bluuebunny/crossref_metadata_2025 huggingface dataset:
DP06 (P10) Blastic plasmacytoid dendritic cell neoplasm: two representative cases
Authors: Taneja Neha
Published: June 2023

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignant proliferation of plasmacytoid dendritic cells, representing <1% of primary cutaneous lymphomas. It most commonly presents in the skin and has a poor prognosis with median survival of 1 year. The fifth World Health Organization classification of haematolymphoid tumours encompasses two entities in plasmacytoid dendritic cell neoplasms: BPDCN and ‘mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm’. We present two cases, one representing each subset. Our first case was a 58-year-old man who presented with an asymptomatic, rapidly progressive, skin coloured-to-ery­thematous and hyperpigmented firm papules, nodules and plaques over the trunk, upper limbs and face of 2.5 months’ duration. This was associated with loss of appetite, loss of weight and leucopenia (2180 cells μL–1). Skin biopsy revealed a grenz zone with pandermal infiltration by large cells with high nuclear:cytoplasmic ratio, vesicular nuclei and prominent nucleoli and frequent mitotic figures. Immunohistochemistry (IHC) was leucocyte common antigen (LCA)+ but CD3–, CD20–, myeloperoxidase (MPO)– and CD117–. Bone marrow biopsy showed a similar infiltrate of cells, but the peripheral blood smear and flow cytometry was within normal limits. Further IHC was CD4+, CD56+, CD43+ and CD123+, establishing a diagnosis of BPDCN, and the patient was initiated on the Hoelzer protocol with 80% clearance of lesions after two cycles of chemotherapy. The second case was a 60-year-old woman who presented with asymptomatic firm skin-coloured nodules on her scalp, trunk, extremities and oral mucosa, associated with a low-grade fever, fatigability, weight loss, generalized lymphadenopathy and hepatosplenomegaly of 4 months’ duration. Histopathology showed similar features to the first case, with IHC being negative for CD3, CD20, CD138 and MPO. However, cells were LCA+, CD4+, CD56+ and CD43+. Bone marrow showed 77% acute leukaemia blasts with a MPO+ result, establishing diagnosis of acute myeloid leukaemia, suggestive of a mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm. To conclude, BPDCN is an aggressive neoplasm that commonly presents in the skin and should be suspected by dermatologists when screening IHC for lymphoid and myeloid cell lines is negative in a suspected case of leukaemia cutis. A panel of CD4/CD56/CD43/CD123 may be used to establish the diagnosis.
DP14 Going against the grain: eosinophilic dermatosis presenting as erythema gyratum repens
Authors: Ting Jason Siong Kai , Eisner Mark , Venkatesan Sowmya , Fatah Saman
Published: June 2023

Erythema gyratum repens (EGR) is a rare, paraneoplastic rash with a characteristic woodgrain appearance. It is heavily associated with malignancies, including lung, oesophageal and breast cancers. However, other conditions can mimic EGR, including leucocytoclastic vasculitis, immunobullous and papulosquamous conditions. We report an unusual presentation of eosinophilic dermatosis with an EGR-like pattern, not associated with malignancy. A 67-year-old woman presented with a 2-week history of a pruritic eruption on her legs. It initially started with three small circular erythematous macules on the right leg and one on the left leg. Over the course of a few days, the three macules evolved into large concentric annular patches simulating woodgrain, which raised the clinical suspicion of EGR. After a week, the patches began to blister with accentuation of some of the blisters on the edge of the annular patches. She denied any previous history of skin problems or changes in medication and was otherwise well with no systemic symptoms, including fever. In view of the almost 70% chance of an underlying malignancy, she was thoroughly investigated. Her full blood count, eosinophil count, liver function test, renal profile and serum C3 and C4 were normal. Skin basement membrane/desmosome antibodies and Borrelia burgdorferi IgG and IgM antibodies were also negative. Histology revealed prominent epidermal spongiosis with some corneal and intraepidermal vesicles that were cell-poor and contained only red blood cells. The underlying dermis showed prominent papillary dermal oedema with a brisk interstitial and superficial/deep perivascular mixed inflammatory infiltrate containing numerous eosinophils but no obvious flame figures. There was also eosinophil infiltration into the underlying subcutaneous fat. Direct immunofluorescence was negative. The histological pattern was that of an eosinophil-rich dermatitis with vesiculation; the history and morphology of the eruption were not compatible with bullous insect bites. An eosinophilic dermatosis such as eosinophilic cellulitis presenting with an EGR-like pattern was considered to be the most likely possibility for her presentation. Computed tomography of the neck, thorax, abdomen and pelvis, bidirectional endoscopy and mammography revealed no malignancies. She was treated with prednisolone 30 mg daily for 10 days with Elocon® ointment, and the eruption improved remarkably leaving postinflammatory colour changes that subsequently resolved. We would like to raise the awareness that an EGR-like pattern can be found in several other dermatoses, including eosinophilic dermatosis, and woodgrain pattern is not always equivalent to EGR or a high risk of associated malignancies (Table 1).Table 1Erythema gyratum repens-like dermatosesLeucocytoclastic vasculitisImmunobullousPapulosquamousBullous pemphigoidPsoriasisEpidermolysis bullosa acquisitaPityriasis rubra pilarisLinear IgA dermatoses
DP26 Syringocystadenocarcinoma papilliferum masquerading as squamous cell carcinoma
Authors: Applewaite Rona , Mehta Anisha
Published: June 2023

