19 Courses


Publications

All Publications


  • Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma Updates on Classification and Management DERMATOLOGIC CLINICS Soleymani, T., Aasi, S. Z., Novoa, R., Hollmig, S. 2019; 37 (3): 253-+
  • Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Updates on Classification and Management. Dermatologic clinics Soleymani, T., Aasi, S. Z., Novoa, R., Hollmig, S. T. 2019; 37 (3): 253–59

    Abstract

    Atypical fibroxanthoma and undifferentiated pleomorphic sarcoma, or pleomorphic dermal sarcoma, are rare malignant cutaneous neoplasms existing along a clinicopathologic spectrum. Although these tumors share many similarities, recognition of distinguishing characteristics may predict differences in clinical behavior and outcomes. Salient features defining atypical fibroxanthoma include superficial tumors with minimal high-risk histologic features. Deeper tumors with high-risk histologic features are often clinically aggressive and should be appropriately designated as pleomorphic dermal sarcoma. Surgery remains gold standard in management; tumor extirpation with complete margin control is critical. In the high-risk tumor cohort, comprehensive evaluation and multidisciplinary management is paramount for optimal outcomes.

    View details for PubMedID 31084719

  • Dissecting intratumoral heterogeneity and microenvironment interactions in SCC through single-cell RNA-sequencing Ji, A., Rubin, A., Reynolds, D., Guo, M., Bhaduri, A., George, B., Hollmig, S., Aasi, S., Khavari, P. ELSEVIER SCIENCE INC. 2019: S24
  • An open-label phase 2 clinical trial of topical remetinostat gel for basal cell carcinoma Urman, N., Eichstadt, S., Do, H., Mirza, A. N., Li, S., Oro, A., Aasi, S., Sarin, K. Y. ELSEVIER SCIENCE INC. 2019: S171
  • Dissecting the keratinocyte lineage of basal cell carcinoma using single cell RNA sequencing Lee, G., Guerrero-Juarez, C. F., Do, H., Aasi, S., Nie, Q., Sarin, K. Y., Atwood, S. ELSEVIER SCIENCE INC. 2019: S27
  • LAP2 Proteins Chaperone GLI1 Movement between the Lamina and Chromatin to Regulate Transcription CELL Mirza, A. N., McKellar, S. A., Urman, N. M., Brown, A. S., Hollmig, T., Aasi, S. Z., Oro, A. E. 2019; 176 (1-2): 198-+
  • PD-L1 Expression and Tumor-Infiltrating Lymphocytes in High-Risk and Metastatic Cutaneous Squamous Cell Carcinoma OTOLARYNGOLOGY-HEAD AND NECK SURGERY Amoils, M., Kim, J., Lee, C., Sunwoo, J. B., Colevas, A., Aasi, S. Z., Hollmig, S., Ma, Y., Divi, V. 2019; 160 (1): 93–99
  • Corrigendum to 'Clinical perineural invasion of cutaneous head and neck cancer: Impact of radiotherapy, imaging, and nerve growth factor receptors on symptom control and prognosis'. [Oral Oncol. 85 (2018) 60-67]. Oral oncology Chen, J. J., Harris, J. P., Kong, C. S., Sunwoo, J. B., Divi, V., Horst, K. C., Aasi, S. Z., Hollmig, S. T., Hara, W. Y. 2019

    View details for DOI 10.1016/j.oraloncology.2019.05.024

    View details for PubMedID 31174982

  • LAP2 Proteins Chaperone GLI1 Movement between the Lamina and Chromatin to Regulate Transcription. Cell Mirza, A. N., McKellar, S. A., Urman, N. M., Brown, A. S., Hollmig, T., Aasi, S. Z., Oro, A. E. 2018

    Abstract

    Understanding transcription factor navigation through the nucleus remains critical for developing targeted therapeutics. The GLI1 transcription factor must maintain maximal Hedgehog pathway output in basal cell carcinomas (BCCs), and we have previously shown that resistant BCCs increase GLI1 deacetylation through atypical protein kinase Ciota/lambda (aPKC) andHDAC1. Here we identify a lamina-associated polypeptide 2 (LAP2) isoform-dependent nuclear chaperoning system that regulates GLI1 movement between the nuclear lamina and nucleoplasm to achieve maximal activation. LAP2beta forms a two-site interaction with the GLI1 zinc-finger domain and acetylation site, stabilizing an acetylation-dependent reserve on the inner nuclear membrane (INM). By contrast, the nucleoplasmic LAP2alpha competes with LAP2beta for GLI1 while scaffolding HDAC1 to deacetylate the secondary binding site. aPKC functions to promote GLI1 association with LAP2alpha, promoting egress off the INM. GLI1 intranuclear trafficking by LAP2 isoforms represents a powerful signal amplifier in BCCs with implications for zinc finger-based signal transduction and therapeutics.

    View details for PubMedID 30503211

  • Clinical perineural invasion of cutaneous head and neck cancer: Impact of radiotherapy, imaging, and nerve growth factor receptors on symptom control and prognosis. Oral oncology Chen, J. J., Harris, J. P., Kong, C. S., Sunwoo, J. B., Divi, V., Horst, K. C., Aasi, S. Z., Hollmig, S. T., Hara, W. Y. 2018; 85: 60–67

