This application proposes a renewal of a Midcareer Investigator Award in Patient-Oriented Research for Mary-Margaret Chren, MD, Professor of Dermatology at the University of California, San Francisco (UCSF). Dr. Chren's long-term career objectives are to perform rigorous research to improve the health of patients with skin diseases, and to use her research to develop first-rate investigators in patient-oriented research in skin diseases. This renewed award will build on her previous work and accomplish her immediate career objectives: first, to expand and complete the next phase of the Nonmelanoma Skin Cancer (NMSC) Cohort Study, a 10-year comparative effectiveness study of treatments for NMSC (the most common malignancy);second, to build on these findings to develop and perform a targeted multicenter clinical trial of treatments for NMSC;third, to use these research data as a substrate for the mentoring of clinician investigators in patient-oriented research;and fourth, to increase the scope of her mentoring activity by serving an expanded leadership role with the Mentorship Development Program of the UCSF Clinical &Translational Science Institute (CTSI). The proposed research will fill a gap in current knowledge about the comparative efficacy of the two most common treatments for NMSC, surgical excision and histologically-guided serial excision, or Mohs surgery. The research will undertake the incremental developmental steps to design and conduct a multicenter randomized controlled trial of excision and Mohs surgery for primary facial basal cell carcinomas (BCC). These steps include establishment of research, clinical, and stakeholder advisory groups, composition of study tools, drafting of study procedures, and pilot-testing of procedures. After infrastructure development, 1200 patients with primary facial BCC will be randomized to surgical excision or Mohs surgery. The primary outcome is tumor recurrence at five years;secondary outcome is skin-related quality of life. The proposed mentoring plan has three parts: didactic curricula, """"""""hands-on"""""""" research, and career development;with the renewed award, didactic options will be fully integrated with CTSI's comprehensive program of highly-directed courses. This enhanced integration will be fostered by Dr. Chren's role as leader of the Mentor Evaluation Plan for the CTSI's Mentorship Development Program. Together, the Research Plan and Mentoring Plan provide a new five-year strategy that is directly relevant to the NIH and NIAMS missions of pursuing and applying knowledge to reduce disease burden, and training scientists to carry out such research.

Public Health Relevance

This application proposes renewal of an award to support a mentoring program in patient-oriented research in skin diseases, using an expanded research program on improving care for nonmelanoma skin cancer. The proposal is relevant to the public health because it focuses on ensuring that sufficient numbers of highly-trained and well- mentored scientists are available to perform top-quality research on health care and how to improve it. In addition, rigorous studies are needed to compare different treatments for nonmelanoma skin cancer, which is the most common malignancy;the work proposed in this application addresses that public health need.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Baker, Carl
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Wehner, Mackenzie R; Cidre Serrano, Wilmarie; Nosrati, Adi et al. (2018) All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis. J Am Acad Dermatol 78:663-672.e3
Stuart, Sarah E; Schoen, Patrick; Jin, Chengshi et al. (2017) Tumor recurrence of keratinocyte carcinomas judged appropriate for Mohs micrographic surgery using Appropriate Use Criteria. J Am Acad Dermatol 76:1131-1138.e1
Chren, Mary-Margaret; Arron, Sarah T (2016) Research that Guides Clinical Decisions. J Invest Dermatol 136:1535-1537
Linos, Eleni; Chren, Mary-Margaret; Stijacic Cenzer, Irena et al. (2016) Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? J Am Geriatr Soc 64:1610-5
Linos, Eleni; Berger, Timothy; Chren, Mary-Margaret (2015) Point: Care of potential low-risk basal cell carcinomas (BCCs) at the end of life: The key role of the dermatologist. J Am Acad Dermatol 73:158-61
Wehner, Mackenzie R; Linos, Eleni; Parvataneni, Rupa et al. (2015) Timing of subsequent new tumors in patients who present with basal cell carcinoma or cutaneous squamous cell carcinoma. JAMA Dermatol 151:382-8
Grewal, S K; Chren, M M; Parvataneni, R et al. (2015) 'What is it about your skin cancer that bothers you the most?': 700 patients respond. Br J Dermatol 173:296-7
Wehner, Mackenzie R; Chren, Mary-Margaret; Nameth, Danielle et al. (2014) International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 150:390-400
Linos, Eleni; Schroeder, Steven A; Chren, Mary-Margaret (2014) Potential overdiagnosis of basal cell carcinoma in older patients with limited life expectancy. JAMA 312:997-8
Galles, Elyse; Parvataneni, Rupa; Stuart, Sarah E et al. (2014) Patient-reported outcomes of electrodessication and curettage for treatment of nonmelanoma skin cancer. J Am Acad Dermatol 71:1026-8

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