bluuebunny/crossref_metadata_2025 huggingface dataset:
The city of tomorrow: Challenges and Solutions. A case study of a coastal town.
Authors: Voukkali I , Papamichael I , Loizia P , Stylianou M , Zorpas AA
Published: June 2023

Urbanization trends and environmental concerns are interconnected due to the increased demand of natural resources, waste production and greenhouse gas emissions. One of the most important anthropogenic factors affecting ecosystems and sustainability is the rapid growth of cities in both size and complexity. According to United Nations as at mid-2017, the global population was an estimated 7.6 billion people, and it is expected to reach 9.8 billion (2050). As the world urbanizes, the role of cities in defining sustainability outcomes increases in importance. Even though cities expansion contributes to economic prosperity and social growth, at the same time, it poses severe challenges both to the environment and social system. The changing from “unsustainable cities” to “sustainable, green and smart cities”, has become a major topic in research community and policy making for endorsing urban sustainability. As a result, the United Nation Sustainable Development Goals were developed as an ambitious blueprint for achieving peace and prosperity while also protecting the environment. Especially SDG 11 is dealing with making cities inclusive, safe, resilient and sustainable. Moreover, Circular Economy is receiving increasing attention globally as a way to overcome the current production and consumption model based on continuous growth and increasing resources input, with aim to increase the efficiency of resource use in order to achieve balance and harmony between economy, environment and society. The objective of this paper was to identified the major challenges occurred due to the rapid urbanization in a coastal area giving emphasis to Particulate Matters Emissions PM2.5, and how the use of the PM2.5 emission index could be used as an indicator for determining the urban metabolism of an island area taking into account that the increase in the concentration of PM in an area is directly related to the increase of anthropogenic activities resulting from population growth and consequently the increase in flows of materials and services and at the same time the increase in the production of solid and liquid waste and gaseous emissions. The higher the index, the greater the degree of metabolism of an area and the impact on air quality.
The city race to carbon neutrality; a realistic dream or a chimera?
Authors: Alexandri E
Published: June 2023

This paper examines whether carbon neutrality of a city like Athens could be an achievable target, concentrating on energy induced greenhouse gas emissions. The main focus is on buildings, but the trends in transport are also investigated. Taking into consideration these examined trends, emphasis is given on technologies that have been put forward for the decarbonisation of cities, such as energy savings and electrification of all energy consuming activities. The incorporation of these technologies is examined within a time frame of approximately 30 years, in order to investigate how, with which technologies and synergies the city can reach carbon neutrality by 2050, taking into account the effect of the undergoing energy crisis. In these projections, various scenarios are examined, taking into consideration not only the effect of national plans for the decarbonisation of electricity production, but also the current energy crisis, which might lead to an increase in the carbon footprint of electricity. Optimistic and pessimistic scenarios, regarding the decarbonisation of electricity, energy demand trends, energy costs that lead to the rise of energy poverty within the city are investigated. Conclusions are drawn on the synergies that must take place so that energy efficiency technologies that have been put forward can be effective for the transformation of Athenian buildings and activities into carbon neutral ones, or can lead to the failure of such a goal.
Assessing the fragmentation-barrier effect in urban areas: The case study of Thessaloniki, Greece
Authors: Sdoukopoulos A , Pitsiava-Latinopoulou M , Politis I
Published: June 2023

Transport infrastructure is an integral part of every urban area serving the accessibility and mobility needs of people and goods. However, despite its significant role, transport infrastructure, due to its geometric and functional characteristics, can sometimes act as a physical or psychological barrier to the movement of vulnerable road users, thus fragmenting the urban space. The fragmentation of the built environment, or in other words, the “barrier effect”, is a problem that has attracted growing attention during the last decades as a consequence of its severe negative impacts, the entailing social and economic inequalities, and the increasing population ageing. In this context, the current paper presents a methodological approach for assessing the degree of fragmentation of urban areas. The proposed methodological approach utilises the well-established landscape fragmentation indicator “effective mesh size - meff” and attempts to adapt it to the urban environment. Moreover, it presents a slight modification in its structure, thus leading to values ranging from 0 to 1, to facilitate comparative analyses between different areas and favour the easier interpretation of the results. In order to highlight any issues of usability and credibility, the methodological approach presented in the paper was also applied to the seven municipalities that comprise the Metropolitan Area of Thessaloniki. The pilot implementation underlined significant differences between the aforementioned cases and highlighted the value and reliability of the methodological approach.
Non-visual daylight potential in offices: a parametric study
Authors: Gkouvelou E , Moskoveli D , Khanie M S
Published: June 2023