    Abstract

    OBJECTIVES: Clinical perineural invasion (CPNI) of cutaneous head and neck cancer is associated with poor prognosis and presents a therapeutic dilemma. The purpose of this study was to determine the relationship between CPNI and nerve growth factor receptors (NGFR), and the impact of radiotherapy (RT), imaging, and NGFR on symptom control and disease-related outcomes.MATERIALS AND METHODS: We retrospectively reviewed patients with CPNI of cutaneous head and neck cancer who were treated with RT between 2010 and 2015 at our institution. Exact chi-square and Wilcoxon rank-sum tests compared patients with positive versus negative staining for TrkA and/or CD271. Gray's test determined differences in cumulative incidences of 1- and 2-year locoregional recurrence (LRR) and cancer-specific mortality (CSM).RESULTS: Twenty-three patients had a median overall follow-up of 31.4 months from initial clinical symptoms and 19.7 months from pathological confirmation of PNI. The most prevalent symptoms were numbness (70%) and pain (57%). Sixteen patients (70%) experienced symptom improvement or control, especially decreased pain (85%), within a median of 2.6 months from starting RT. The 1- and 2-year rates of overall LRR were 37% and 71%, while those of overall CSM were 11% and 25%, respectively. Patients who stained positively for TrkA and/or CD271 had significantly worse LRR compared to patients who stained negatively for both markers (p = 0.046).CONCLUSION: Positive TrkA and/or CD271 staining predicts worse outcomes. Patients may benefit from aggressive RT for local control and symptom improvement. Future research is needed to identify the potential for anti-nerve growth factor therapies in CPNI.

    View details for PubMedID 30220321

  • Clinical perineural invasion of cutaneous head and neck cancer: Impact of radiotherapy, imaging, and nerve growth factor receptors on symptom control and prognosis ORAL ONCOLOGY Chen, J., Harris, J. P., Kong, C. S., Sunwoo, J. B., Divi, V., Horst, K. C., Aasi, S. Z., Hollmig, S., Hara, W. Y. 2018; 85: 60–67
  • Frequent basal cell cancer development is a clinical marker for inherited cancer susceptibility JCI INSIGHT Cho, H. G., Kuo, K. Y., Li, S., Bailey, I., Aasi, S., Chang, A. S., Oro, A. E., Tang, J. Y., Sarin, K. Y. 2018; 3 (15)

    Abstract

    Innate DNA repair mechanisms play a critical role in protecting skin keratinocytes from UV mutagenesis and skin cancer development. We hypothesized that individuals who develop frequent skin cancers may harbor germline defects in DNA repair genes and have increased predisposition to internal malignancies. We enrolled 61 patients with unusually frequent basal cell carcinoma (BCC) development, seen at Stanford Hospital and Clinics from January 2005 until December 2015, for germline analysis of 29 DNA repair genes. In parallel, a case-control retrospective review was performed to interrogate the association of malignancies with frequent BCC development in a large US medical insurance claims database (Truven), which included 13,264 individuals with 6 or more BCCs from 2007 to 2011. 19.7% of the frequent BCC cohort harbored pathogenic mutations in DNA repair genes: APC, BARD1, BRCA1, BRCA2, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, NBN, and PALB2. Individuals with 6 or more BCCs had an increased risk of other malignancies, with a 3.5-fold increase in the frequent BCC cohort and a 3.2-fold increase in the Truven database. Individuals who developed frequent BCCs have an increased prevalence of germline mutations in DNA repair genes and increased malignancy risk. Our data implicate frequent BCC development as an external marker of inherited cancer risk.

    View details for DOI 10.1172/jci.insight.122744

    View details for Web of Science ID 000441201300022

    View details for PubMedID 30089731

  • PD-L1 Expression and Tumor-Infiltrating Lymphocytes in High-Risk and Metastatic Cutaneous Squamous Cell Carcinoma. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Amoils, M., Kim, J., Lee, C., Sunwoo, J. B., Colevas, A. D., Aasi, S. Z., Hollmig, S. T., Ma, Y., Divi, A. V. 2018: 194599818788057

    Abstract

    Objective To characterize programmed death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocyte (TIL) positivity for locally aggressive or regionally metastatic cutaneous head and neck squamous cell carcinoma (cHNSCC). Study Design Retrospective chart review, followed by immunohistochemical staining of archived tumor specimens. Setting Tertiary academic medical center. Subjects and Methods After identification of 101 patients treated surgically for locally advanced or regionally metastatic cHNSCC, archived tissue was stained and graded for PD-L1 expression in addition to TIL presence. Cross-tabulation was performed to examine the association between either of these variables and clinicopathologic features and outcomes. Results A total of 101 patients met inclusion criteria, but archived tissue was available only for 83 (31 primaries, 52 metastases). The majority of primary tumors demonstrated grade 1 PD-L1 staining, while grade 2 staining was more likely for metastases. Neither high- nor low-grade PD-L1 expression correlated with any clinicopathologic variable for primary tumors. However, for metastases, high-grade staining was significantly associated with regional recurrence (15 of 19, P = .02). TILs were present for 65% of primary tumors and 90% of regional metastases but did not correlate with any clinicopathologic variables. Conclusion Diffuse expression of PD-L1 in this study highlights the possibility of using immunotherapy in the form of programmed death 1/PD-L1 blockade to improve treatment for this devastating disease. However, further studies are needed to clarify the significance of PD-L1 expression and TIL positivity for locally advanced or regionally metastatic cHNSCC.

