Clinical Focus

  • Cancer > Cutaneous (Dermatologic) Oncology
  • Dermatology
  • Skin Cancer
  • Geriatric dermatology
  • basal cell carcinoma
  • non-melanoma skin cancer
  • clinical trials
  • acne rosacea
  • rosacea

Academic Appointments

Administrative Appointments

  • Director of Adult Dermatological Clinical Trials, Stanford Dermatology (2007 - Present)
  • Director of the Advanced Basal Cell Carcinoma Clinic, Stanford Dermatology (2011 - Present)

Honors & Awards

  • Fellow, American Academy of Dermatology (2007)
  • Career Development Award, Dermatology Foundation (2009)
  • Research Scholar Award, American Skin Association (2013, 2014)
  • Leadership Forum, American Academy of Dermatology (2014)
  • Research Grant/Award, National Rosacea Society (2014-2015)

Boards, Advisory Committees, Professional Organizations

  • Member, American Academy of Dermatology (2004 - Present)
  • Member, Society of Investigative Dermatology (2007 - Present)
  • Core Curriculum Task Force Appointee, 2015-2018, American Academy of Dermatology (2015 - Present)

Professional Education

  • Residency:Stanford University Hospital and Clinics - Dermatology Department (2007) CA
  • Fellowship:Stanford University Hospital and Clinics - Dermatology Department (2004) CA
  • Residency:UCSF - Department of OB/GYN and REI (2002) CA
  • Internship:UCSF - Department of OB/GYN and REI (2000) CA
  • Medical Education:Harvard Medical School (1999) MA
  • Board Certification: Dermatology, American Board of Dermatology (2007)
  • MD, Harvard Medical School, Medicine (1999)

Community and International Work

  • Doctor Radio, Redwood City, CA


    Aging Skin

    Partnering Organization(s)

    New York University (NYU) Langone Medical Center

    Populations Served

    National radio audience in United States



    Ongoing Project


    Opportunities for Student Involvement


  • Cutting Edge Clinical Trials in Older Adults, Stanford Medicine Outpatient Center


    Evidence based medicine and therapies in older adults

    Partnering Organization(s)

    San Francisco Dermatological Society and Stanford University School of Medicine

    Populations Served

    Community based dermatologists, primary care physicians



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

I have two main research interests:
1) to better understand and treat patients with aggressive basal cell carcinomas
2) to better understand the genetic and epigenetic mechanisms of healthy human skin aging and to translate these insights into better care of skin diseases enriched in older patients particularly skin cancer and rosacea

Clinical Trials

  • A Study Evaluating the Efficacy and Safety of Vismodegib (GDC-0449) in Operable Basal Cell Carcinoma Not Recruiting

    This was a 3-cohort, open-label study of vismodegib (GDC-0449) in new (non-recurrent) operable basal cell carcinoma of the nodular subtype.

    Stanford is currently not accepting patients for this trial. For more information, please contact Shruthi Rangaraj, (650) 721 - 7159.

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  • A Phase II Study of Efficacy and Safety in Patients With Locally Advanced or Metastatic Basal Cell Carcinoma Not Recruiting

    This study will assess the efficacy and safety of oral treatment with two dose levels of LDE225 in patients with locally advanced or metastatic BCC.

    Stanford is currently not accepting patients for this trial. For more information, please contact Shruthi Rangaraj, (650) 721 - 7159.

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  • A Study in Advanced Cancer Not Recruiting

    The purpose of this study is to find a recommended dose level and schedule of dosing LY2940680 that can safely be taken by patients with advanced cancer. The study will also explore the changes in a cancer marker level in skin, hair follicles, buccal cells, and tumor cells. Finally, the study will help document any antitumor activity this drug may have.

    Stanford is currently not accepting patients for this trial. For more information, please contact Anne Chang, 650-721-7151.

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  • A Study of Pharmacokinetic Drug Interaction Study of the Hedgehog Pathway Inhibitor GDC-0449 in Combination With Rosiglitazone or Combined Oral Contraceptive in Patients With Locally Advanced or Metastatic Solid Tumors That Are Refractory to Standard Therapy or for Whom No Standard Therapy Exists Not Recruiting

    This is a single-arm, multicenter, Phase Ib study designed to describe the effect of GDC-0449 on the pharmacokinetics of rosiglitazone and oral contraceptives in patients with advanced solid tumors who are refractory to treatment or for whom no standard therapy exists.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ruth Lira, (650) 723 - 1367.

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  • Vismodegib in Treating Patients With Basal Cell Carcinoma 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.

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  • Erismodegib and Buparlisib in Treating Patients With Advanced or Metastatic Basal Cell Carcinoma Recruiting

    This pilot trial studies how well erismodegib and buparlisib work in treating patients with basal cell carcinoma that has spread to other places in the body. Erismodegib and buparlisib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

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  • Levocarnitine in Treating Patients With Vismodegib-Associated Muscle Spasms Recruiting

    This randomized clinical trial studies levocarnitine in treating patients with vismodegib-associated muscle spasms. Levocarnitine may decrease muscle spasms caused by vismodegib.

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  • A Study of Vismodegib (GDC-0449) in Patients With Locally Advanced or Metastatic Basal Cell Carcinoma Not Recruiting

    This is an open-label, non-comparative, multicenter, expanded access study of Vismodegib (GDC-0449) in patients with locally advanced basal cell carcinoma (BCC) or metastatic BCC (mBCC) who are otherwise without satisfactory treatment options.

    Stanford is currently not accepting patients for this trial. For more information, please contact Shruthi Rangaraj, (650) 721 - 7159.

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  • An Observational Study of Treatment Patterns and Effectiveness and Safety Outcomes in Advanced Basal Cell Carcinoma and Basal Cell Carcinoma Nevus Syndrome Patients(RegiSONIC) Not Recruiting

    This multi-center, prospective, observational cohort study will evaluate the effectiveness, safety and utilization of treatments in patients with advanced basal cell carcinoma and basal cell carcinoma nevus syndrome. The total study duration is anticipated to be a maximum of 8 years, including 3 years for patient recruitment and 5 years follow-up.