A building design where appropriate daylighting is considered from early stages can enhance the building’s energy performance, as well as human well-being and productivity. Daylight naturally regulates our daily biological clock, which synchronizes our circadian rhythms. This paper presents a simulation-based parametric study to evaluate the non-visual daylight potential. A side-lit single office room in the Danish climate was simulated in Grasshopper 3D. Using the Lark plug-in, grid-based and image-based workflows were created to generate illuminance, circadian light and Equivalent Melanopic Lux. In this study we compared two design cases with extremely high and low thermal and daylighting conditions. The impact of orientation on the circadian rhythms of a sitting person with a pre-defined view-direction under an overcast and a clear sky was investigated. The results indicate that certain design combinations can minimize daylight access up to three times leading to a higher risk of circadian disruption. These disruptions were the highest in winter and under the overcast sky. No clear impact of the building-orientation on the circadian stimulation for the defined view-direction was observed. Hence, it is essential that the view-direction is set optimally. Evaluating circadian response in early phases can lead to inclusive decision-making for enhanced indoor conditions.
Study and analysis of the climate in Greek cities with the aid of climatic data: Climate analysis as a design tool in undergraduate students’ projects
Authors: Bougiatioti F , Alexandrou E , Kotsenos A
Published: June 2023

The analysis of the climate and the microclimatic conditions of a place is directly linked with the principles of bioclimatic architecture and thus provides an insight for the first stages of the design or redesign of buildings. The aim of this article is to provide a methodology for the first stages of building design which as far as bioclimatic and sustainable parameters are concerned, involves the analysis and the comprehension of the climate. Climatic analysis can be done with a combination of different sources, data and software, with the primary aim being the identification of the basic climatic parameters and their effect on comfort and energy consumption. After that, and with the use of psychrometric diagrams, climatic data can be directly linked to bioclimatic design strategies that can be introduced from the very beginning of a design project. The proposed methodology has been developed within the framework of undergraduate architectural technology courses and could be applied not only to undergraduate and postgraduate students’ design projects, but also to professional work, such as architectural competitions around the world and actual projects.
Application of a thermo-physiological model to determine sweating thermo-active zone for a medical staff subject
Authors: Ascione F , De Masi R F , Nižetić S , Šolić P , Tariello F , Vanoli G P
Published: June 2023

Thermo-physiological models represent a valid approach for the study of person-environment energy interactions and constitute an alternative and promising methodology for the study of comfort in all those cases in which the Fanger’s statistical model is not applicable. By dividing the body into several segments, and these into several nodes, including physiological variables among the inputs and detailing the representation of clothing, these models are better suited to application in the healthcare sector, as they can take into account pathological states that alter physiological responses (patients) and specific types of clothing and activities (medical staff). In this work, the Tanabe 65 MN model, implemented in the ABICS opensource software, has been used to identify the thermo-active zones in which sweating occurs on at least one section of the body for a person of the medical staff. A parametric analysis was developed by varying the ambient temperature (20 - 36 °C), the relative humidity (40 - 60%), the metabolic rate (1.5 - 2.0 met) and considering a young subject (30 years) and an older one (60 years). These zones were identified on charts correlating the skin temperature to the ambient one. In both cases, a similar trend is observed: the average temperature of the skin, at which sweating occurs, increases as the ambient temperature grows and on average this mechanism is activated for lower skin temperatures in the case of the older individual.
Analysis of Swedish school buildings’ energy performance certificates with focus on ventilation systems
Authors: Cabovská B , Teli D , Dalenbäck J-O
Published: June 2023

Energy performance certificates are valuable sources of information about buildings. They are primarily used to assess the buildings’ energy performance, however the data included can also be used for building stock description or analysis from different perspectives. School buildings account for a substantial part of the Swedish public building stock and represent a great opportunity for implementation of energy saving strategies. To improve the energy efficiency, it is first important to analyse and understand the current energy use and identify the key factors responsible for most of the energy use. In Sweden, data used for EPC compilation are in most cases real measured data opposite to other European countries where EPC comprises calculated data practices. Therefore, the energy performance value provides a much more realistic representation of the building energy use. This study analyses certain aspects of school buildings’ energy performance using data available in EPCs, such as year of construction, floor area, heat supply systems and ventilation system. Comparison with data from some other European countries is also presented. The data which could be included in the certificate to extend the potential of EPC use in other areas, such as evaluation of indoor environmental quality, is also discussed.
Theoretical and experimental investigation of ventilation rates and their relation with IAQ and thermal comfort in university classrooms during SARS-COV-2 pandemic
Authors: Papadopoulos Giannis , Nikolentzos Apostolos , Tolis Evangelos I. , Panaras Giorgos
Published: June 2023

During the pandemic of Covid-19, ventilation rate of buildings and especially in spaces with high occupancy like classrooms, presents high research interest. The ventilation strategies, combined with the use of masks, contribute to the decrease of the infection risk of Covid-19. Also, ventilation improves Indoor Air Quality (IAQ), contributing to the good health of the users and potentially influences their thermal comfort. In the proposed work, the experimental investigation of the ventilation’s adequacy in naturally ventilated classrooms located at the University of Western Macedonia, in Kozani, Greece, took place. Measurements include thermal comfort parameters, as well as IAQ ones, namely carbon dioxide (CO2), volatile organic compounds (VOCs), aldehydes and ozone (O3). The air exchange rates were determined according to the tracer gas decay and equilibrium analysis methods, using CO2 as tracer gas, while simulations analysis using appropriate computational approaches was applied. The results between tracer gas method and simulation analysis were compared, allowing the validation of the adopted models. Given that for both approaches natural ventilation proved to be inadequate, different simulated scenarios of ventilation, including natural and mechanical configuration, were investigated; the relation of ventilation rates to IAQ and thermal comfort was investigated. Moreover, the infection risk, given the determined or simulated IAQ, was assessed, according to relevant approaches.
Importance of air quality indicators for office environments: An overview
Authors: Čulić A , Nižetić S , Šolić P , Perković T , Ascione F
Published: June 2023