    View details for PubMedID 30012051

  • Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Margulis, K., Chiou, A. S., Aasi, S. Z., Tibshirani, R. J., Tang, J. Y., Zare, R. N. 2018; 115 (25): 6347–52
  • Merkel Cell Carcinoma, Version 1.2018 Clinical Practice Guidelines in Oncology JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Bichakjian, C. K., Olencki, T., Aasi, S. Z., Alam, M., Andersen, J. S., Blitzblau, R., Bowen, G. M., Contreras, C. M., Daniels, G. A., Decker, R., Farma, J. M., Fisher, K., Gastman, B., Ghosh, K., Grekin, R. C., Grossman, K., Ho, A. L., Lewis, K. D., Loss, M., Lydiatt, D. D., Messina, J., Nehal, K. S., Nghiem, P., Puzanov, I., Schmults, C. D., Shaha, A. R., Thomas, V., Xu, Y. G., Zic, J. A., Hoffmann, K. G., Engh, A. M. 2018; 16 (6): 742–74

    Abstract

    This selection from the NCCN Guidelines for Merkel Cell Carcinoma (MCC) focuses on areas impacted by recently emerging data, including sections describing MCC risk factors, diagnosis, workup, follow-up, and management of advanced disease with radiation and systemic therapy. Included in these sections are discussion of the new recommendations for use of Merkel cell polyomavirus as a biomarker and new recommendations for use of checkpoint immunotherapies to treat metastatic or unresectable disease. The next update of the complete version of the NCCN Guidelines for MCC will include more detailed information about elements of pathology and addresses additional aspects of management of MCC, including surgical management of the primary tumor and draining nodal basin, radiation therapy as primary treatment, and management of recurrence.

    View details for DOI 10.6004/jnccn.018.0055

    View details for Web of Science ID 000435146500010

    View details for PubMedID 29891526

  • MRTF inhibition displays promising therapeutic potential in human BCC patient explants Whitson, R. J., Mirza, A., Yao, C. Y., McKeller, S. A., Hollmig, S., Aasi, S., Sarin, K. Y., Tang, J., Oro, A. E. ELSEVIER SCIENCE INC. 2018: S36
  • Distinguishing malignant from benign microscopic skin lesions using desorption electrospray ionization mass spectrometry imaging. Proceedings of the National Academy of Sciences of the United States of America Margulis, K., Chiou, A. S., Aasi, S. Z., Tibshirani, R. J., Tang, J. Y., Zare, R. N. 2018

    Abstract

    Detection of microscopic skin lesions presents a considerable challenge in diagnosing early-stage malignancies as well as in residual tumor interrogation after surgical intervention. In this study, we established the capability of desorption electrospray ionization mass spectrometry imaging (DESI-MSI) to distinguish between micrometer-sized tumor aggregates of basal cell carcinoma (BCC), a common skin cancer, and normal human skin. We analyzed 86 human specimens collected during Mohs micrographic surgery for BCC to cross-examine spatial distributions of numerous lipids and metabolites in BCC aggregates versus adjacent skin. Statistical analysis using the least absolute shrinkage and selection operation (Lasso) was employed to categorize each 200-µm-diameter picture element (pixel) of investigated skin tissue map as BCC or normal. Lasso identified 24 molecular ion signals, which are significant for pixel classification. These ion signals included lipids observed at m/z 200-1,200 and Krebs cycle metabolites observed at m/z < 200. Based on these features, Lasso yielded an overall 94.1% diagnostic accuracy pixel by pixel of the skin map compared with histopathological evaluation. We suggest that DESI-MSI/Lasso analysis can be employed as a complementary technique for delineation of microscopic skin tumors.

    View details for PubMedID 29866838

  • Noncanonical hedgehog pathway activation through SRF-MKL1 promotes drug resistance in basal cell carcinomas. Nature medicine Whitson, R. J., Lee, A., Urman, N. M., Mirza, A., Yao, C. Y., Brown, A. S., Li, J. R., Shankar, G., Fry, M. A., Atwood, S. X., Lee, E. Y., Hollmig, S. T., Aasi, S. Z., Sarin, K. Y., Scott, M. P., Epstein, E. H., Tang, J. Y., Oro, A. E. 2018; 24 (3): 271–81

    Abstract

    Hedgehog pathway-dependent cancers can escape Smoothened (SMO) inhibition through mutations in genes encoding canonical hedgehog pathway components; however, around 50% of drug-resistant basal cell carcinomas (BCCs) lack additional variants of these genes. Here we use multidimensional genomics analysis of human and mouse drug-resistant BCCs to identify a noncanonical hedgehog activation pathway driven by the transcription factor serum response factor (SRF). Active SRF along with its coactivator megakaryoblastic leukemia 1 (MKL1) binds DNA near hedgehog target genes and forms a previously unknown protein complex with the hedgehog transcription factor glioma-associated oncogene family zinc finger-1 (GLI1), causing amplification of GLI1 transcriptional activity. We show that cytoskeletal activation through Rho and the formin family member Diaphanous (mDia) is required for SRF-MKL-driven GLI1 activation and for tumor cell viability. Remarkably, nuclear MKL1 staining served as a biomarker in tumors from mice and human subjects to predict tumor responsiveness to MKL inhibitors, highlighting the therapeutic potential of targeting this pathway. Thus, our study illuminates, for the first time, cytoskeletal-activation-driven transcription as a personalized therapeutic target for combatting drug-resistant malignancies.

    View details for PubMedID 29400712

    View details for PubMedCentralID PMC5839965

  • Node-positive cutaneous squamous cell carcinoma of the head and neck: Survival, high-risk features, and adjuvant chemoradiotherapy outcomes. Head & neck Amoils, M., Lee, C. S., Sunwoo, J., Aasi, S. Z., Hara, W., Kim, J., Sirjani, D., Colevas, A. D., Chang, A. L., Divi, V. 2017

    Abstract

    Data lacks to guide treatment of regionally metastatic cutaneous head and neck squamous cell carcinoma (HNSCC).We conducted a retrospective review of 80 patients treated for regionally metastatic cutaneous HNSCC. The effect of various clinicopathologic variables on overall survival (OS) was investigated, in addition to outcomes by treatment modality.On multivariate regression, cutaneous primary >2 cm (p = .03) and extracapsular spread (ECS; p = .01) were significantly associated with decreased OS. Location of regional metastasis (neck vs parotid vs both) had no effect on OS (p = .2), nor did the presence of a cutaneous primary at the time of presentation (p = .9). The 3-year survival was 43%, 52%, and 49% for surgery alone, adjuvant radiation, and adjuvant chemoradiation, respectively. Fifty-one percent of patients had a recurrence of their disease.Regionally metastatic cutaneous HNSCC is an aggressive disease associated with high recurrence rates. Patients with tumors >2 cm and ECS have poorer OS despite adjuvant therapy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 881-885, 2017.

