Participating in the Repository
When you or your child has tissue removed for diagnostic purposes it is sent to a pathology laboratory to be analyzed. Once a diagnosis is made, these tissue samples are stored at the laboratory so they can be reviewed at a later date if necessary.
By agreeing to participate in this repository you give permission to our researchers to conduct studies on your stored tissue. If your doctor feels it is necessary to perform additional biopsies we may use some of this tissue in the repository. We may contact your doctor every few years for follow-up clinical information.
We promise not to ask you for additional tissue samples and not to release any personal or confidential information.
How to Participate
To participate, first call us at (203) 737-1090 or 1 (866)430-7259.
Once you have spoken with us, you may print out and fill out the appropriate consent forms, listed below:
- Adult consent form
- Adolescent assent form (13-18)
- Child assent form (children 7-12)
- Parental permission form (required for all children and adolescents younger than 18)
Note: only the parental permission form is required for children younger than 7.
Please also fill out the release form so we can obtain biopsy material from the pathology laboratory where the diagnosis was made:
Once you have completed the necessary consent forms and the release forms, mail them to:
Spitzoid Neoplasm Repository
c/o Rossitza Lazova
15 York Street, LMP 5031
P.O. Box 208059
New Haven, CT 06520-8059
If you would like to receive email updates on our research and other breakthroughs in the study of spitzoid neoplasms send an email with “mailing list” in the subject line to firstname.lastname@example.org.
Email information is confidential and will not be distributed for any purpose.
Pathologists or dermatopathologists who would like to contribute a case:
Please send us histologic slides and paraffin blocks on your patient after requesting an entry code for the Spitzoid Neoplasm Repository.
Dermatologists and other physicians can:
- Provide the patient with our contact information
- Give us permission to contact the patient directly
If patients are lost to follow up, please request an entry code for the Spitzoid Neoplasm Repository, then sign the release form linked below and send it to us in order to obtain tissue samples and paraffin blocks from the laboratory where the patient’s biopsy was diagnosed: