University Of Michigan Research Articles

Protocol for a discrete choice experiment: understanding preferences for seeking health services for survivors of sexual violence in Uganda

IntroductionSexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan...

Destroying Phantom Jams with Connectivity and Automation: Nonlinear Dynamics and Control of Mixed Traffic

Connected automated vehicles (CAVs) have the potential to improve the efficiency of vehicular traffic. In this paper, we discuss how CAVs can positively impact the dynamic behavior of mixed traffic systems on highways through the lens of nonlinear dynamics theory. First, we show that human-driven traffic exhibits a bistability phenomenon, in which the same drivers can both drive smoothly or cause congestion, depending on perturbations like a braking of an individual driver. As such, bistability can lead to unexpected phantom traffic jams, which are undesired. By analyzing the corresponding nonlinear dynamical model, we explain the mechanism of bistability and identify which human driver parameters may cause it. Second, we study mixed traffic that includes both human drivers and CAVs, and we analyze how CAVs affect the nonlinear dynamic behavior. We show that a large-enough penetration of CAVs in the traffic flow can eliminate bistability, and we identify the controller parameters of CAVs that are able to do so. Ultimately, this helps to achieve stable and smooth mobility on highways. History: This paper has been accepted for the Transportation Science Special Issue on ISTTT25 Conference. Funding: This work was supported by the University of Michigan’s Center for Connected and Automated Transportation [U.S. DOT Grant 69A3551747105]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/trsc.2023.0498 .

PARP inhibitor therapy in patients with IDH1 mutated cholangiocarcinoma.

Isocitrate dehydrogenase 1 (IDH1) missense mutations occur at a frequency of 10%-15% in intrahepatic cholangiocarcinoma (iCCA). IDH1 mutations result in accumulation of (R)-2-hydroxyglutarate, an oncometabolite that leads to DNA hypermethylation and impairment of homologous recombination (HR). Impairment of HR results in a "BRCAness" phenotype which may confer sensitivity to poly(ADP ribose) polymerase (PARP) inhibition. We conducted a retrospective cohort review to identify patients with advanced, IDH1 mutated iCCA treated with a PARP inhibitor (PARPi) at the University of Michigan between 2018 and 2023. Patients are described with respect to prior lines of therapy, response to platinum-based chemotherapy, and progression-free survival (PFS) and overall survival (OS) from the time of PARPi initiation. Between 2018 and 2023 we identified 40 patients with IDH1 mutated iCCA of which 6 patients were treated with a PARPi as monotherapy or in combination with an ATR inhibitor or anti-PD-1 immune checkpoint inhibitor. Majority of patients (n = 5) carried an IDH1 R132C mutation per tissue-based next generation sequencing. All patients had previously received at least one line of cisplatin-based systemic therapy for advanced disease prior to treatment with PARPi. PFS and OS from time of PARPi initiation ranged from 1.4 to 18.5 months and 2.8 to 42.4 months, respectively. Best response on PARPi therapy included 2 partial responses. This is the first case series to describe PARPi treatment in IDH1 mutated iCCA. Results underscore the limitation of PARPi monotherapy, potentially support combined PARPi therapies, and highlight a need for effective treatment options for patients with IDH1 mutated iCCA.

Staged Excision Technique for Periocular Cutaneous Melanoma: Long-Term Outcomes of the Square Procedure.

To examine the long-term outcome of the staged excision via the square procedure for the treatment of periocular thin cutaneous melanoma. A retrospective chart review of 95 periocular cutaneous melanoma-in-situ and microinvasive melanoma tumors that were treated with the square procedure between April 1, 1994 and December 31, 2018 at the University of Michigan. Demographic and clinical data were evaluated. Of 95 cases, 19 (20%) were atypical junctional melanocytic proliferation with features of early melanoma-in-situ, 63 (66.3%) were melanoma-in-situ and 13 (13.7) were microinvasive melanoma with Breslow depth less than 1 mm. Tumor-free margins were achieved with a median margin of 10 mm (range 5-40 mm). Most cases (68.4%) required multiple excision stages. Surgical revision was necessary in 17.9% of cases and was associated with larger defect size. Local recurrence was noted in 8 patients (8.4%) at a median of 42 months postreconstruction. No tumor characteristics were found to predict recurrence. The square procedure for periocular melanoma offers an 8.4% recurrence rate, consistent with literature reports on similar staged excision approaches. The staged excision provides an excellent option for comprehensive margin review and tumor control with acceptable cosmetic results after reconstruction.