    View details for DOI 10.1002/hed.24692

    View details for PubMedID 28252823

  • Combined inhibition of atypical PKC and histone deacetylase 1 is cooperative in basal cell carcinoma treatment. JCI insight Mirza, A. N., Fry, M. A., Urman, N. M., Atwood, S. X., Roffey, J., Ott, G. R., Chen, B., Lee, A., Brown, A. S., Aasi, S. Z., Hollmig, T., Ator, M. A., Dorsey, B. D., Ruggeri, B. R., Zificsak, C. A., Sirota, M., Tang, J. Y., Butte, A., Epstein, E., Sarin, K. Y., Oro, A. E. 2017; 2 (21)

    Abstract

    Advanced basal cell carcinomas (BCCs) circumvent Smoothened (SMO) inhibition by activating GLI transcription factors to sustain the high levels of Hedgehog (HH) signaling required for their survival. Unfortunately, there is a lack of efficacious therapies. We performed a gene expression-based drug repositioning screen in silico and identified the FDA-approved histone deacetylase (HDAC) inhibitor, vorinostat, as a top therapeutic candidate. We show that vorinostat only inhibits proliferation of BCC cells in vitro and BCC allografts in vivo at high dose, limiting its usefulness as a monotherapy. We leveraged this in silico approach to identify drug combinations that increase the therapeutic window of vorinostat and identified atypical PKC Ɩ/ʎ (aPKC) as a HDAC costimulator of HH signaling. We found that aPKC promotes GLI1-HDAC1 association in vitro, linking two positive feedback loops. Combination targeting of HDAC1 and aPKC robustly inhibited GLI1, lowering drug doses needed in vitro, in vivo, and ex vivo in patient-derived BCC explants. We identified a bioavailable and selective small-molecule aPKC inhibitor, bringing the pharmacological blockade of aPKC and HDAC1 into the realm of clinical possibility. Our findings provide a compelling rationale and candidate drugs for combined targeting of HDAC1 and aPKC in HH-dependent cancers.

    View details for PubMedID 29093271

  • Classification of basal cell carcinoma in human skin using machine learning and quantitative features captured by polarization sensitive optical coherence tomography BIOMEDICAL OPTICS EXPRESS Marvdashti, T., Duan, L., Aasi, S. Z., Tang, J. Y., Bowden, A. K. 2016; 7 (9): 3721-3735

    Abstract

    We report the first fully automated detection of basal cell carcinoma (BCC), the most commonly occurring type of skin cancer, in human skin using polarization-sensitive optical coherence tomography (PS-OCT). Our proposed automated procedure entails building a machine-learning based classifier by extracting image features from the two complementary image contrasts offered by PS-OCT, intensity and phase retardation (PR), and selecting a subset of features that yields a classifier with the highest accuracy. Our classifier achieved 95.4% sensitivity and specificity, validated by leave-one-patient-out cross validation (LOPOCV), in detecting BCC in human skin samples collected from 42 patients. Moreover, we show the superiority of our classifier over the best possible classifier based on features extracted from intensity-only data, which demonstrates the significance of PR data in detecting BCC.

    View details for DOI 10.1364/BOE.7.003721

    View details for Web of Science ID 000385416500045

    View details for PubMedCentralID PMC5030045

  • Classification of basal cell carcinoma in human skin using machine learning and quantitative features captured by polarization sensitive optical coherence tomography. Biomedical optics express Marvdashti, T., Duan, L., Aasi, S. Z., Tang, J. Y., Ellerbee Bowden, A. K. 2016; 7 (9): 3721-3735

    Abstract

    We report the first fully automated detection of basal cell carcinoma (BCC), the most commonly occurring type of skin cancer, in human skin using polarization-sensitive optical coherence tomography (PS-OCT). Our proposed automated procedure entails building a machine-learning based classifier by extracting image features from the two complementary image contrasts offered by PS-OCT, intensity and phase retardation (PR), and selecting a subset of features that yields a classifier with the highest accuracy. Our classifier achieved 95.4% sensitivity and specificity, validated by leave-one-patient-out cross validation (LOPOCV), in detecting BCC in human skin samples collected from 42 patients. Moreover, we show the superiority of our classifier over the best possible classifier based on features extracted from intensity-only data, which demonstrates the significance of PR data in detecting BCC.

    View details for PubMedID 27699133

  • Update to an open-label clinical trial of vismodegib as neoadjuvant before surgery for high-risk basal cell carcinoma (BCC) JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Kwon, G. P., Ally, M., Bailey-Healy, I., Oro, A. E., Kim, J., Chang, A., Aasi, S., Tang, J. Y. 2016; 75 (1): 213–15

    View details for PubMedID 27317518

  • Management of High-Risk Squamous Cell Carcinoma of the Skin. Current treatment options in oncology Fu, T., Aasi, S. Z., Hollmig, S. T. 2016; 17 (7): 34-?