Air quality in office buildings has got an impact on working productivity as well as on the working satisfaction in office environments. Moreover, final effect can be linked with thermal comfort conditions since they have significant impact on energy consumption in offices. In this study various factors have been investigated and analysed in order to understand their impact on air quality and occupants’ satisfaction with the environmental conditions. The second perspective of the overview was focused on analysis of the air quality interconnection with thermal comfort conditions, since they are linked. The current issues as well as challenges in the field were also discussed within this investigation. The results of conducted research would be directly useful for more advanced consideration of personal air quality and thermal comfort conditions as vital aspect of smart and high-performance buildings.
The Effect of Improper Interfering in The Historical Architecture on Energy Wasting (Case Study: Bibi-Roqayyeh House, Yazd, Iran)
Authors: Yazdi H , Mügge G , Movafagh S , Fallahi MH , Ludwig F , Moazen S
Published: June 2023

Intelligent traditional architecture in Iran functions as a sustainable system with the goal to achieve thermal comfort. Buildings in Iranian architecture have a strong connection with the surrounding buildings, making the city an integrated whole. Generally, it is said that it is not possible to remove any part of this system without affecting the whole system’s performance. This research shows how removing some components of the system could affect the energy consumption of the whole. the question raised in our research and the answer obtained through this simulation is essential for controlling and optimizing interventions in historic cities. The case study is the Bibi-Roqayyeh traditional house in Yazd, Iran. First, the energy performance of the building under real conditions is simulated in Design-Builder software. Next, the energy performance of the building without the neighbors, the SABAT, and the traditional high Parapet are simulated. Overall, the simulation results show an increase in the total energy consumption of the main building after removing the selected components. The total energy consumption of the house is increased by 21.81% when all neighbors, the SABAT, and the old Parapet are removed. Each part affects the thermal comfort and energy consumption of the building, even if its primary function is not related to the thermal system.
Urban heritage and the four pillars of sustainability: Urban-scale facility management in the World Heritage sites
Authors: Prabowo B N , Salaj A T
Published: June 2023

The discussion addressing sustainability issues of the World Heritage (WH) as cultural sites that holds outstanding universal values (OUV) has started to surface since the adoption of the “Strategic Action Plan for the Implementation of the World Heritage Convention 2012-2022”, specifically in the third goal, which states that “heritage protection and conservation should consider present and future environmental, societal, and economic needs.” This goal aligned with the first three pillars of sustainability. After the introduction of “culture” as the fourth pillar of sustainability by UCLG in 2011, the issue of sustainability in the WH sites has drawn global attention. The balance of all four pillars of sustainability within protected sites can potentially be achieved by improving efficiencies through urban-scale facility management (Urban FM). The principles of Urban FM aligned with UNESCO’s recommendation on the Historic Urban Landscape (HUL) approach, which is a holistic approach to managing historic sites. This study discusses aspects of managing urban-scale facilities in urban heritage areas and aims to shed light on the knowledge of Urban FM at WH sites by employing a literature review approach. The preliminary findings indicate that culture, the fourth pillar of sustainability, was involved and bound to the other three pillars: economic, social, and environmental. Within WH sites, urban-scale facility management needs to be considered seriously to ensure the protection of OUV that efficiently defines the existence of their status as World Heritage.
Energy retrofitting of heritage buildings: an integrated methodology
Authors: Kyritsi E , Philokyprou M , Kyriakidis A , Michael A , Michopoulos A
Published: June 2023

A resilient and sustainable way of life presupposes the reduction of the energy consumption and the relevant greenhouse gas (carbon) emissions. This approach leads to the establishment and implementation of various directives and regulations regarding the refurbishment of the existing building stock. Often, these regulations exclude heritage buildings due to the lack of robust methodologies which will ensure a balance between the energy retrofitting and preservation of the building’s heritage values. Heritage buildings however, host a variety of public uses and their holistic and successful energy upgrade could serve as an excellent example of a heritage building energy refurbishment to the community. Thus, there is an emerging need for developing such methodologies. This paper aims to propose an integrated methodology for the energy retrofitting of heritage buildings, based on a multi-criteria decision-making process for the selection of the appropriate retrofitting solutions considering simultaneously the heritage significance, the heritage and the energy impact.
Rose-inspired 3D 1T-MoS
x
/Ti3C2T
x
/TiO2 photocatalyst for water purification
Authors: Chen Lu , Qiang Taotao , Zhang Xiancheng
Published: June 2023