    Stanford is currently not accepting patients for this trial. For more information, please contact Anne Chang, 650-721-7151.

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  • A Study of Vismodegib (GDC-0449) in Patients Treated With Vismodegib in a Previous Genentech-sponsored Phase I or II Cancer Study Not Recruiting

    This was a multicenter, open-label extension study. Patients who received vismodegib (GDC-0449) in a Genentech-sponsored study and who had completed the parent study or who continued to receive vismodegib at the time the parent study closed were eligible for continued treatment in this protocol.

    Stanford is currently not accepting patients for this trial. For more information, please contact Shruthi Rangaraj, (650) 721 - 7159.

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  • A Phase 1 Study of IPI-926 in Patients With Advanced and/or Metastatic Solid Tumor Malignancies Not Recruiting

    The primary objectives of the study are: - To determine the safety and the maximum tolerated dose (MTD) of IPI-926 - To examine the pharmacokinetic parameters of IPI-926 and its characterized major metabolite(s) - To recommend a dose and schedule of IPI-926 for subsequent studies

    Stanford is currently not accepting patients for this trial. For more information, please contact Shruthi Rangaraj, (650) 721 - 7159.

    View full details

  • A Study Evaluating the Efficacy and Safety of Vismodegib (GDC-0449, Hedgehog Pathway Inhibitor) in Patients With Advanced Basal Cell Carcinoma Not Recruiting

    This was a Phase II, single-arm, two-cohort multicenter clinical trial evaluating the efficacy and safety of vismodegib (GDC-0449) in patients with advanced basal cell carcinoma. All patients received vismodegib until evidence of progression, intolerable toxicities most probably attributable to vismodegib, or withdrawal from the study.

    Stanford is currently not accepting patients for this trial. For more information, please contact Katherine Connors, (650) 721 - 7159.

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2015-16 Courses

Stanford Advisees


All Publications

  • Incidental regression of an advanced basal cell carcinoma after ipilimumab exposure for metastatic melanoma Journal of the American Academy of Dermatology Case Reports Mohan, S., Kuo, K. Y., Chang, A. S. 2016
  • Estimation of individual cumulative ultraviolet exposure using a geographically-adjusted, openly-accessible tool BioMed Central Dermatology Zhu, G. A., Raber, I., Sakshuwong, S., Li, A., Tan, C., Chang, A. S. 2016; Accepted
  • Efffects of combined treatment with arsenic trioxide and itraconazole in patients with refractory metastatic basal cell carcinoma. JAMA Dermatology Ally, M., Ransohoff, K., Sarin, K., Bailey-Healy, I., Kim, J., Beachy, P., Chang, A. S., Oro, A. E., Tang, J. Y., Colevas, A. D. 2016
  • Concurrent Vismodegib and Radiotherapy for Recurrent, Advanced Basal Cell Carcinoma. JAMA dermatology Pollom, E. L., Bui, T. T., Chang, A. L., Colevas, A. D., Hara, W. Y. 2015; 151 (9): 998-1001


    Vismodegib is a targeted agent recently approved for treating patients who develop recurrent or locally advanced basal cell carcinoma (BCC), and will inevitably be integrated into existing therapy for advanced BCC as it becomes increasingly used. Improved understanding of how vismodegib interacts with other treatment modalities, including radiotherapy, would help optimize multidisciplinary therapy and clinical outcomes.We report 2 cases of recurrent, advanced BCC treated from April 1, 2012, through October 31, 2014, with concurrent radiotherapy and vismodegib. Concurrent treatment appeared to be well tolerated and efficacious, with both patients having no evidence of progressive disease at last follow-up.We found that the combination of vismodegib and radiotherapy is feasible for patients with recurrent or locally advanced BCC and that combined use of currently available therapies for advanced BCC warrants further prospective study.

    View details for DOI 10.1001/jamadermatol.2015.0326

    View details for PubMedID 25874733

  • The role of the dermatologist in detecting elder abuse and neglect JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Danesh, M. J., Chang, A. L. 2015; 73 (2): 285-293
  • Management of Cutaneous and Extracutaneous Side Effects of Smoothened Inhibitor Therapy for Advanced Basal Cell Carcinoma CLINICAL CANCER RESEARCH Mohan, S. V., Chang, A. L. 2015; 21 (12): 2677-2683
  • Assessment of the Genetic Basis of Rosacea by Genome-Wide Association Study JOURNAL OF INVESTIGATIVE DERMATOLOGY Chang, A. L., Raber, I., Xu, J., Li, R., Spitale, R., Chen, J., Kiefer, A. K., Tian, C., Eriksson, N. K., Hinds, D. A., Tung, J. Y. 2015; 135 (6): 1548-1555


    Rosacea is a common, chronic skin disease that is currently incurable. Although environmental factors influence rosacea, the genetic basis of rosacea is not established. In this genome-wide association study, a discovery group of 22,952 individuals (2,618 rosacea cases and 20,334 controls) was analyzed, leading to identification of two significant single-nucleotide polymorphisms (SNPs) associated with rosacea, one of which replicated in a new group of 29,481 individuals (3,205 rosacea cases and 26,262 controls). The confirmed SNP, rs763035 (P=8.0 × 10(-11) discovery group; P=0.00031 replication group), is intergenic between HLA-DRA and BTNL2. Exploratory immunohistochemical analysis of HLA-DRA and BTNL2 expression in papulopustular rosacea lesions from six individuals, including one with the rs763035 variant, revealed staining in the perifollicular inflammatory infiltrate of rosacea for both proteins. In addition, three HLA alleles, all MHC class II proteins, were significantly associated with rosacea in the discovery group and confirmed in the replication group: HLA-DRB1*03:01 (P=1.0 × 10(-8) discovery group; P=4.4 × 10(-6) replication group), HLA-DQB1*02:01 (P=1.3 × 10(-8) discovery group; P=7.2 × 10(-6) replication group), and HLA-DQA1*05:01 (P=1.4 × 10(-8) discovery group; P=7.6 × 10(-6) replication group). Collectively, the gene variants identified in this study support the concept of a genetic component for rosacea, and provide candidate targets for future studies to better understand and treat rosacea.