Research trends and hotspots in exercise interventions for liver cirrhosis: A bibliometric analysis via CiteSpace.

Cirrhosis is a chronic liver disease with severe consequences for a patient's health and survival. Exercise is an essential therapeutic strategy for both cirrhosis prevention and treatment. On the other hand, information regarding the present status of exercise-related research in cirrhosis is limited. Therefore, this study seeks to close the information gap in the scientific literature by using bibliometric techniques to analyze the trends, focal points, and cutting-edge research areas on exercise and cirrhosis. On September 22, 2023, research articles and reviews on exercise intervention for cirrhosis were obtained and downloaded from the Web of Science Core Collection (WoSCC). Subsequently, we employed CiteSpace (version 6.1.R6) to conduct bibliometric and knowledge graph analyses. 588 papers in 301 scholarly journals were written by 673 authors from 460 institutions spread over 63 countries and regions. The most productive nation among them is the United States. Not only is Zobair M. Younossi 1 of the most prolific writers, but he also receives the most co-citations. Most articles were published by the University of Michigan in the US, with the University of Alberta in Canada coming in second. Meanwhile, the WORLD JOURNAL OF GASTROENTEROLOGY has the most published articles, whereas HEPATOLOGY has the greatest number of co-citations. Apart from the theme words, the most frequently utilized keywords were "quality of life," "insulin resistance," and "mortality." Future research may concentrate on "obesity," "sarcopenia," and "Mediterranean diet," according to the analysis of keyword emergence. CiteSpace is used in this work to visually represent the topic of exercise intervention in cirrhosis, offering valuable information to researchers regarding the field's current status and possible future direction.

Global Medical Supply Inequities

The global issue of medical supply inequity exists as some countries have excess medical supplies, which leads to large amounts of medical supply waste resulting in both economical and environmental harm. However, many countries face the opposite issue and instead have a shortage of necessary, life-saving medical supplies. The duality of the issue is a harsh and widespread reality throughout the world. For example, the United States generates about 4.7 million pounds of medical waste yearly (Zygourakis et al., 2015; Thiel et al., 2020). In contrast, India, especially during the COVID-19 epidemic, faced a massive shortage of essential equipment like N-95 respirators, face shields, as well as ventilators. To reduce the worldwide inequities that arise due to the imbalance of medical supplies, Blueprints for Pangaea (B4P), a medical surplus recovery organization was founded. B4P, headquartered at the University of Michigan in Ann Arbor, redistributes unused medical supplies to places in need both locally and internationally, effectively reducing medical supply inequities one shipment at a time. This paper aims to explore the key components and global dynamics contributing to medical waste and to consider B4P as a potential model for addressing this problem.

Tumor Subtype Classification Tool for HPV-associated Head and Neck Cancers.

Molecular subtypes of HPV-associated Head and Neck Squamous Cell Carcinoma (HNSCC), named IMU (immune strong) and KRT (highly keratinized), are well-recognized and have been shown to have distinct mechanisms of carcinogenesis, clinical outcomes, and potentially differing optimal treatment strategies. Currently, no standardized method exists to subtype a new HPV+ HNSCC tumor. Our paper introduces a machine learning-based classifier and webtool to reliably subtype HPV+ HNSCC tumors using the IMU/KRT paradigm and highlights the importance of subtype in HPV+ HNSCC. To develop a robust, accurate machine learning-based classification tool that standardizes the process of subtyping HPV+ HNSCC, and to investigate the clinical, demographic, and molecular features associated with subtype in a meta-analysis of four patient cohorts. We conducted RNA-seq on 67 HNSCC FFPE blocks from University of Michigan hospital. Combining this with three publicly available datasets, we utilized a total of 229 HPV+ HNSCC RNA-seq samples. All participants were HPV+ according to RNA expression. An ensemble machine learning approach with five algorithms and three different input training gene sets were developed, with final subtype determined by majority vote. Several additional steps were taken to ensure rigor and reproducibility throughout. The classifier was trained and tested using 84 subtype-labeled HPV+ RNA-seq samples from two cohorts: University of Michigan (UM; n=18) and TCGA-HNC (n=66). The classifier robustness was validated with two independent cohorts: 83 samples from the HPV Virome Consortium and 62 additional samples from UM. We revealed 24 of 39 tested clinicodemographic and molecular variables significantly associated with subtype. The classifier achieved 100% accuracy in the test set. Validation on two additional cohorts demonstrated successful separation by known features of the subtypes. Investigating the relationship between subtype and 39 molecular and clinicodemographic variables revealed IMU is associated with epithelial-mesenchymal transition (p=2.25×10-4), various immune cell types, and lower radiation resistance (p=0.0050), while KRT is more highly keratinized (p=2.53×10-8), and more likely female than IMU (p=0.0082). This study provides a reliable classifier for subtyping HPV+ HNSCC tumors as either IMU or KRT based on bulk RNA-seq data, and additionally, improves our understanding of the HPV+ HNSCC subtypes.