The rose-inspired photocatalyst, 1T-MoS
x
/Ti3C2T
x
/TiO2, demonstrated exceptional activity in the simultaneous removal of hexavalent chromium (Cr(VI)) and methylene blue (MB), achieving high efficiencies of 97.7% and 97.2% respectively. Furthermore, it exhibited effective degradation of another dye, Rhodamine B (Rh.B). Scanning electron microscopy figures showed its unique nanoflower morphology. The introduction of titanium carbide nanosheets (Ti3C2T
x
) and the formation of Schottky junctions can effectively prolong the carrier lifetime. The degradation path of MB was deduced by liquid chromatography–mass spectrometry, which confirmed the process of photocatalytic decomposition of organic pollutants. Compared to physical purification methods, it offers the advantage of not only removing pollutants but also degrading them. Furthermore, by utilizing MB as a sacrificial agent, the reduction can take place in a mild neutral environment, resulting in minimized secondary pollution. Through its distinctive three-dimensional structure and the Ti3C2T
x
cocatalyst, the 1T-MoS
x
/Ti3C2T
x
/TiO2 photocatalyst demonstrates remarkable catalytic activity, and effective purification of wastewater containing Cr(VI) and organic dyes.
Investment casting of semi-solid 6063 aluminum alloy using the GISS process
Authors: Thanabumrungkul Sangop , Jumpol Waraporn , Meemongkol Napisphon , Wannasin Jessada
Published: June 2023

Investment casting has long been known as a process that can produce complex parts with fine details. However, it has not been used widely for parts that need to be anodized and whose nonuniform color is affected by the type of cast aluminum. Although 6063 aluminum is widely used in color anodizing for decoration purposes, it is almost entirely wrought. Some studies have used aluminum 6063 in cast aluminum, but no investment casting studies have been reported. The objective of this work is to develop a new semi-solid investment casting process using 6063 aluminum alloys to achieve a cosmetic anodized workpiece. To study the feasibility of the gas-induced superheated slurry (GISS) investment casting process, the effects of rheocasting time, mold temperature, and vacuum assistance were investigated. The results showed that the samples produced using the GISS process had a uniform microstructure and less porosity. The uniform color after anodizing and coloring also confirmed these processes. From the results, it can be summarized that the GISS process is feasible for application in aluminum 6063 investment casting for anodizing and coloring purposes.
002 National clinical audit on the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in adults
Authors: Tasker Fiona , Smith Steven P , Mustapa Firouz , de Berker David
Published: June 2023

UK guidelines for the management of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in adults, published by the British Association of Dermatologists (BAD) in 2016, outline a set of audit standards (Creamer D, Walsh SA, Dziewulski P et al. U.K. guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol 2016; 174:1194–227). Our aim was to audit the current management of SJS/TEN in adults against audit standards in the BAD guidelines. BAD members were invited to submit data on five consecutive adults with SJS/TEN per department over an 8-week period in 2022. All data were obtained from respondents using a Microsoft Excel spreadsheet proforma returned to the BAD by email. No patient-identifiable data were requested. Initial data extraction was conducted using a novel and reproducible program written in the R statistical language (V3.7 and the readxl, ggplot2 and ggthemes packages). The data analysis was also performed using Microsoft Excel. Thirty-nine (29%) dermatology centres in the UK participated and data for 147 adults with SJS/TEN were collected. Within 24 h of a diagnosis being made or suspected, the following were documented: Severity-of-Illness Score for TEN (SCORTEN) for 52% (n = 76/147) of submitted cases, list of medications for 77% (n = 113) and timelines for commencement/alterations of medications for 71% (n = 104). Initial assessment was of the eyes (by an ophthalmologist) for 48% (n = 71) of cases, the mouth in 88% (n = 130), the genital skin in 70% (n = 103) and the urinary tract in 63% (n = 93). In the first 10 days after a suspected or confirmed diagnosis of SJS/TEN, daily assessments of the mouth were documented in 18% (n = 26) of cases, the eyes in 8% (n = 12) and the urinary tract and genital skin in 10% (n = 14). Documentation regarding advice on (i) avoidance of the culprit drug was present for 58% (n = 76/130) of cases and (ii) request for a medic alert bracelet/amulet in 6% (n = 9/147). In adults with SJS/TEN, drug causality assessment was documented adequately. Initial assessment of the mouth, eyes, urinary tract and genital skin was good to fair; however, daily assessments were poor. Other audit standards that require improving include documentation of SCORTEN and advice to avoid the culprit drug and request a medic alert bracelet/amulet. In adults with SJS/TEN, there are multiple points in the assessment pathway that require careful documentation and regular review. These are a challenge for many clinical inpatient environments. Care within a burns unit or similar may not be possible for all. This audit suggests that some form of assessment and clinical review checklist might enable colleagues to maintain standards outlined in the guideline. Among these, use of SCORTEN, advice to avoid the culprit drug and requests for a Medic Alert bracelet/amulet are key.
008 How often and how quickly do people with a first cutaneous squamous cell carcinoma develop further tumours? Analysis of national registry data between 2013 and 2020 in England
Authors: van Bodegraven Birgitta , Vernon Sally , Chen Cong , Harwood Catherine A , Matin Rubeta N , Proby Charlotte , Venables Zoe C
Published: June 2023