    Abstract

    Non-melanoma skin cancer (NMSC) is the most common malignancy in the USA, with cutaneous squamous cell carcinomas (cSCCs) constituting approximately 20 % of all NMSC. While cSCCs typically behave in an indolent fashion and can be cured with local destructive or surgical methods, a small subset metastasizes and induces significant morbidity and mortality. Identifying and aggressively treating these "high-risk" cSCCs (HRcSCCs) is thus paramount. Recent improvements in staging cSCCs appear to offer better risk stratification than earlier staging criteria. Radiologic imaging and sentinel lymph node biopsy may be beneficial in certain cases of HRcSCC, although more studies are needed before these techniques should be uniformly incorporated into management. Surgery with complete margin control, such as that offered by the Mohs micrographic technique, represents the first-line treatment for these tumors. Radiation therapy is likely most beneficial in the adjuvant setting. Chemotherapy is typically best reserved for patients with metastatic or locally advance disease that is not controllable with surgical and/or radiation therapies. Newer targeted treatments, such as EGFR inhibitors and immunotherapies may offer greater efficacy in these settings, although further evaluation is needed.

    View details for DOI 10.1007/s11864-016-0408-2

    View details for PubMedID 27262708

  • Basal Cell Skin Cancer, Version 1.2016 JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Bichakjian, C. K., Olencki, T., Aasi, S. Z., Alam, M., Andersen, J. S., Berg, D., Bowen, G. M., Cheney, R. T., Daniels, G. A., Glass, L. F., Grekin, R. C., Grossman, K., Higgins, S. A., Ho, A. L., Lewis, K. D., Lydiatt, D. D., Nehal, K. S., Nghiem, P., Olsen, E. A., Schmults, C. D., Sekulic, A., Shaha, A. R., Thorstad, W. L., Tuli, M., Urist, M. M., Wang, T. S., Wong, S. L., Zic, J. A., Hoffmann, K. G., Engh, A. 2016; 14 (5): 574-596

    Abstract

    Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy. Two hedgehog pathway inhibitors were recently approved by the FDA for systemic treatment of advanced and metastatic BCC, and others are in development. The NCCN Guidelines for Basal Cell Skin Cancer, published in full herein, include recommendations for selecting among the various surgical approaches based on patient-, lesion-, and disease-specific factors, as well as guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors.

    View details for Web of Science ID 000375888500012

  • Skin Cancer Prevention and Treatment in Solid Organ Transplant Patients: A Survey of the International Transplant Skin Cancer Collaborative. Dermatologic surgery Wang, A., Chan, A., Aasi, S., Lee, C., Krathen, M. 2016; 42 (5): 682-683

    View details for DOI 10.1097/DSS.0000000000000668

    View details for PubMedID 27045747

  • Histopathologic assessment of depth of follicular invasion of squamous cell carcinoma (SCC) in situ (SCCis): Implications for treatment approach JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Christensen, S. R., McNiff, J. M., Cool, A. J., Aasi, S. Z., Hanlon, A. M., Leffell, D. J. 2016; 74 (2): 356-362

    Abstract

    Squamous cell carcinoma in situ (SCCis) has been reported to involve the hair follicle epithelium. Deep follicular invasion is often cited as a cause of treatment failure.We sought to define the frequency and the depth of hair follicle invasion by SCCis.The study included both a retrospective review of intraoperative pathology specimens from 42 SCCis cases treated with Mohs micrographic surgery and a prospective evaluation of serially sectioned SCCis tissue from 12 additional patients. Pathology specimens were analyzed for follicular invasion of SCCis.SCCis invasion of the superficial hair follicle infundibulum was observed in 61.3% to 87.5% of cases in the 2 cohorts, whereas invasion of the isthmus and lower follicle was observed in only 8.3% to 12.5% of cases. In most tumors the depth of follicular invasion was comparable with the thickness of the surrounding epidermis. The maximum observed depth of follicular invasion was 0.82 mm.The study was performed on a limited number of cases referred for surgery at a single institution.Although SCCis invasion of the upper hair follicle infundibulum is common, deep invasion below the level of the surrounding epidermis is rare. This may have implications for optimal therapy of this condition.

    View details for DOI 10.1016/j.jaad.2015.09.060

    View details for Web of Science ID 000368272600022

  • Histopathologic assessment of depth of follicular invasion of squamous cell carcinoma (SCC) in situ (SCCis): Implications for treatment approach. Journal of the American Academy of Dermatology Christensen, S. R., McNiff, J. M., Cool, A. J., Aasi, S. Z., Hanlon, A. M., Leffell, D. J. 2016; 74 (2): 356–62

    Abstract

    Squamous cell carcinoma in situ (SCCis) has been reported to involve the hair follicle epithelium. Deep follicular invasion is often cited as a cause of treatment failure.We sought to define the frequency and the depth of hair follicle invasion by SCCis.The study included both a retrospective review of intraoperative pathology specimens from 42 SCCis cases treated with Mohs micrographic surgery and a prospective evaluation of serially sectioned SCCis tissue from 12 additional patients. Pathology specimens were analyzed for follicular invasion of SCCis.SCCis invasion of the superficial hair follicle infundibulum was observed in 61.3% to 87.5% of cases in the 2 cohorts, whereas invasion of the isthmus and lower follicle was observed in only 8.3% to 12.5% of cases. In most tumors the depth of follicular invasion was comparable with the thickness of the surrounding epidermis. The maximum observed depth of follicular invasion was 0.82 mm.The study was performed on a limited number of cases referred for surgery at a single institution.Although SCCis invasion of the upper hair follicle infundibulum is common, deep invasion below the level of the surrounding epidermis is rare. This may have implications for optimal therapy of this condition.