All Visualisations Have Crooked Tales/Tails

AbstractThe breadth of architectural typologies is waning, or so Perry Kulper, Professor of Architecture at Taubman College, University of Michigan, tells us. Kulper's work has for decades focused on the development of dexterous, agile and creative methodologies for speculating about the possibilities of architecture(s) explored through notions of equivalence, remixing, reinterpreting and reimagining. Developed through seven spatial spectral strategies for an installation at the 2023 Chicago Architecture Biennial, familiar landmarks of the city are rescaled and combined to become other implements, adornments and spaces, bringing an uncanny familiarity to their propositions.

Teaching Antimicrobial Decision-Making in Medical Education: A Qualitative Study

Background: Inappropriate use of antimicrobials contributes to the growing threat of antibiotic resistance. While physicians encounter infections in virtually every facet of medical practice, research has shown that physicians have difficulty determining the need for antimicrobials and choosing the right drug. Physicians’ difficulties with antimicrobial prescribing likely begin early in medical education, yet little is known about how medical students learn to make antimicrobial choices. Our study sought to better understand how medical students learn antimicrobial decision-making, including the impact of a new learning tool introduced in the Infectious Diseases (ID) and Microbiology preclinical course. Method: From 2021-2023, we conducted 18 individual interviews with a purposive sample of medical students at the University of Michigan who had taken the preclinical ID/Microbiology course during the 2019-2021 curricular years. We asked participants how they learned to make antimicrobial decisions and how the course and clinical rotations influenced their understanding of antimicrobial choice. The six participants who took the 2021 course were additionally asked how an antimicrobial decision-making tool introduced that year impacted that process (Figure 1). The tool was adapted from prior work on antimicrobial reasoning (Abdoler et al, 2020). Participants were asked whether they remembered being introduced to the tool (approximately 18 months prior) and if they utilized it during their clinical rotations. Results were analyzed using Dedoose Software to facilitate thematic analysis. Result: Several themes emerged on analysis. Nearly all participants reflected that they learned elements of antimicrobial decision-making during clinical rotations, through observation or direct interaction with physician mentors and patients. Several participants described the preclinical period as content learning, with clinical rotations providing a space to consolidate and scaffold knowledge, as well as transfer knowledge to new situations or tasks. Of the 6 students interviewed regarding the antimicrobial decision-making tool, only one remembered it and could accurately describe its components prior to being shown the tool during the interview. Conclusion: Results suggest that participants view the preclinical ID/Microbiology course primarily as an opportunity to learn content, and perceive learning antimicrobial decision-making directly from practicing physicians in the clinical portion of medical school. An antimicrobial decision-making tool introduced during the preclinical ID/Microbiology course in 2021 did not impact students’ conceptualization of how they learned this skill. Given that practicing physicians often make antimicrobial prescribing errors, regular re-introduction of the tool during clinical rotations may help bridge preclinical antimicrobial educational content to the clinical phase of learning, counteract inappropriate antimicrobial lessons encountered clinically, and ground students' burgeoning antimicrobial prescribing skills in a logical reasoning model.