In England, cutaneous squamous cell carcinoma (cSCC) has an incidence rate of 85.2 per 100 000 person-years and over 30 000 new incident patients annually. Subsequent cSCC are common. Improved understanding of the frequency and time frames is important for cancer prevention, management guidelines and service provision. The aim of this study was to describe national cSCC accrual data in England. This retrospective cancer registry cohort study used data provided by the National Disease Registration Service. Cancer registrations are created from National Health Service (NHS) data feeds, primarily pathology reports from NHS laboratories. Patients with a first-ever registered cSCC during 2013–2015 were identified. All cSCC pathology reports from 2013 to 2020 were analysed in the 5 years following the first cSCC diagnosis date. To account for supplemental reporting and the possibility that two reports within a short time frame double count the same tumour (e.g. diagnostic biopsy followed by therapeutic excision), a washout period of 112 days (16 weeks) was used (i.e. cSCC was designated as a separate tumour when registration exceeded this period after the preceding cSCC diagnosis date). Sensitivity analysis assessed effects of several washout periods. Pathology reports were not reviewed, and a proportion of subsequent tumours may represent recurrences beyond the washout period or delayed treatment. A total of 79 301 first-ever cSCC tumours were registered. After applying the 112-day washout period, 22 225 subsequent tumours remained for analysis up to 2020. In total, 15 544 (19.6%), 4437 (5.6%) and 1426 (1.8%) of people developed a second, third and fourth cSCC tumour within 5 years, respectively. Within 1 year of the first-ever cSCC, 5676 (7.2%) patients had a second cSCC, increasing to 15.1% (n = 11 968) and 19.6% (n = 15 544) by years 3 and 5, respectively. The median interval between first and second cSCC was 550 days [interquartile range (IQR) 256–1046], second-to-third cSCC interval 392 days (IQR 219–708), third-to-fourth 283 days (IQR 175–492) and fourth-to-fifth 235 days (IQR 160–398). The accrual estimates are sensitive to the washout period. However, even with a 365-day washout period, 3.4% and 5.1% had developed a second cSCC by years 3 and 5, respectively. These data show that one in five patients will develop another cSCC within 5 years of their first-ever cSCC. Data on cSCC accrual rates are limited globally to single-centre or regional datasets. This national study provides detailed information on accrual rates in England, which are important for informing all aspects of clinical care, health service provision and design of future clinical trials for cSCC prevention.
RF05 A national report on incidence, patient demographics and tumour characteristics of melanoma by BRAF, NRAS and KIT genotype: England 2016–2019
Authors: Mistry Khaylen , Levell Nick , Kennedy Oliver , Richardson Kathryn , Karponis Dimitrios , McRonald Fiona , Hardy Steven , Lüchtenborg Margreet , Lee Rebecca , Lorigan Paul , Venables Zoe
Published: June 2023

Although studies have shown variation between countries in the incidence and characteristics of patients and tumours associated with melanoma BRAF, NRAS and KIT mutations, no national molecular genetics data from England have been published. In 2022, the National Institute for Health and Care Excellence highlighted the need for national cohort studies to evaluate the role of biomarkers. This descriptive national observational study used National Disease Registration Service (NDRS) data to identify all site melanoma cases that were diagnosed and underwent molecular genetic testing in England between 2016 and 2019. The NDRS collects molecular genetics data from most genomic laboratories nationally but does not routinely receive results for BRAF testing by immunohistochemistry (IHC) done at local pathology laboratories. Molecular genetic testing and incidence of wild-type (WT), BRAF mutant (+), NRAS+ and KIT+ melanomas were described. Demographic (sex, age, ethnicity, deprivation, geographical region) and tumour factors (site, stage) of BRAF+, NRAS+, KIT+ and WT tumours were described. In total, 61 514 new melanomas were registered in England between 2016 and 2019. Thirteen per cent (n = 7925), 5.0% (n = 3084) and 1.2% (n = 743) of tumours underwent BRAF, NRAS and KIT testing, respectively. BRAF testing rates varied across regions from 19.9% (n = 1040/5217) in the West Midlands to 5.5% (n = 227/4114) in the North East. Thirty-four per cent (n = 2674/7925), 30.5% (n = 942/3084) and 8.6% (n = 64/743) of tumours were BRAF+, NRAS+ and KIT+, respectively. Thirty-four per cent (n = 1523/4479) of males and 37.6% (n = 1132/3014) of females with cutaneous melanomas were BRAF+. Forty-six per cent (n = 1693/3712) of patients aged < 70 years and 20.5% (n = 332/1622) aged ≥ 80 years were BRAF+. The highest proportion of BRAF+ cutaneous melanoma were identified in the North East (46.7%, n = 106/227) and the lowest in the West Midlands (32.6%, n = 339/1040). Thirty-two per cent (n = 560/1760) of males and 30.0% (n = 349/1167) of females with cutaneous melanoma were NRAS+. Twenty-six per cent (n = 356/1354) of patients aged < 70 years and 31.8% (n = 229/718) aged ≥ 80 years were NRAS+. The highest proportion of NRAS+ cutaneous melanoma were in the West Midlands (40%, n = 14/35) and the lowest in the North East (28.3%, n = 36/127). We report the largest and most complete dataset for national molecular genetics of melanoma ever published. Regional differences in BRAF testing may be explained by variations in local practice and methods used, and differences in population age, but could impact on treatment options. Lack of IHC, testing nonuniformity and lack of whole melanoma population data (early-stage nonrecurrent tumours and tumours in frail elderly patients may be excluded) were limitations.
CPC06 Congenital urticaria pigmentosa mistaken for nonaccidental injury
Authors: Porter Emma , Heffron Cynthia , Murphy Lesley Ann , O’Connor Cathal
Published: June 2023