    View details for DOI 10.1038/jid.2015.53

    View details for Web of Science ID 000354389200015

    View details for PubMedID 25695682

  • Smoothened Variants Explain the Majority of Drug Resistance in Basal Cell Carcinoma CANCER CELL Atwood, S. X., Sarin, K. Y., Whitson, R. J., Li, J. R., Kim, G., Rezaee, M., Ally, M. S., Kim, J., Yao, C., Chang, A. L., Oro, A. E., Tang, J. Y. 2015; 27 (3): 342-353


    Advanced basal cell carcinomas (BCCs) frequently acquire resistance to Smoothened (SMO) inhibitors through unknown mechanisms. Here we identify SMO mutations in 50% (22 of 44) of resistant BCCs and show that these mutations maintain Hedgehog signaling in the presence of SMO inhibitors. Alterations include four ligand binding pocket mutations defining sites of inhibitor binding and four variants conferring constitutive activity and inhibitor resistance, illuminating pivotal residues that ensure receptor autoinhibition. In the presence of a SMO inhibitor, tumor cells containing either class of SMO mutants effectively outcompete cells containing the wild-type SMO. Finally, we show that both classes of SMO variants respond to aPKC-ι/λ or GLI2 inhibitors that operate downstream of SMO, setting the stage for the clinical use of GLI antagonists.

    View details for DOI 10.1016/j.ccell.2015.02.002

    View details for Web of Science ID 000350977200007

    View details for PubMedID 25759020

  • Novel GATA6 Mutations in Patients with Pancreatic Agenesis and Congenital Heart Malformations PLOS ONE Chao, C. S., McKnight, K. D., Cox, K. L., Chang, A. S., Kim, S. K., Feldman, B. J. 2015; DOI: 10.1371/journal.pone.0118449
  • Recent advances in geriatric dermatology edited by Chang, A. S. Springer. 2015
  • Incidental regression of an advanced basal cell carcinoma after ipilimumab exposure for metastatic melanoma Journal of the American Academy of Dermatology Case Reports Mohan, S., Kuo, K. Y., Chang, A. S. 2015
  • Mutations in the kinetochore gene KNSTRN in basal cell carcinoma Journal of Investigative Dermatology Jaju, P., Nguyen, C., Mah, A., Atwood, S., Li, J., Zia, A., Chang, A. S., Oro, A. E., Tang, J. Y., Lee, C. S., Sarin, K. Y. 2015; TBD

    View details for DOI 10.1038/jid.2015.339

  • A Qualitative Comparison of Symptoms and Impact of Varying Stages of Basal Cell Carcinoma Dermatol Ther Steenrod, A. W., Smyth, E. N., Bush, E. N., Chang, A. L., Arron, S. T., Helfrich, Y. R., Von Hoff, D. D., Brail, L. H., Coyne, K. S. 2015; Article DigitalPreview Abstract PMID: 26324194
  • RAS/MAPK activation drives resistance to Smo inhibition, metastasis and tumor evolution in Shh pathway-dependent tumors Cancer Research Zhao, X., Ponomryov, T., Ornell, K., Zhou, P., Dabral, S., Pak, E., Li, W., Atwood, S. X., Whitson, R. J., Chang, A. S., Oro, A. E., Chang, J. A., Kelleher, J. F., Segal, R. A. 2015
  • A case report of unresectable cutaneous squamous cell carcinoma responsive to a PD1 inhibitor JAMA Dermatology Chang, A. S., Kim, J., Sullivan-Chang, L., Luciano, R., Colevas, A. D. 2015; TBD
  • Rolling the genetic dice: neutral and deleterious Smoothened mutations in drug-resistant basal cell carcinoma Journal of Investigative Dermatology Atwood, S. X., et al 2015; doi: 10.1038/jid.2015.115
  • Overall and Progression-Free Survival of Stage 4 Cutaneous Squamous Cell Carcinoma at a Single Large Referral Center Journal of the American Academy of Dermatology Zhu, G. A., Chang, A. S. 2015; 73 (1): 165-166
  • Pivotal ERIVANCE BCC study: 12-month update of efficacy and safety of vismodegib in advanced basal cell carcinoma Journal of the American Academy of Dermatology Sekulic, A., Migden, M., Lewis, K., Hainsworth, J., Solomon, J., Yoo, S., Arron, S. T., Friedlander, P. A., Marmur, E., Rudin, C., Chang, A. S., Dirix, L., Hou, J., Yue, H., Hauschild, A. 2015; 72 (6): 1021-1026
  • Randomized, Double-Blind Study of Two Dosages of Sonidegib (LDE225) in Patients With Locally Advanced or Metastatic Basal Cell Carcinoma Lancet Oncology Migden, M. R., et al 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-U304
  • Two Different Scenarios of Squamous Cell Carcinoma Within Advanced Basal Cell Carcinomas Cases Illustrating the Importance of Serial Biopsy During Vismodegib Usage JAMA DERMATOLOGY Zhu, G. A., Sundram, U., Chang, A. L. 2014; 150 (9): 970-973
  • Emergence of chemoresistance in a metastatic basal cell carcinoma patient after complete response to hedgehog pathway inhibitor vismodegib (GDC-0449) AUSTRALASIAN JOURNAL OF DERMATOLOGY Meani, R. E., Lim, S., Chang, A. L., Kelly, J. W. 2014; 55 (3): 218-221


    Vismodegib (GDC-0449, Genentech, USA), a small molecule inhibitor of the Hedgehog signalling pathway, has potent anti-tumour activity in advanced basal cell carcinoma (BCC). We report a case of a 67-year-old Australian man with metastatic BCC including pulmonary disease with malignant effusion who showed a dramatic complete response to vismodegib but subsequently experienced a recurrence of pulmonary disease, indicative of chemoresistance to vismodegib. This case is the first to illustrate chemoresistance in a patient with metastatic BCC, and demonstrates the need for closely monitoring metastatic BCC patients even after an apparently complete response.