Top 50 most influential publications in robotic-assisted pulmonary lobectomy

BackgroundSince the early 2000s, robotic-assisted surgery has evolved in the field of thoracic surgery, and robotic-assisted pulmonary lobectomy (RAPL) has become a popular and safe treatment method for patients seeking removal of lung cancer. The purpose of the current study was to identify and examine the top-50 most influential articles in RAPL from 2003 to 2021 using bibliometric analysis. Hypothesis, materials, and methodsThe Clarivate Web of Science Core Collection was systematically searched to gather data on RAPL. Descriptive information for each article was collected and reported using descriptive statistics. The terms “robotic” AND “pulmonary” AND “lobectomy” were used to search this database and returned 468 articles published since 2003. ResultsBibliometric analysis of the top-50 most influential manuscripts concluded that these articles were published between the years 2003 and 2021 and were collectively cited 2476 times. Mean number of total citations per article was 49.5 (95% confidence interval [37.8, 61.2]). The most influential articles experienced greatest increase in citations in 2020 with 450 total citations and an average of 9.0 citations per article. Our analysis demonstrated an increase in total number of citations for RAPL from 2003 to 2021, and 68% of the most cited articles were published after 2016. All 50 articles were published in English, and the United States (32) and the People's Republic of China (6) had the top number of publications. The top affiliation was the University of Michigan with 6 publications. The most popular journals were Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery, with 7 and 6, respectively, of the top 50 manuscripts. ConclusionGiven the rising popularity of RAPL since 2003, a current list of the most influential articles in RAPL can provide a reference point to guide better practice and address future areas of thoracic research.

Sporting Revolutions: The 1970s and the Making of Modern College Athletics

At the beginning of the 1970s, college sports were on turbulent ground. “Colleges prepare for the impact of rising costs and more campus unrest,” warned the New York Times. The Los Angeles Times was a bit blunter in its prognosis, reporting that “like housewives everywhere, athletic directors of the nation's colleges [were] having budget trouble.” National Collegiate Athletics Association (NCAA) Executive Director, Walter Byers, warned of “cadres of disgruntled athletes,” demanding rights, money, and control. Byers was also troubled by Title IX, the new educational amendment mandating gender equity in federally funded schools, including in athletic departments. “The possible doom of our collegiate sports is near,” Byers proclaimed. “There is not an athletic department in the country where officials are optimistic,” University of Michigan's Athletic Director (AD), Don Canham, lamented. Norv Richey, University of Oregon's AD concurred, declaring, “The future of intercollegiate athletics are in peril.”

Progress and research trends in neurogenic bladder after spinal cord injury bibliometric analysis based on web of science database: An observational study.

Neurogenic bladder (NB) is a significant complication that often occurs after spinal cord injury. It results from urinary dysfunction caused by the injury, disrupting the normal neural control of the bladder and urethra. Symptoms of NB can include urinary frequency, urgency, incontinence, and retention, all of which can greatly impact the quality of life of affected individuals. While there are articles and reviews on NB, fewer specifically address NB following spinal cord injury. This study examined 1095 publications from January 1, 2000, to March 27, 2024, in the Web of Science core database using bibliometric software like VOSviewer, CiteSpace, and Bibliometrics. The analysis revealed an increasing trend in the number of publications, with the United States and China leading in research output. Professor Jeremy B. Myers from the University of Utah had the highest number of publications, while the University of Michigan and the University of Pittsburgh were the institutions with the most publications. The journal Neurourology and Urodynamics had the highest number of articles, and common keywords included management, quality of life, and dysfunction, highlighting key areas of focus for scholars.

Functional connectivity of the posterior cingulate cortex in autism spectrum disorder

The purpose of this study was to assess the functional connectivity of the posterior cingulate cortex in autism spectrum disorder (ASD). We used resting-state functional magnetic resonance imaging (rsfMRI) brain scans of adolescents diagnosed with ASD and a neurotypical control group. The Autism Brain Imaging Data Exchange (ABIDE) consortium was utilized to acquire data from the University of Michigan (145 subjects) and data from the New York University (183 subjects). The posterior cingulate cortex showed reduced connectivity with the anterior cingulate cortex for the ASD group compared to the control group. These two brain regions have previously both been linked to ASD symptomology. Specifically, the posterior cingulate cortex has been associated with behavioral control and executive functions, which appear to be responsible for the repetitive and restricted behaviors (RRB) in ASD. Our findings support previous data indicating a neurobiological basis of the disorder, and the specific functional connectivity changes involving the posterior cingulate cortex and anterior cingulate cortex may be a potential neurobiological biomarker for the observed RRBs in ASD.

Early practice makes histology masters: The use of a formative assessment quiz to prepare histology learners for a high-stakes final examination.