A male infant presented to his general practitioner for a routine 6-week check. His parents reported the presence of tan–brown lesions since birth. The marks were uniform in colour, were present on the trunk, scalp and face, and were not overlying bony prominences. There was concern that these lesions represented bruising as a manifestation of nonaccidental injury (NAI), and urgent paediatric review was arranged. He was admitted for investigation of potential NAI, and dermatology consultation was sought. On examination, scattered reddish brown-to-tan macules and papules were noted on the torso and limbs, not overlying bony prominences. Darier sign was negative, although some reactive cutis marmorata was appreciable on the trunk following rubbing of multiple lesions. A diagnosis of urticaria pigmentosa (UP), or cutaneous mastocytosis, was made clinically. Skin biopsies demonstrated an infiltrate of spindled and round mast cells and scattered eosinophils within the superficial and mid-dermis, with immunohistochemistry positive for CD117, consistent with UP. Blood tests during admission showed a normal complete blood count and coagulation screen (including von Willebrand factor), normal renal and liver function, normal lactate dehydrogenase, normal immunoglobulins and normal mast cell tryptase. Cranial ultrasound and liver ultrasound were normal. Mastocytosis is a spectrum of disease characterized by pathological accumulation of mast cells in tissues, including skin, bone marrow and the gastrointestinal tract. Cutaneous mastocytosis can be further classified as maculopapular cutaneous mastocytosis, also known as UP, diffuse cutaneous mastocytosis and localized cutaneous mastocytomas. With UP, children typically present in the first 2 years of life with multiple reddish-brown macules, papules and/or plaques distributed anywhere on the body, most commonly the trunk. In darkly pigmented skin, lesions may be hyperpigmented and erythema less appreciable. Darier sign, a transient urticarial response upon gentle rubbing of the skin, is classic and supportive of diagnosis, although it is not always demonstrable. UP has rarely been reported to be misdiagnosed as NAI. Other ‘bruising’ mimics include disorders of coagulation, Valsalva petechiae, vasculitis, acute haemorrhagic oedema, incontinentia pigmenti, phytophotodermatitis, coin rubbing, spooning, cupping, Mongolian spots, morphoea, neuroblastoma and ink stains, some of which may be unfamiliar to paediatricians or dermatologists. Dermatologists have a crucial role in recognizing cutaneous manifestations of NAI in children, which commonly includes bruising, particularly in infants who are not yet mobile. While consideration of NAI is important in all children presenting for medical care, this case highlights the importance of considering underlying dermatoses to avoid unwarranted distress and unnecessary investigations.
P14 Bullous sweet syndrome as a presentation of chronic myelogenous leukaemia
Authors: Syed Zarnain Shah , Abbas Syeda Wajiha , Shaikh Usman
Published: June 2023

A variety of cutaneous lesions are frequently encountered in clinical practice that could be secondary to allergic reactions, infections or an underlying systemic illness, including malignancy. Some of the most commonly observed paraneoplastic dermatological manifestations include acanthosis nigricans, necrolytic migratory erythema, acrodermatitis paraneoplastica, exfoliative erythroderma, paraneoplastic pemphigus, pyoderma gangrenosum and Sweet syndrome. Sweet syndrome is a neutrophilic dermatosis characterized by a particular constellation of clinical symptoms, signs and histopathological findings: pyrexia; peripheral leucocytosis; and painful erythematous skin lesions (papules, plaques and nodules) that typically reveal a dense dermal neutrophilic infiltrate and dramatic recovery of both symptoms and physical findings following treatment with systemic corticosteroids. Sweet syndrome is frequently related to malignancies and chronic inflammatory disorders, and it can also be caused by drugs. It can also be triggered by past infections or during pregnancy. We present a case of bullous variant of Sweet syndrome associated with chronic myelogenous leukaemia (CML) where the patient presented with crusted bullae and tender erythematous crusted plaques on all four limbs and face. Investigations revealed leucocytosis with peripherally circulating blasts, myelocytes and metamyelocytes. Skin biopsy revealed Sweet syndrome and bone marrow biopsy confirmed evidence of CML in the accelerated phase. The skin lesions, which had previously been resistant to therapy, surprisingly disappeared within 3 days of initiating systemic corticosteroids. In this case, the skin lesions were a crucial clinical finding in detecting and treating the underlying CML. Because of the early intervention, our patient had a good outcome.
P20 A mysterious case of recurrent malignant melanoma
Authors: Mandala Meghana , Awash Noor
Published: June 2023