    View details for DOI 10.1111/ajd.12196

    View details for Web of Science ID 000340406400018

    View details for PubMedID 25117162

  • Patient With Gorlin Syndrome and Metastatic Basal Cell Carcinoma Refractory to Smoothened Inhibitors JAMA DERMATOLOGY Zhu, G. A., Li, A. S., Chang, A. L. 2014; 150 (8): 877-879
  • Overall and progression-free survival in metastatic basosquamous cancer: A case series. Journal of the American Academy of Dermatology Zhu, G. A., Danial, C., Liu, A., Li, S., Su Chang, A. L. 2014; 70 (6): 1145-1146

    View details for DOI 10.1016/j.jaad.2014.03.003

    View details for PubMedID 24831322

  • Precision medicine and precision therapeutics: Hedgehog signaling pathway, basal cell carcinoma and beyond. Seminars in cutaneous medicine and surgery Mohan, S. V., Chang, A. L. 2014; 33 (2): 68-71


    Precision medicine and precision therapeutics is currently in its infancy with tremendous potential to improve patient care by better identifying individuals at risk for skin cancer and predict tumor responses to treatment. This review focuses on the Hedgehog signaling pathway, its critical role in the pathogenesis of basal cell carcinoma, and the emergence of targeted treatments for advanced basal cell carcinoma. Opportunities to utilize precision medicine are outlined, such as molecular profiling to predict basal cell carcinoma response to targeted therapy and to inform therapeutic decisions.

    View details for PubMedID 25085664

  • Only Skin Deep: Optimism and Public Self-Consciousness Did Not Associate With the Placebo Response in a Dermatology Clinical Trial JOURNAL OF DRUGS IN DERMATOLOGY Garshick, M. K., Chang, A. L., Kimball, A. B. 2014; 13 (6): 719-722
  • Three case reports illustrating reversible cutaneous side effects of vismodegib treatment Cutis Kwong, B., Danial, C., Liu, A., Chun, K., Chang, A. S. 2014
  • Dermatologic clinical trials: a practical approach Clinical dermatology trials 101: a primer for dermatologists Mohan, S., Chang, A. S. Springer. 2014; 1st: 47
  • Low rate of dermatology outpatient visits in Asian-Americans: initial survey study for associated patient-related factors BioMed Central Dermatology Lingala, B., Wysong, A., Li, S., Truong, A., Kim, D., Chang, A. S. 2014; 14 (13)
  • Expanded access study of patients with advanced basal cell carcinoma treated with the Hedgehog pathway inhibitor, vismodegib JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chang, A. L., Solomon, J. A., Hainsworth, J. D., Goldberg, L., McKenna, E., Day, B., Chen, D. M., Weiss, G. J. 2014; 70 (1): 60-69


    Vismodegib, a first-in-class Hedgehog pathway inhibitor, was US Food and Drug Administration (FDA) approved for advanced basal cell carcinomas (BCCs) based on a single, nonrandomized, phase-II trial. Consequently, additional clinical data are critical to confirm the efficacy and safety of vismodegib.We sought to assess efficacy and safety of vismodegib, while providing early drug access to patients with advanced BCC and limited treatment options.This was an open-label, multicenter study in patients with advanced BCC inappropriate for radiotherapy or surgery. Patients received 150 mg vismodegib daily until disease progression or intolerable toxicity. Tumor response was assessed via Response Evaluation Criteria in Solid Tumors version 1.0.A total of 119 patients with advanced BCC took vismodegib for a median of 5.5 months. Objective responses occurred in 46.4% of locally advanced BCC and 30.8% of patients with metastatic BCC. Response was negatively associated with prior systemic therapy in patients with locally advanced BCC (P = .002). Mean follow-up for safety was 6.5 months, with muscle spasms (70.6%), dysgeusia (70.6%), alopecia (58.0%), and diarrhea (25.2%) as the most common adverse events.Abbreviated follow-up time because of study termination upon FDA approval was a limitation.This study provides important clinical data supporting the efficacy and safety of vismodegib. Larger studies are underway to assess predictors of response and long-term outcomes.

    View details for DOI 10.1016/j.jaad.2013.09.012

    View details for Web of Science ID 000328694200015

    View details for PubMedID 24189279

  • Advanced basal cell carcinoma: epidemiology and therapeutic innovations Curr Derm Rep Mohan, S., Chang, A. S. 2014; 3 (1): 40-45
  • Oral Smoothened Inhibitor for Advanced Basal Cell Carcinoma of the Hand: A Case Report HAND Zhu, G. A., Chen, A., Chang, A. S. 2014; 9 (1): 127-8
  • Identification of genes promoting skin youthfulness Journal of Investigative Dermatology Chang, A. S., Atzmon, G., Bergman, A., Atwood, S., Brugmann, S., Chang, H. Y., Barzilai, N. 2014; 134 (3): 651-657

    View details for DOI 10.1038/jid.2013.381

  • Markedly improved overall survival in 10 consecutive patients with metastatic basal cell carcinoma. British journal of dermatology Danial, C., Lingala, B., Balise, R., Oro, A. E., Reddy, S., Colevas, A., Chang, A. L. 2013; 169 (3): 673-676


    BACKGROUND: Metastatic basal cell carcinoma (BCC) is a rare but life-threatening condition. Prior estimates of overall survival (OS) from time of diagnosis of distant metastasis to death are approximately 8-14 months. However, these estimates are based on analyses of case reports published prior to 1984. OBJECTIVES: To assess a more updated OS in metastatic BCC patients at a single academic institution. METHODS: Using patients from 1997 to 2011, a retrospective chart review was performed on biopsy-confirmed cases of distant metastatic BCC at Stanford University School of Medicine. Kaplan-Meier analysis was used to determine OS and progression free survival (PFS). RESULTS: Ten consecutive cases of distant metastatic BCC were identified. Median OS was 7.3 (95% confidence interval, CI; 1.6, ∞) years; median PFS was 3.4 (95% CI; 1.1, 5.2) years. CONCLUSION: Our findings suggest that OS in patients with distant metastaticBCC may be more favorable than previously reported.