Assessment of learners in the anatomical sciences is a complex task as it not only tests students' fact knowledge, but also the analysis of visual information. Sometimes, novice histology learners must acquire image recognition skills of microscopic structures in a short time frame. This paper describes a strategy of offering first year dental students at the University of Michigan a short, non-grade contributing, formative assessment quiz in order to better prepare them for a high-stakes, final summative histology examination. Data collected over 7 years indicate that students, who made use of this formative assessment opportunity, performed significantly better in their summative examination than students, who did not. Especially early practice quiz users profited most. Students, who used the practice quiz until they achieved a perfect score, also had statistically higher final examination scores. Students, who did not use the practice quiz, had a significantly lower cumulative D1-year Grade Point Average (D1-GPA) than students, who did, indicating that academically weaker students often underuse supporting learning resources. In general, scores from the Dental Admission Test (DAT) were weak predictors of learning success in the DENT 510 histology course. In contrast, the D1-GPA values had a medium strength positive correlation with final histology examination scores. The major problem that was encountered with this practice quiz strategy was that many students waited until close to the day of the final examination before taking advantage of this feedback opportunity, thereby reducing its potential benefit for improving their overall learning strategy for histology.

Self-driven ion deflectometry measurements using MeV fusion-driven protons and accelerated deuterons in the deuterated hybrid x-pinch on the MAIZE LTD generator

We report on the results of point-projection ion deflectometry measurements from a mid-size university z-pinch experiment. A 1 MA 8 kJ LTD generator at the University of Michigan (called MAIZE) drove a hybrid x-pinch (HXP) with a deuterated polyethylene fiber load to produce a point-like source of MeV ions for backlighting. In these experiments, 2.7 MeV protons were generated by DD beam-target fusion reactions. Due to the kinematics of beam-target fusion, the proton energies were down-shifted from the more standard 3.02 MeV proton energy that is released from the center-of-mass rest frame of a DD reaction. In addition to the 2.7 MeV protons, strongly anisotropic beams of 3 MeV accelerated deuterons were detected by ion diagnostics placed at a radial distance of 90 mm from the x-pinch. Numerical reconstruction of experimental data generated by deflected hydrogen ion trajectories evaluated the total current in the vacuum load region. Numerical ion-tracking simulations show that accelerated deuteron beams exited the ion source region at large angles with respect to the pinch current direction.

One Classroom, Different Perspectives: Promoting Mutual Understanding between “Secular” and “Religious” Students of Islamic Studies in Russia and the United States

Abstract The article discusses the results from several co-taught courses in Islamic studies shared as a virtual exchange between the University of Michigan (U-M), USA, and Saint Petersburg State University (SPbU), Russian Federation. These courses were designed and taught to expand the range of perspectives to which students were exposed and allow them to learn how their study subject is conceptualized and studied by their peers in the partner country. The SPbU student cohort included graduates of Islamic religious colleges from different regions of the Russian Federation who shared the classroom with “secular” university students specializing in Islamic studies. The U-M cohort included students of various religious, ethnic, and academic backgrounds. In addition to weekly online meetings, the international teams met virtually outside class to prepare questions for weekly synchronous discussions and to work on a group presentation to be delivered at the end of the semester.

Developing a Bayesian workshop for full-time staff statisticians.

There are two main schools of thought about statistical inference: frequentist and Bayesian. The frequentist approach relies solely on available data for predictions, while the Bayesian approach incorporates both data and prior knowledge about the event of interest. Bayesian methods were developed hundreds of years ago; however, they were rarely used due to computational challenges and conflicts between the two schools of thought. Recent advances in computational capabilities and a shift toward leveraging prior knowledge for inferences have led to increased use of Bayesian methods. Many biostatisticians with expertise in frequentist approaches lack the skills to apply Bayesian techniques. To address this gap, four faculty experts in Bayesian modeling at the University of Michigan developed a practical, customized workshop series. The training, tailored to accommodate the schedules of full-time staff, focused on immersive, project-based learning rather than traditional lecture-based methods. Surveys were conducted to assess the impact of the program. All 20 participants completed the program and when surveyed reported an increased understanding of Bayesian theory and greater confidence in using these techniques. Capstone projects demonstrated participants' ability to apply Bayesian methodology. The workshop not only enhanced the participants' skills but also positioned them to readily apply Bayesian techniques in their work. Accommodating the schedules of full-time biostatistical staff enabled full participation. The immersive project-based learning approach resulted in building skills and increasing confidence among staff statisticians who were unfamiliar with Bayesian methods and their practical applications.