A 74-year-old White man presented to community dermatology services in 2020 with one lesion on the right temple and one on the left forehead. These were investigated with punch biopsies and reported as benign intradermal melanocytic naevi. One year later, he was referred to our teledermatology clinic with a pink nodule on the right temple, which had never healed following the 2020 biopsy. The teledermatology photos were more in keeping with basal cell carcinoma (BCC) and he was booked in for an excision. Histology reported the lesion as ulcerated invasive malignant melanoma (Breslow thickness 3.1 mm and mitotic figures). At this stage, previous biopsies from 2020 were reviewed and invasive malignant melanoma (MM) was confirmed. He was reviewed in the clinic and, on skin examination, he had a 7-mm BCC on the right upper nasal bridge. We found a small scar, but no lesions, on the left temple. He had areas of psoriasis on his elbows and knees. No organomegaly or lymphadenopathy was identified on systemic examination. He underwent wide local excision (WLE) of the right temple MM scar with sentinel lymph node biopsies from the right neck, which were negative. Initial radiological imaging did not show any metastases. Three-month follow-up computed tomography showed colon thickening, and the patient was diagnosed with hepatic flexure tumour, which was treated with right hemicolectomy. Further imaging showed no evidence of metastases. In September 2022, a new 6-mm, light-brown indentation was identified on the medial edge of the melanoma scar on the right temple. Initially, the biopsy results reported recurrent melanoma. Further histological slide review and immunochemical analysis demonstrated langerin with multinucleated histiocyte-like cell infiltrates and lymphohistiocytic inflammatory cell infiltrates; Langerhans cell histiocytosis (LCH) was diagnosed. He underwent WLE of this lesion and positron emission tomography; we are still awaiting the results. He has been referred to a specialist haematology team and is awaiting further management. LCH is a rare, multisystem haematological disorder of the clonal proliferation of Langerhans cells. Existing case reports document LCH with concomitant presentations of myeloproliferative disorders, particularly myeloid leukaemias, or noncutaneous manifestations, including pulmonary presentations. To the best of our knowledge, there have been no reports of LCH presenting exclusively with cutaneous manifestations clinically mimicking recurrent MM. The rare incidence and misleading presentation of LCH often results in its lack of consideration as a differential diagnosis for recurrent solitary skin lesions in adults. This case also highlights the diagnostic challenges and thorough investigation required for this unique condition.
P23 Primary penile melanoma and penile lichen sclerosus
Authors: Dear Kate , Kravvas George , Sim Sharmaine , James Mariel , Watchorn Richard , Haider Aiman , Ellery Peter , Freeman Alex , Alnajjar Hussain , Muneer Asif , Bunker Chris
Published: June 2023

The association between squamous cell malignancies and genital lichen sclerosus (GLSc) is well established. There is an increasing literature regarding the relationship of GLSc with genital malignant melanoma (MM). While there have been several reported cases of vulvar melanoma associated with lichen sclerosus (LSc), there have been fewer cases published with regard to male genital (M)GLSc and penile (Pe)MM. The aims of this study were to explore the relationship between PeMM and MGLSc by reviewing all cases managed by our multidisciplinary service over a period of 11 years. All patients known to our tertiary urology and male genital dermatology service with a diagnosis of penile MM and where histology was available for review were identified over an 11-year period (2011–2022). Two independent dermatologists reviewed the clinical records and photographs where available. Two independent mutually blinded histopathologists reviewed the histology and recorded features of GLSc where present. In cases of discordance between histopathologists, a third independent histopathologist reviewed the cases. Eleven patients were identified for inclusion in the study. Overall, GLSc was present on histopathology in nine of 11 cases (82%). Findings were concordantly positive in five cases and concordantly negative in one case. In cases with discordant findings (n = 5), the third histopathologist determined GLSc to be present in four cases and absent in one case. Clinical photographs were available for three cases and clinical features of GLSc were seen in all of them; they also all had positive histopathological findings. Clinical notes, including electronic notes and letters, were available for review in eight cases. Symptoms in keeping with GLSc were mentioned in only one case, and signs suggestive of GLSc were documented in three cases. Penile MM is a rare entity accounting for 0.7% of penile cancer and 0.1% of MM cases. Like other malignancies, MM is a multifactorial disease caused by a combination of environmental factors and altered host responses contributing to an alteration of regulatory processes. Although ultraviolet exposure is important in the pathogenesis of extragenital MM, this cannot be a factor for genital disease. However, specific risk factors for genital MM have not yet been elucidated. To our knowledge, there have only been three previously documented cases (all from our group) of PeMM coexisting with GLSc. This present study finding of GLSc in 9 of 11 men with PeMM, is suggestive of a causative relationship. We postulate that this is related to chronic melanocytic distress created by chronic inflammation secondary to LSc.
P24 A pharmacist-led acne service as a novel and highly effective model of care utilizing the full potential of a multiprofessional workforce
Authors: Michlewska Sylwia , Herkes Morag , Bertram Chandra , Salmon Nicola
Published: June 2023

The aim of this study was to establish a pharmacist-led acne clinic in the dermatology department in our teaching hospital, evaluate its quality and measure patient satisfaction with the new service. Two pharmacist independent prescribers (PIPs) underwent training in dermatologist-led clinics. An acne service was established, where dermatologists refer patients to PIPs for a course of treatment with isotretinoin. A set of evidence-based quality indicators (QIs) was developed and peer-reviewed by a multidisciplinary team and then used to evaluate service quality. Adherence to QIs was established through retrospective review of medical records for all patients seen by PIPs over a 12-month period. Patient satisfaction with the pharmacist-led clinic was measured by administration of anonymized questionnaires over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. During a 12-month period, 81 patients [70% females, median age 23 years (range 14–44)] were referred to a pharmacist-led clinic and PIPs delivered 307 appointments, saving an estimated 100 h of dermatologist time. Five patients required an additional dermatologist appointment and seven required additional dermatologist advice. We report ≥ 90% adherence to 11 of 14 QIs focusing on isotretinoin prescribing and patient monitoring, including mental health assessment using the Patient Health Questionnaire-9 tool. We identified the lowest adherence to QI 5 (45%; a final pregnancy test 5 weeks after stopping isotretinoin); however, six female patients disengaged with the service without completing the treatment. We report 70% adherence to QI 3 [use of Medicines and Healthcare products Regulatory Agency (MHRA)-recommended contraception] and 76% adherence to QI 1 (indication for isotretinoin). Corrective measures were implemented to improve adherence to QI 5 (a patient invitation for a final pregnancy test) and QI 3 (patient consent form compliant with MHRA recommendations on contraception). PIP consultations were rated as excellent by 76% of responders with acne (69% response rate; 33 surveys completed). All free-text comments (n = 10) were positive, with one suggestion for improvement (booking appointments in advance). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 10), ‘multidisciplinary team service delivery’ (n = 4), ‘ensuring patient understanding’ (n = 3), ‘pharmacist knowledge’ (n = 3), ‘professionalism’ (n = 2) and ‘medical team input’ (n = 1). There have been no patient complaints or adverse outcomes related to the pharmacist-led acne clinic since it was launched. PIPs successfully deliver a high-quality acne service that increases the overall dermatology service capacity. Patients report high satisfaction and appreciation of PIP knowledge and skills. The developed QIs and patient satisfaction questionnaire can be used for quality monitoring by other clinicians.
P42 Are chest X-rays still necessary for prebiologic tuberculosis screening? A retrospective audit
Authors: Tan Daniel Yi Liang , Kim Younghoon , Hasan Zeeshaan , Bewley Anthony , Mehrtens Sarah , Mohandas Padma
Published: June 2023

Biologics are commonly used in autoimmune dermatological conditions as an option if other treatments are unsuccessful or contraindicated. However, one major side-effect of biologics is immunosuppression, which may lead to the reactivation of latent tuberculosis (TB) in patients. The British Association of Dermatology has implemented guidelines that require doctors to screen for TB before prescribing biologics to patients. The 2020 guidelines advise screening questions, performance of a chest X-ray (CXR) and an interferon-γ release assay (IGRA). Current studies show that CXR has a sensitivity of 15% when diagnosing latent TB. While there is no gold standard for diagnosing latent TB, the IGRA is a commonly used test and is shown to be four times more effective than the tuberculin skin test. This study questions the diagnostic value of CXR in the screening of TB in asymptomatic patients, and whether it should be removed from the guidelines for such patients. A retrospective audit of dermatological patients in our trust was done over a 24-month period (January 2020–January 2022). Patients selected for the audit were those diagnosed with psoriasis or hidradenitis suppurativa and started on biologics during this 24-month period. Patients were assessed on the following: patient history, CXR results, IGRA results and screening outcomes. The data were quantitatively analysed to uncover the necessity of performing a CXR on patients starting biologics. Between January 2020 and January 2022, 77 patients were scheduled for prebiologic TB screening; CXRs were performed in 74 patients (96%), while 72 (94%) of patients had IGRA tests. During this period, three patients (4%) were diagnosed with latent TB based on positive IGRA results and normal CXR findings. They were subsequently treated for latent TB infection prior to biologic therapy. None of the patients with negative IGRA results had positive CXR findings for TB. This finding suggests that CXR is unnecessary at the initial stage of prebiologic TB screening for asymptomatic patients. IGRA can detect both latent and active TB, while CXR is recommended for the diagnosis of active TB. Mandating CXR comes at a cost to the National Health Service and subjects patients to unnecessary radiation exposure. We propose that CXR be done only for patients who are either symptomatic for TB or have a positive IGRA result.