    View details for PubMedID 26670714

  • Two dimensional imaging of basal cell carcinoma using desorption electrospray ionization mass spectrometry (DESI-MS) Chiou, A. S., Eberlin, L. S., Planell-Mendez, I., Ransohoff, K. J., Tang, I. Y., Aasi, S. Z., Zare, R. N. NATURE PUBLISHING GROUP. 2015: S36
  • FIRST REPORT OF ERBIUM LASER AS THE PREFERRED TREATMENT IN A COMPARISON OF FIVE MODALITIES FOR STEATOCYSTOMA MULTIPLEX Crispin, M., Ally, M., Hollmig, T., Aasi, S., Rahman, Z. WILEY-BLACKWELL. 2015: 51
  • Towards automated detection of basal cell carcinoma from polarization sensitive optical coherence tomography images of human skin Marvdashti, T., Duan, L., Ransohoff, K. J., Aasi, S. Z., Tang, J. Y., Ellerbee, A. K., IEEE IEEE. 2015
  • An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma. Journal of the American Academy of Dermatology Ally, M. S., Aasi, S., Wysong, A., Teng, C., Anderson, E., Bailey-Healy, I., Oro, A., Kim, J., Chang, A. L., Tang, J. Y. 2014; 71 (5): 904-911 e1

    Abstract

    Vismodegib is an oral hedgehog-pathway inhibitor approved for advanced basal cell carcinoma (BCC). Although most BCCs are amenable to surgery, excision of large tumors in aesthetically sensitive sites may compromise function or cosmesis.We sought to evaluate the reduction in BCC surgical defect area after 3 to 6 months of neoadjuvant vismodegib.This was an open-label, single-arm intervention trial with a primary outcome of change in target-tumor surgical defect area pre- and post-vismodegib (150 mg/d). Secondary outcomes were change in tumor area and tolerability.Eleven of 15 enrolled patients, aged 39 to 100 years, completed the trial. Thirteen target tumors were excised after a mean of 4±2 months of vismodegib. In all, 29% (4 of 14 patients) could not complete more than 3 months because of vismodegib-related side effects. The mean baseline target-tumor diameter was 3.2 cm, and 10 of 13 tumors occurred on the face. Overall, vismodegib reduced the surgical defect area by 27% (95% confidence interval -45.7% to -7.9%; P=.006) from baseline. Vismodegib was not effective in patients who received less than 3 months. Over a mean follow-up of 11.5 (range 4-21) months for all tumors, only 1 tumor recurred at 17 months post-Mohs micrographic surgery.Short follow-up time and no placebo control are limitations.Neoadjuvant vismodegib appears to reduce surgical defect area when taken for 3 months or longer for nonrecurrent BCCs in functionally sensitive locations. Further studies with larger sample sizes and long-term follow-up are warranted.

    View details for DOI 10.1016/j.jaad.2014.05.020

    View details for PubMedID 24929884

  • An investigator-initiated open-label clinical trial of vismodegib as a neoadjuvant to surgery for high-risk basal cell carcinoma JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Ally, M. S., Aasi, S., Wysong, A., Teng, C., Anderson, E., Bailey-Healy, I., Oro, A., Kim, J., Chang, A. L., Tang, J. Y. 2014; 71 (5): 904-U304

    Abstract

    Vismodegib is an oral hedgehog-pathway inhibitor approved for advanced basal cell carcinoma (BCC). Although most BCCs are amenable to surgery, excision of large tumors in aesthetically sensitive sites may compromise function or cosmesis.We sought to evaluate the reduction in BCC surgical defect area after 3 to 6 months of neoadjuvant vismodegib.This was an open-label, single-arm intervention trial with a primary outcome of change in target-tumor surgical defect area pre- and post-vismodegib (150 mg/d). Secondary outcomes were change in tumor area and tolerability.Eleven of 15 enrolled patients, aged 39 to 100 years, completed the trial. Thirteen target tumors were excised after a mean of 4±2 months of vismodegib. In all, 29% (4 of 14 patients) could not complete more than 3 months because of vismodegib-related side effects. The mean baseline target-tumor diameter was 3.2 cm, and 10 of 13 tumors occurred on the face. Overall, vismodegib reduced the surgical defect area by 27% (95% confidence interval -45.7% to -7.9%; P=.006) from baseline. Vismodegib was not effective in patients who received less than 3 months. Over a mean follow-up of 11.5 (range 4-21) months for all tumors, only 1 tumor recurred at 17 months post-Mohs micrographic surgery.Short follow-up time and no placebo control are limitations.Neoadjuvant vismodegib appears to reduce surgical defect area when taken for 3 months or longer for nonrecurrent BCCs in functionally sensitive locations. Further studies with larger sample sizes and long-term follow-up are warranted.

    View details for DOI 10.1016/j.jaad.2014.05.020

    View details for Web of Science ID 000343918200035

  • Recurrent point mutations in the kinetochore gene KNSTRN in cutaneous squamous cell carcinoma NATURE GENETICS Lee, C. S., Bhaduri, A., Mah, A., Johnson, W. L., Ungewickell, A., Aros, C. J., Nguyen, C. B., Rios, E. J., Siprashvili, Z., Straight, A., Kim, J., Aasi, S. Z., Khavari, P. A. 2014; 46 (10): 1060-1062

    Abstract

    Here we report the discovery of recurrent mutations concentrated at an ultraviolet signature hotspot in KNSTRN, which encodes a kinetochore protein, in 19% of cutaneous squamous cell carcinomas (SCCs). Cancer-associated KNSTRN mutations, most notably those encoding p.Ser24Phe, disrupt chromatid cohesion in normal cells, occur in SCC precursors, correlate with increased aneuploidy in primary tumors and enhance tumorigenesis in vivo. These findings suggest a role for KNSTRN mutagenesis in SCC development.