Small tuck for superior oblique palsy

PurposeTo investigate the surgical outcomes of small superior oblique (SO) tuck—denoting minimal tendon laxity—in patients with unilateral SO palsy. MethodsThe medical records of consecutive patients treated with ≤6 mm SO tuck from 2000 to 2018 at Kellogg Eye Center, University of Michigan, were reviewed retrospectively. Tendon tucks were performed to a fairly uniform tension in an amount that just eliminated slack in the tendon. Pre- and postoperative motility measurements were compared. Patients were excluded if they had a history of prior strabismus surgery or concurrent vertical rectus or inferior oblique surgery. ResultsA total of 27 cases (14 males) met inclusion criteria. The median age at surgery was 47 years (range 3–74 years). The mean SO tuck (total, both arms of tuck) was 4.9 mm (range, 2–6 mm). After surgery, median hypertropia decreased from 9Δ to 1Δ in primary position and from 20Δ to 4Δ in the SO field of action (contralateral downgaze). Lateral incomitance (difference in hypertropia between contralateral and ipsilateral gaze) decreased from 10Δ to 2Δ (P < 0.001 in each case). Six patients had diplopia in upgaze postoperatively that was not symptomatic enough to require reoperation. Six patients had residual hypertropia requiring additional surgery. ConclusionsSmall SO tuck provided disproportionate correction of hypertropia in the SO field of action and nearly eliminated lateral incomitance without producing unacceptable iatrogenic Brown syndrome. Even in the absence of tendon laxity, SO tuck was a good surgical option for SO palsy in our cohort where there was marked lateral incomitance and the greatest deviation was in the SO field of action.

Clinical outcomes in salivary adenoid cystic carcinoma.

6102 Background: Adenoid cystic carcinoma (ACC) is a rare salivary gland malignancy with a paucity of clinical outcome data. As such, evidence supporting and informing current guidelines remains limited. Methods: Inclusion criteria stipulated adults with adenoid cystic carcinoma treated at the University of Michigan between 1988 and 2019 with complete records (n=102). Clinical variables including demographics, disease stage, and treatment modality were abstracted. Pathologic variables analyzed included tumor grade, perineural invasion, lymphovascular invasion, and surgical margin status. Multivariate analyses were performed with disease recurrence calculated with Kaplan-Meier methodology as the primary outcome. Results: Mean age at diagnosis was 59 years; stage I and II disease accounted for 35 (38%) patients. Initial treatment was most commonly surgery with adjuvant radiation (77%). Median follow-up was 3 years. Distant metastatic disease developed in 34 (33%) patients. Most common sites included lung (68%), bone (21%), and brain (21%). Median time to distant metastases was 46 months with median overall survival of 58 months. Patients with locoregional recurrence experienced median survival of 91 months. Multivariate analysis adjusted for grade, perineural invasion, and surgical margin status (Table). Grade 3 tumors with predominantly solid histologic pattern pose higher risk of recurrence compared to grade 1 tubular histologic patterns as a reference (HR 3.69, 95% CI 1.15-11.88, p=0.028). Conclusions: Survival among patients with adenoid cystic carcinoma after locoregional recurrence is significantly better compared to those experiencing distant metastasis. Furthermore, tumor grade is most predictive of recurrence. Additionally, distant metastases may emerge over the course of many years. These data from one of the largest retrospective databases to date may inform the development of disease-specific surveillance guidelines and novel salvage treatment paradigms. [Table: see text]

A retrospective cohort study of genetic referral and diagnosis of Birt-Hogg-Dubé Syndrome in patients with Trichodiscoma and Fibrofolliculoma skin lesions.

Birt-Hogg-Dubé (BHD) syndrome is a genetic condition caused by pathogenic variants in the FLCN gene resulting in benign skin lesions, spontaneous pneumothorax, and increased risk for a variety of renal tumors. Skin manifestations of BHD include trichodiscoma (TD) and fibrofolliculoma (FF), which may represent the same pathologic entity. These lesions can identify BHD patients, who upon positive genetic testing can be considered for life-long surveillance for renal neoplasms. To characterize patients diagnosed with TD and FF including rates and outcomes of genetics referral. Retrospective chart reviews of patients with confirmed or possible diagnosis of TD or FF at the University of Michigan from September 2002 through October 2020 to assess pathologic findings, personal and family history of BHD manifestations, referral for genetic evaluation, and genetic testing results. 64 patients had a pathologic diagnosis of TD or FF, 16 of whom (25%) were referred to cancer genetics. Fourteen patients completed genetic evaluation, 9 of whom were diagnosed with BHD (64%), with 6 unique pathogenic variants in FLCN. Providers should consider referral for genetic evaluation for patients with biopsy-proven TD or FF, as early diagnosis of BHD provides the opportunity for early detection and treatment of other BHD-associated conditions.