    View details for DOI 10.1111/bjd.12333

    View details for PubMedID 23521172

  • Geriatric dermatology Part I. Geriatric pharmacology for the dermatologist JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Endo, J. O., Wong, J. W., Norman, R. A., Chang, A. L. 2013; 68 (4)


    Issues related to prescribing dermatologic drugs in the elderly are less recognized than age-related skin findings. This is related in part to the lack of a standardized residency training curriculum in geriatric dermatology. As the number of elderly patients rises in the United States, drug-related iatrogenic complications will become increasingly important. This review discusses age-related changes in pharmacokinetics and pharmacodynamics of common dermatologic drugs. These changes include volume of distribution, renal function, liver toxicity from interactions of commonly prescribed drugs, and medications that can decompensate cognition in the older patient population. We outline seven prescribing principles related to older dermatology patients, including useful strategies to reduce polypharmacy and improve drug adherence, using an evidence-based approach whenever possible.

    View details for DOI 10.1016/j.jaad.2012.10.063

    View details for Web of Science ID 000317201100010

    View details for PubMedID 23522421

  • Rejuvenation of Gene Expression Pattern of Aged Human Skin by Broadband Light Treatment: A Pilot Study JOURNAL OF INVESTIGATIVE DERMATOLOGY Chang, A. L., Bitter, P. H., Qu, K., Lin, M., Rapicavoli, N. A., Chang, H. Y. 2013; 133 (2): 394-402


    Studies in model organisms suggest that aged cells can be functionally rejuvenated, but whether this concept applies to human skin is unclear. Here we apply 3'-end sequencing for expression quantification ("3-seq") to discover the gene expression program associated with human photoaging and intrinsic skin aging (collectively termed "skin aging"), and the impact of broadband light (BBL) treatment. We find that skin aging was associated with a significantly altered expression level of 2,265 coding and noncoding RNAs, of which 1,293 became "rejuvenated" after BBL treatment; i.e., they became more similar to their expression level in youthful skin. Rejuvenated genes (RGs) included several known key regulators of organismal longevity and their proximal long noncoding RNAs. Skin aging is not associated with systematic changes in 3'-end mRNA processing. Hence, BBL treatment can restore gene expression pattern of photoaged and intrinsically aged human skin to resemble young skin. In addition, our data reveal, to our knowledge, a previously unreported set of targets that may lead to new insights into the human skin aging process.

    View details for DOI 10.1038/jid.2012.287

    View details for Web of Science ID 000313668000018

    View details for PubMedID 22931923

  • Phase 1 Study of the Hedgehog Pathway Inhibitor IPI-926 in Adult Patients with Solid Tumors Cancer Clinical Research, doi:10.1158/1078-0432.CCR-12-3654 Weiss, G. J., Miller, W. H., Chang, A. S., Sharfman, W. H., Ross, R. W., Rudin, C. M. 2013; 19 (10): 2766-74
  • Surgical excision after neoadjuvant therapy with vismodegib for a locally advanced basal cell carcinoma and additional resistant basal cell carcinomas in a Gorlin's syndrome patient JAMA Dermatology Chang AS, Atwood S, Tartar D, Oro AE 2013; 149 (5): 639-41
  • New onset of keratoacanthomas after vismodegib for locally advanced basal cell carcinomas: a report of two cases JAMA Dermatology Aasi S, Silkiss R, Tang JY, Epstein E, Wysong A, Chang AS 2013; 149 (2): 242-3
  • Geriatric Dermatology Review: Major Changes in Skin Function in Older Patients and Their Contribution to Common Clinical Challenges. Journal of the American Medical Directors Association Chang, A. L., Wong, J. W., Endo, J. O., Norman, R. A. 2013


    There is a paucity of data to guide evidence-based treatment decisions in managing older dermatologic patients, in part because of the frequent exclusion of older adults from clinical trials. Hence, we provide a comprehensive review of important conditions in geriatric dermatology, or "dermatogeriatrics." It is our hope the field of "dermatogeriatrics" will become more evidence-based and recognized as a field in its own right so that we can better meet the needs of our growing numbers of older patients, now and in the future.

    View details for PubMedID 23664020

  • Geriatric Dermatology. Part 2. Risk factors and cutaneous signs of elder mistreatment for the dermatologist Journal of the American Academy of Dermatology Chang AS, Wong J, Endo JO, Norman R 2013; 68 (4): 533e1-e10
  • Vismodegib for periocular and orbital basal cell carcinoma JAMA Ophthalmology Gill, H., Moscato, E. E., Chang, A. S., Soon, S., Silkiss, R. 2013; 131 (12): 1591-4
  • A simple intervention to reinforce awareness of tanning bed use and skin cancer in non-medical skin care professionals in Southern California INTERNATIONAL JOURNAL OF DERMATOLOGY Ng, A. T., Chang, A. L., Cockburn, M., Peng, D. H. 2012; 51 (11): 1307-1312


    (i) To assess the baseline knowledge of non-medical skin care professionals (estheticians, cosmetologists, massage therapists) on tanning bed use and its association with melanoma; and (ii) to provide preliminary evidence of the potential impact of a fast and simple educational intervention on tanning beds and melanoma on the awareness of non-medical skin care professionals towards skin cancer prevention.A pre-intervention survey was administered to non-medical skin care professional at salons or spas in Southern California to assess baseline knowledge on tanning and skin cancer. This was followed immediately by a 10-minute oral presentation on tanning bed use and its association with melanoma. One month later, a post-intervention survey was distributed to individuals who attended the initial oral presentation.Significant changes pre- and post-intervention were found in non-medical skin care professionals' answer responses to the following: (i) increased speaking to clients about cancer risk with tanning bed use 42-66% (OR 2.44; 95% CI 1.39, 4.30)]; (ii) decreased personal tanning bed use (23-15% [OR 0.61; 95% CI 0.37, 1.00]); and (iii) decreased belief that tanning beds are an excellent cosmetic tool (29-20% [OR 0.60; 95% CI 0.38, 0.96]).This study provides preliminary evidence that non-medical skin care professionals could be an important source of primary prevention information for reducing the burden of melanoma.

    View details for DOI 10.1111/j.1365-4632.2011.05425.x

    View details for Web of Science ID 000310272600006

    View details for PubMedID 23067078

  • Hedgehog pathway inhibition and the race against tumor evolution JOURNAL OF CELL BIOLOGY Atwood, S. X., Chang, A. L., Oro, A. E. 2012; 199 (2): 193-197


    Dependence of basal cell carcinomas and medulloblastomas on the Hedgehog pathway provides an opportunity for targeted or "personalized" therapy. The recent effectiveness and FDA approval of the first Smoothened inhibitors validates this class of agents, but has revealed drug-resistant tumor variants that bypass Smoothened inhibition. Here, we summarize the effectiveness of Hedgehog pathway inhibitors and highlight promising areas for the development of next generation drug antagonists for Hedgehog-dependent cancers.

    View details for DOI 10.1083/jcb.201207140

    View details for Web of Science ID 000309982400002

    View details for PubMedID 23071148

  • Translocation Affecting Sonic Hedgehog Genes in Basal-Cell Carcinoma NEW ENGLAND JOURNAL OF MEDICINE Gomez-Ospina, N., Chang, A. L., Qu, K., Oro, A. E. 2012; 366 (23): 2233-2234

    View details for Web of Science ID 000304863400029

    View details for PubMedID 22670922

  • Efficacy and Safety of Vismodegib in Advanced Basal-Cell Carcinoma NEW ENGLAND JOURNAL OF MEDICINE Sekulic, A., Migden, M. R., Oro, A. E., Dirix, L., Lewis, K. D., Hainsworth, J. D., Solomon, J. A., Yoo, S., Arron, S. T., Friedlander, P. A., Marmur, E., Rudin, C. M., Chang, A. L., Low, J. A., Mackey, H. M., Yauch, R. L., Graham, R. A., Reddy, J. C., Hauschild, A. 2012; 366 (23): 2171-2179


    Alterations in hedgehog signaling are implicated in the pathogenesis of basal-cell carcinoma. Although most basal-cell carcinomas are treated surgically, no effective therapy exists for locally advanced or metastatic basal-cell carcinoma. A phase 1 study of vismodegib (GDC-0449), a first-in-class, small-molecule inhibitor of the hedgehog pathway, showed a 58% response rate among patients with advanced basal-cell carcinoma.In this multicenter, international, two-cohort, nonrandomized study, we enrolled patients with metastatic basal-cell carcinoma and those with locally advanced basal-cell carcinoma who had inoperable disease or for whom surgery was inappropriate (because of multiple recurrences and a low likelihood of surgical cure, or substantial anticipated disfigurement). All patients received 150 mg of oral vismodegib daily. The primary end point was the independently assessed objective response rate; the primary hypotheses were that the response rate would be greater than 20% for patients with locally advanced basal-cell carcinoma and greater than 10% for those with metastatic basal-cell carcinoma.In 33 patients with metastatic basal-cell carcinoma, the independently assessed response rate was 30% (95% confidence interval [CI], 16 to 48; P=0.001). In 63 patients with locally advanced basal-cell carcinoma, the independently assessed response rate was 43% (95% CI, 31 to 56; P<0.001), with complete responses in 13 patients (21%). The median duration of response was 7.6 months in both cohorts. Adverse events occurring in more than 30% of patients were muscle spasms, alopecia, dysgeusia (taste disturbance), weight loss, and fatigue. Serious adverse events were reported in 25% of patients; seven deaths due to adverse events were noted.Vismodegib is associated with tumor responses in patients with locally advanced or metastatic basal-cell carcinoma. (Funded by Genentech; Erivance BCC number, NCT00833417.).

    View details for Web of Science ID 000304863400006

    View details for PubMedID 22670903

  • An Exploratory Study to Determine the Association Between Assessed Facial Skin Aging and Plasma Isoprostane Levels in Middle-Aged Japanese Women DERMATOLOGIC SURGERY Chang, A. L., Lingala, B., Chang, T. C., Kern, D. G., Wood, S. M., Toyoda, H., Knaggs, H. E. 2012; 38 (3): 462-470


    One of the central mechanisms of aging is hypothesized to be oxidative stress. Quantification of oxidative stress in human organ systems has been difficult. One of the best methods is using plasma isoprostane levels, which have been shown to reflect oxidative stress in multiple nondermatologic organ systems.To determine whether severity of aging of human skin is associated with plasma isoprostane levels, specifically prostaglandin F2a (PGF2a) and 8-iso-PGF2a while controlling for covariates such as body mass index, ultraviolet light exposure, diet, medication, supplement use, and stress levels.Facial skin aging assessments performed by four blinded dermatologists were correlated with plasma isoprostane levels in 46 healthy, nonsmoking Japanese women aged 45 to 60.Individuals whose assessed skin age exceeded chronological age had mean plasma isoprostane levels of PGF2a and 8-iso-PGF2a that were higher than those whose skin age was assessed to be less than chronological age (p = .001 and .001, respectively). These results remained statistically significant when adjusted for confounding variables (8-iso-PGF2a, p = .02; PGF2a, p = .03).Plasma isoprostanes as markers of accelerated aging of the skin merit further study.