    View details for DOI 10.1038/ng.3091

    View details for Web of Science ID 000342554100007

    View details for PubMedCentralID PMC4324615

  • Recurrent point mutations in the kinetochore gene KNSTRN in cutaneous squamous cell carcinoma. Nature genetics Lee, C. S., Bhaduri, A., Mah, A., Johnson, W. L., Ungewickell, A., Aros, C. J., Nguyen, C. B., Rios, E. J., Siprashvili, Z., Straight, A., Kim, J., Aasi, S. Z., Khavari, P. A. 2014; 46 (10): 1060-1062

    Abstract

    Here we report the discovery of recurrent mutations concentrated at an ultraviolet signature hotspot in KNSTRN, which encodes a kinetochore protein, in 19% of cutaneous squamous cell carcinomas (SCCs). Cancer-associated KNSTRN mutations, most notably those encoding p.Ser24Phe, disrupt chromatid cohesion in normal cells, occur in SCC precursors, correlate with increased aneuploidy in primary tumors and enhance tumorigenesis in vivo. These findings suggest a role for KNSTRN mutagenesis in SCC development.

    View details for DOI 10.1038/ng.3091

    View details for PubMedID 25194279

  • The Role of Vismodegib in the Management of Advanced Basal Cell Skin Cancers: A Review CURRENT DERMATOLOGY REPORTS Ally, M. S., Aasi, S. Z. 2014; 3 (2): 98–102
  • Single-stage turn-over muscular hinge flap with Burow's full-thickness skin graft to repair oral commissure defect. Dermatologic surgery Wysong, A., Aasi, S. Z. 2013; 39 (10): 1530-1534

    View details for DOI 10.1111/dsu.12216

    View details for PubMedID 23590278

  • Comment on basal cell carcinoma rebound after cessation of vismodegib in an individual with basal cell nevus syndrome. Dermatologic surgery Ally, M. S., Wysong, A., Tang, J. Y., Aasi, S. 2013; 39 (9): 1413-1414

    View details for DOI 10.1111/dsu.12250

    View details for PubMedID 23682843

  • Update on metastatic basal cell carcinoma: a summary of published cases from 1981 through 2011. JAMA dermatology Wysong, A., Aasi, S. Z., Tang, J. Y. 2013; 149 (5): 615-616

    View details for DOI 10.1001/jamadermatol.2013.3064

    View details for PubMedID 23677097

  • New Onset of Keratoacanthomas After Vismodegib Treatment for Locally Advanced Basal Cell Carcinomas: A Report of 2 Cases JAMA DERMATOLOGY Aasi, S., Silkiss, R., Tang, J. Y., Wysong, A., Liu, A., Epstein, E., Oro, A. E., Chang, A. L. 2013; 149 (2): 242-243
  • Atlas of Practical Mohs Histopathology Aasi, S. Z., Leffell, D. J., Lazova, R. Z. 2013
  • Is Tanning Bed Exposure Associated With Aggressive Basal Cell Carcinoma? JOURNAL OF CLINICAL ONCOLOGY Gamba, C. A., Wysong, A., Million, L., Aasi, S., Kim, J., Tang, J. Y. 2012; 30 (32): E333-E336

    View details for DOI 10.1200/JCO.2012.42.1008

    View details for Web of Science ID 000310914800006

    View details for PubMedID 23008324

  • Hemorrhagic complications in dermatologic surgery DERMATOLOGIC THERAPY Bunick, C. G., Aasi, S. Z. 2011; 24 (6): 537-550

    Abstract

    The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and anti-platelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery.

    View details for DOI 10.1111/j.1529-8019.2012.01454.x

    View details for Web of Science ID 000303004600004

    View details for PubMedID 22515669

  • Cosmetic concerns and management strategies to combat aging MATURITAS Robinson, D. M., Aasi, S. Z. 2011; 70 (3): 256-260

    Abstract

    Multiple modalities with varying degrees of complexity and risks exist in the treatment of the aging face. Paramount to all treatment paradigms is photoprotection to prevent further damage. Intervetions should be geared towards addressing the intrinsic and extrinsic signs of aging and can include topical retinoid therapy, superficial chemical and laser resurfacing, botulinum toxin and soft tissue fillers. The combination of these primary, secondary, and tertiary therapies will address the underlying pathophysiologic changes of the aging face and thus will provide the optimal aesthetic outcome.

    View details for DOI 10.1016/j.maturitas.2011.07.020

    View details for Web of Science ID 000296684900009

    View details for PubMedID 21873005

  • Cancer of the skin Cancer Principles and Practice of Oncology Reszko A, Aasi SZ, Wilson LD, Leffell DJ 2011; 9: 1610-1633
  • Melanoma and Non-melanoma Skin Cancer Dermatology A Pictorial Review Aasi SZ, Cox KM 2010; 2: 193-206
  • Commentary: Expanding the Donor Site Options for Full-Thickness Skin Grafts Dermatol Surg. Aasi SZ 2010; 36: 532-533
  • Z-plasty made simple. Dermatology research and practice Aasi, S. Z. 2010; 2010: 982623-?

    Abstract

    A Z-plasty is a critical and reliable technique that is useful for scar revisions and correction of free margin distortion. A Z-plasty can help lengthen a contracted scar, change the direction of a scar so that it is better aligned with the relaxed skin tension lines, or interrupt and break a scar for better camouflage. This article will review the technique of a basic Z-plasty as well as provide case examples of its use in free margin distortion and scar revision.

    View details for DOI 10.1155/2010/982623

    View details for PubMedID 21789038

  • Mohs micrographic surgery histopathology concordance Annual Meeting of the American-College-of-Mohs-Micrographic-Surgery-and-Cutaneous-Oncology Mariwalla, K., Aasi, S. Z., Glusac, E. J., Leffell, D. J. MOSBY-ELSEVIER. 2009: 94–98

    Abstract

    The low recurrence rate and tissue-sparing benefit associated with Mohs micrographic surgery (MMS) requires accurate interpretation of frozen sections by the MMS surgeon.We sought to assess concordance between dermatopathologists and MMS surgeons when reporting cutaneous malignancy in the MMS setting.This study is a retrospective analysis of 1156 slides submitted during 10 years as part of a pre-existing randomized, blinded, quality assurance protocol. Slides were read by one of 5 dermatopathologists and represent cases from 3 MMS surgeons and 5 MMS fellows. Agreement or disagreement was recorded.Of the 1156 slides, 32 slides (2.8%) were disparate. Aside from differences regarding intraepidermal neoplasia, the concordance rate was 99.7%.This study represents data collected at a single institution in the United States alone.There was statistically significant concordance between MMS surgeons and dermatopathologists in frozen section interpretation in the MMS setting. Discordance was primarily related to the interpretation of in situ malignancy.

    View details for DOI 10.1016/j.jaad.2008.09.061

    View details for Web of Science ID 000262261700010

    View details for PubMedID 19103361

  • Skin cancer prevention and photo protection in organ transplant recipients Skin Diseases in Organ Transplantation Aasi SZ 2008: 295-301
  • Cancer of the skin Cancer Principles and Practice of Oncology Thomas VD, Aasi SZ, Wilson LD, Leffel DJ 2008; 8: 863-1888
  • Dermatologic surgery: introduction to anatomy and approach Fitzpatrick's Dermatology in General Medicine Aasi SZ, Pennington B 2008; 7: 2289-2301
  • Free margin distortion Complications in Cutaneous Surgery Aasi SZ 2008: 95-114
  • Dermatologic diseases and disorders Geriatrics Review Syllabus Aasi SZ 2006; 6: 309-319
  • Multiple facial angiofibromas: A cutaneous manifestation of Birt-Hogg-Dube syndrome Meeting of the New-England-Dermatological-Society Schaffer, J. V., Gohara, M. A., McNiff, J. M., Aasi, S. Z., Dvoretzky, I. MOSBY-ELSEVIER. 2005: S108–S111

    Abstract

    Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant genodermatosis characterized by a triad of skin tumors--fibrofolliculomas, trichodiscomas, and acrochordons--together with an increased risk of renal tumors and spontaneous pneumothoraces. This report describes multiple facial angiofibromas as the predominant initial manifestation of BHDS. The patient had a total of 41 facial papules removed via shave excision, initially for diagnostic and then for therapeutic purposes; histologic evaluation revealed diagnostic features of angiofibroma in 39 lesions and fibrofolliculoma in only 2. BHDS should be considered, along with tuberous sclerosis and multiple endocrine neoplasia type 1, in the differential diagnosis of multiple facial angiofibromas, particularly when onset is in adulthood.

    View details for DOI 10.1016/j.jaad.2004.11.021

    View details for Web of Science ID 000231081400003

    View details for PubMedID 16021156

  • Bilobed transposition flap DERMATOLOGIC CLINICS Aasi, S. Z., Leffell, D. J. 2005; 23 (1): 55-?

    Abstract

    This article reviews the indications and techniques for performing a bilobed flap for reconstruction of surgical wounds. Various examples of surgical defects where a bilobed flap can be used are shown. Possible complications and pitfalls are also reviewed.

    View details for DOI 10.1016/j.det.2004.08.004

    View details for Web of Science ID 000226324900006

    View details for PubMedID 15620619

  • Ellipse, ellipse variations and dog-ear repairs Surgery of the Skin Book SE, Aasi SZ, Leffell DJ 2005: 259-272
  • Cancer of the skin Cancer Principles and Practice of Oncology Aasi SZ, Leffell DJ 2005; 7: 1717-1744
  • Idiopathic eruptive macular pigmentation: A case of 21 years' duration JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Mehta, S., Aasi, S., Cole, R., Chu, P., Weinberg, J. M. 2003; 49 (5): S280-S282

    Abstract

    Idiopathic eruptive macular pigmentation is a rare condition characterized by asymptomatic pigmented macules involving the neck, trunk, and proximal portions of the extremities. Age at onset usually varies from 1 to 20 years. The lesions usually appear abruptly and remit spontaneously over months to years. An unusual case of a 24-year-old woman with idiopathic eruptive macular pigmentation lasting 21 years was characterized by several periods of spontaneous resolution followed by recurrences.

    View details for DOI 10.1067/S0190-9622(03)00745-X

    View details for Web of Science ID 000186362900017

    View details for PubMedID 14576654

  • Complications in dermatologic surgery - How safe is safe? ARCHIVES OF DERMATOLOGY Aasi, S. Z., Leffell, D. J. 2003; 139 (2): 213-214

    View details for Web of Science ID 000180971400012

    View details for PubMedID 12588228

  • Dermatologic diseases and disorders Geriatrics Review Syllabus Aasi SZ, Cook B 2002; 5: 390-399
  • Aquagenic palmoplantar keratoderma J Am Acad Dermatol Yan AC, Aasi SZ, Alms DJ, Heymann WR, Paller AS, Honig PJ 2001: 696-699
  • Successful correction of depressed scars of the forehead secondary to trauma and morpheme en coup de saber by autologous free dermal-fat graft. Dermatol Surg. Lapiere JC, Aasi SZ, Cook B, Montalvo A 2000: 793-796
  • Autoantibodies to type VII collagen have heterogeneous subclass and light chain compositions and their complement-activating capacities do not correlate with the inflammatory clinical phenotype. J Clinical Immunol. Gandhi K, Chen M, Aasi SZ, Lapiere JC, Woodley DT, Chan LS 2000; 20: 416-423