    View details for DOI 10.1111/j.1524-4725.2011.02235.x

    View details for Web of Science ID 000300979600017

    View details for PubMedID 22141590

  • A Randomized, Double-Blind, Placebo-Controlled, Pilot Study to Assess the Efficacy and Safety of Clindamycin 1.2% and Tretinoin 0.025% Combination Gel for the Treatment of Acne Rosacea Over 12 Weeks JOURNAL OF DRUGS IN DERMATOLOGY Chang, A. L., Alora-Palli, M., Lima, X. T., Chang, T. C., Cheng, C., Chung, C. M., Amir, O., Kimball, A. B. 2012; 11 (3): 333-339


    Papulopustular acne rosacea is a chronic inflammatory condition which can be difficult to treat. Many patients are unwilling to use systemic medications, and single topical agents alone may not address all the symptoms of rosacea. A combination topical clindamycin phosphate 1.2% and tretinoin 0.025% gel is efficacious for acne vulgaris, and may be helpful for rosacea, since acne vulgaris and rosacea shares many similar clinical and histologic features.To assess the preliminary efficacy and safety of a combination gel consisting of clindamycin phosphate 1.2% and tretinoin 0.025% on papulopustular rosacea after 12 weeks of usage.Randomized, double-blind, placebo controlled two site study of 79 participants with moderate to severe papulopustular acne rosacea using both physician and subjects' validated assessment tools. Primary endpoint consisted of statistically significant reduction in absolute papule or pustule count after 12 weeks of usage.There was no significant difference in papule/pustule count between placebo and treated groups after 12 weeks (P=0.10). However, there was nearly significant improvement in physicians' assessments of the telangiectasia component of rosacea (P=0.06) and erythematotelangiectatic rosacea subtype (P=0.05) in treated versus placebo group after 12 weeks. The only significant adverse event different was facial scaling, which was significantly increased in treated group (P=0.01), but this did not result in discontinuation of study drug.A combination gel of clindamycin phosphate 1.2% and tretinoin 0.025% may improve the telangiectatic component of rosacea and appears to better treat the erythemotelangiectatic subtype of rosacea rather than papulopustular subtype. Our preliminary study suggests that future studies with much larger sample size might confirm our findings.

    View details for Web of Science ID 000301315500006

    View details for PubMedID 22395584

  • Initial assessment of tumor regrowth after vismodegib in advanced basal cell carcinoma patients Archives of Dermatology Chang AS, Oro AE 2012; Aug 20 (epub)
  • Native American Skin Offerings Mistaken for Acne Scars in a College Undergraduate Archives of Dermatology Wong J, Truong AK, Chang AS 2012; 148 (10)
  • Differential effects of dietary supplements on metabolomic profile of smokers versus non-smokers Genome Medicine Spitale RC, Cheng MY, Chun KA, Gorell ES, Munoz CA, Kern DG, Wood SM, Knaggs HE, Wulff J, Beebe KD, Chang AS 2012; 4 (2)
  • A Little Known But Life Threatening Association of Bullous Pemphigoid and Acquired Hemophilia: Case Report and Review of the Literature Journal of Clinical and Experimental Dermatology Research Nguyen C, Gordon J, Chang AS 2012
  • Stratification of highest risk patients with chronic skin ulcers in a Stanford retrospective cohort includes diabetes, need for systemic antibiotics and albumin levels Ulcers Amir O, Liu A, Chang AS 2012; ID7678561
  • A randomized double-blind, placebo-controlled pilot study to assess the efficacy and safety of clindamycin 1.2% and tretinoin 0.025% combination gel for the treatment of acne rosacea over 12 weeks Journal of Drugs in Dermatology Chang, A., Alora-Palli M, Lima XT, Chang TC, Cheng C, Chung CM, Amir O, Kimball AB 2012; 11 (3): 160-66
  • More Than Just A Coincidence: Herpes Zoster and Acne Rosacea Appearing Together as Wolf?s Isotopic Response in an Asian Female International Journal of Case Reports and Images Fijalkowski N, W. K. 2012; Feb
  • A case of Cinderella: erythema dyschromia perstans (ashy dermatosis or dermatosis cinecienta) SkinMed: Dermatology for the Clinician Munoz CA, Chang AS 2011; 9 (1): 63-4
  • Association of facial skin aging and vitamin D levels in middle-aged white women CANCER CAUSES & CONTROL Chang, A. L., Fu, T., Amir, O., Tang, J. Y. 2010; 21 (12): 2315-2316


    To investigate the relationship between UV-induced skin photodamage and 25(OH) vitamin D levels, we performed a cross-sectional study in 45 female subjects aged >40. Menopausal status, smoking status, skin cancer history, oral supplement use, and season of blood draw were recorded and serum 25(OH)D measured. A single-blinded, dermatologist evaluated standardized digital facial images for overall photodamage, erythema/telangiectasias, hyperpigmentation, number of lentigines, and wrinkling. Adjusting for age and season of blood collection, women with lower photodamage scores were associated with a 5-fold increased odds of being vitamin D insufficient (OR 5.0, 95% CI: 1.1, 23). Low scores for specific photodamage parameters including erythema/telangiectasias, hyperpigmentation, and wrinkling were also significantly associated with vitamin D insufficiency. Our results suggest an association between skin aging and 25(OH)D levels.

    View details for DOI 10.1007/s10552-010-9646-y

    View details for Web of Science ID 000288609600041

    View details for PubMedID 20882333

  • Initial Clinical Experience Using a Novel Ultraportable Negative Pressure Wound Therapy Device WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE Fong, K. D., Hu, D., Eichstadt, S. L., Gorell, E., Munoz, C. A., Lorenz, H. P., Chang, A. L. 2010; 22 (9): 230-236
  • A Two-Year, Double-Blind, Randomized Placebo-Controlled Trial of Oral Green Tea Polyphenols on the Long-Term Clinical and Histologic Appearance of Photoaging Skin DERMATOLOGIC SURGERY Janjua, R., Munoz, C., Gorell, E., Rehmus, W., Egbert, B., Kern, D., Chang, A. L. 2009; 35 (7): 1057-1065


    Green tea polyphenols (GTPs) have significant antioxidant and antiinflammatory activities, and prior short-term studies suggest that these compounds may improve photoaging skin.To evaluate the long-term effects of oral GTPs on the clinical and histologic characteristics of photoaging skin.Double-blind, placebo-controlled trial of 56 women aged 25 to 75 randomized to 250 mg GTPs or placebo twice daily for 2 years. A blinded dermatologist scored the appearance of photodamaged facial skin at 0, 6, 12, and 24 months. A blinded dermatopathologist scored the histologic characteristics of sun-exposed arm skin at 0 and 24 months.Clinical assessment of facial skin revealed that the GTP group had significant improvement in overall solar damage at 6 months (p=.02) and significant improvement in erythema and telangiectasias at 12 months (p=.02). The placebo group did not have significant improvements in these parameters at 6 months or 12 months. There were no statistically significant differences in other photoaging parameters at 6, 12, or 24 months in the GTP or placebo groups. Histopathologic analysis of sunexposed arm skin showed no statistically significant difference in photoaging parameters in the GTP group or the placebo group at 24 months.Long-term supplementation with oral GTPs was not superior to placebo in improving clinical or histologic photoaging parameters after 24 months of use.

    View details for DOI 10.1111/j.1524-4725.2009.01183.x

    View details for Web of Science ID 000267658700006

    View details for PubMedID 19469799

  • Preventing diabetic skin ulcers in Latinos-- no small feat: development of a Spanish and English survey for fast assessment of lower extremity skin care practices Archives of Dermatology Munoz, C., Chang, AS 2009; 145 (4): 486-488
  • Oral contraceptives for acne and sexual practices Journal of the American Academy of Dermatology Abuabara K, Chang AL 2009; 60 (3): 515-6
  • Adoption of Western Culture By Californian Asian Americans: Attitudes and Practices Promoting Sun Exposure Archives of Dermatology Gorell ES, Lee C, Munoz CA, Chang AS 2009; 145 (5): 552-555
  • Alefacept for erosive lichen planus: A case series JOURNAL OF DRUGS IN DERMATOLOGY Chang, A. L., Badger, J., Rehmus, W., Kimball, A. B. 2008; 7 (4): 379-383


    Erosive mucosal lichen planus is thought to be an autoimmune disease mediated by increased T-cell activation and proliferation. Alefacept is a biologic agent that selectively targets memory T cells.To evaluate the preliminary efficacy and safety of alefacept in the treatment of moderate to severe mucosal LP.Seven subjects were randomly selected to receive either alefacept 15 mg or placebo every week for 12 weeks. Endpoints of the case series were the Physician Global Assessment (PGA) of disease severity, mucosal pain (MP) severity, and itch severity (IS). Both subjects and investigators were blinded.Two of the subjects receiving alefacept achieved significant improvement during the study. There were no serious adverse events during the course of the study period.In this small case series, alefacept may have conferred a modest therapeutic response in erosive lichen planus (LP). Larger multicenter prospective studies will be needed to determine whether alefacept can improve erosive LP in a statistically significant way.

    View details for Web of Science ID 000255376000010

    View details for PubMedID 18459520

  • A case of argyria after colloidal silver ingestion JOURNAL OF CUTANEOUS PATHOLOGY Chang, A. L., Khosravi, V., Egbert, B. 2006; 33 (12): 809-811


    Argyria is often considered an entity of the past, one which has largely disappeared with the cessation of silver usage in oral medications. However, with the practice of colloidal silver ingestion in current "alternative health" treatments, argyria should be considered in the differential diagnosis of blue-gray hyperpigmentation.A single case report with clinicopathological correlation.Histological examination of skin biopsy specimen, which showed perieccrine brown-black granules, verified that colloidal silver rather than a prescribed medication was the source of the patient's dyspigmentation.

    View details for DOI 10.1111/j.1600-0560.2006.00557.x

    View details for Web of Science ID 000242658700007

    View details for PubMedID 17177941

  • Risk factors associated with striae gravidarum JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chang, A. L., Agredano, Y. Z., Kimball, A. B. 2004; 51 (6): 881-885


    Striae gravidarum (SG) is a poorly characterized but common disfiguring condition of pregnancy.To better characterize the epidemiological factors associated with SG.An anonymous survey administered at Stanford Ambulatory Clinics sampled 161 women who had given birth.Forty-eight-point-three percent of women with SG (43/89) versus 19.4% without SG (14/72) reported mothers with SG (odds ratio = 7.0, 95% confidence interval [CI] 2.7, 18.6). Forty-seven percent of women with SG (42/89 women) versus 18.1% without SG (13/72) reported additional relatives with SG (odds ratio = 7.2, 95% CI 2.9, 18.2). Eighty-one percent of women with SG (68/84) versus 30.5% without SG (18/59) reported a history of breast or thigh striae (odds ratio = 8.6, 95% CI 3.8, 19.9). Forty-seven percent of women with SG versus 17% without SG were non-white (odds ratio = 4.2, 95% CI 1.9, 9.6).This study suggests that a history of breast or thigh striae, family history, and race is significantly predictive of SG development.

    View details for DOI 10.1016/j.jaad.2004.05.030

    View details for Web of Science ID 000225745300002

    View details for PubMedID 15583577

  • Salpingectomy or proximal tubal occlusion of unilateral hydrosalpinx increases the potential for spontaneous pregnancy. Human Reprod Sagoskin AW, Lessey BA, Mottla GL, Richter KS, Chetkowski RJ, Chang AS, Levy MJ, Stillman RJ. 2003; 18 (12): 2634-7
  • Obstetric attending physician characteristics and their impact on vacuum and forceps delivery rates: University of California at San Francisco experience from 1977 to 1999. Am J Obstet Gynecol Chang AL, Noah MS, Laros RK 2002; 186 (6): 1299-303
  • Talin and vinculin play distinct roles in filopodial motility in the neuronal growth cone J Cell Biol. Sydor AM, Su AL, Wang FS, Xu A, Jay DG 1996; 134 (5): 1197-207
  • Chromophore-assisted laser inactivation of patched protein switches cell fate in the larval visual system of Drosophila. Proc Natl Acad Sci U S A 1996; 91 (7): 2664-8

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