Syringocystadenocarcinoma papilliferum (SCACP) is a rare cutaneous adnexal neoplasm with ~30 cases reported. This case highlights the potential diagnostic and treatment challenges. A 52-year-old woman presented with a poorly differentiated carcinoma on the left parietal scalp which recurred 2 and 5 years following the original surgical excision. Initial biopsy of this lesion had shown syringocystadenoma papilliferum (SCAP) with associated syringoma, and a subsequent wider excision revealed suspected poorly differentiated squamous cell carcinoma (SCC) in the deeper dermis that was fully excised; however, the SCAP reached the margins. Excision 2 years later of the first recurrence showed similar histological features, and a second recurrence was excised twice to achieve histological clearance followed by postoperative radiotherapy. She remains tumour-free 2 years later. Upon retrospective review of all specimens, the initial primary tumour excision showed histological findings of a surface exophytic SCAP with mild nuclear enlargement, nucleoli and scattered mitotic figures. An infiltrative lesion was seen beneath this consisting of atypical ductal structures within a fibroblastic stroma. In deeper regions, there was more solid proliferation with some squamous differentiation, although scattered glandular units remained visible. However, the squamous component was predominant in future biopsies and even represented the sole morphological appearance in some. This culminated in the latest biopsy showing a poorly differentiated spindle cell tumour which, with immunohistochemistry (BerEP4-negative; cytokeratin, CK14−, CK5−, p63− and p53-positive; and high Ki67 index), was considered entirely to be a poorly differentiated SCC. Ultimately, this sequence of biopsies actually represented the rare diagnosis of SCACP, which demonstrated progressive squamous differentiation with each recurrence. A previous case published also reported SCACP transition to squamous differentiation (Zhang YH, Wang WL, Rapini RP et al. Syringocystadenocarcinoma papilliferum with transition to areas of squamous differentiation: a case report and review of the literature. Am J Dermatopathol 2012; 34:428–33). Despite the generally favourable prognosis reported, there have been a few cases of locoregional metastasis. Furthermore, recurrence up to 8 years after excision of the primary tumour has been reported (Castillo L, Moreno A, Tardío JC. Syringocystadenocarcinoma papilliferum in situ: report of a case with late recurrence. Am J Dermatopathol 2014; 36:348–52). We present a unique case of doubly recurrent SCACP managed with surgery and adjuvant radiotherapy which highlights the need for long-term follow-up. Furthermore, SCACP may pose a diagnostic challenge due to squamous differentiation of these tumours, which may result in incorrect or delayed diagnosis.
DS06 Does the content of patient information leaflets reflect real-life practice? A comparison of four patient information leaflets in Mohs micrographic surgery
Authors: Demirel Sibel , Affleck Andrew
Published: June 2023

In our experience, patients referred for Mohs micrographic surgery (MMS) often have unrealistic expectations, anticipating defects that are small in size and depth, and incorrectly describe the procedure as removal of skin cancer by ‘taking away thin slices’ or ‘skimming the skin layer by layer’. This observation prompted us to critically appraise four widely accessed online patient information leaflets (PILs) on MMS produced by the British Association of Dermatologists, the American Academy of Dermatology, Dermnetnz.org and the European Society of Micrographic Surgery. Our aim was to evaluate the wording used and propose evidence-based changes to help manage patients’ expectations. We focused on two core themes: (i) excision of tumour by MMS, including the number of stages, and (ii) cosmetic benefit of MMS over standard excision (SE). All of these PILs state the need for ‘stages’ to achieve margin clearance, with an initial margin of excision as low as 1 mm per stage mentioned in one PIL. The leaflets suggest cosmetic benefit and tissue preservation of MMS over SE, and one leaflet ranked this higher than other advantages offered by MMS. We feel that these points are overstated and better addressed with evidence-based facts. Studies have shown that 60% of cases of MMS are cleared in one stage; > 90% of tumours are cleared within two stages, and the number of patients needing three or more stages is only 6% (Macfarlane L, Waters A, Evans A et al. Seven years’ experience of Mohs micrographic surgery in a UK centre, and development of a UK minimum dataset and audit standards. Clin Exp Derm 2013; 38:262–9). In our experience, a surgical margin of 1 mm is not feasible in MMS. There is no direct evidence that MMS improves cosmesis compared with SE (Brown AC, Brindley L, Hunt WTN et al. A review of the evidence for Mohs micrographic surgery. Part 2: basal cell carcinoma. Clin Exp Dermatol 2022; 47:1794–804). Cosmetic and functional outcomes are usually only relevant in high-risk sites (e.g. the central face H zone) and in certain high-risk tumours where wide local excision would be the alternative treatment. In conclusion, we propose that PILs in MMS should avoid using misleading language like ‘thin’ and ‘small’ when describing the procedure. Patient information leaflets should clarify that the vast majority of tumours are cleared after two stages rather than requiring multiple stages. Tissue sparing should not be highlighted as the main advantage of MMS, and patients should not be pledged small wounds and better cosmetic outcomes.
DS14 Same-day surgery promotes sustainability in dermatology
Authors: Costa Blasco Marta , Doyle Claire , Tobin Anne Marie
Published: June 2023

The healthcare sector is responsible for 4.4% of global greenhouse gas (GHG) emissions. To limit global temperature rise by 1.5 °C, as called for in the Paris Agreement, GHG emissions will need to be significantly reduced. As climate change has been labelled the greatest threat to global health in the twenty-first century, all healthcare professionals must attempt to promote sustainable practice where possible. The British Society of Dermatological Surgery sustainability guidelines published in 2022 advocate multiple strategies for improving sustainability in skin cancer surgery, including a reduction of activity via prevention measures, low-carbon alternatives, operational resource use and research and innovation. It is recommended that ‘see-and-treat clinics’ should be offered where staff and facilities are available, as one of several methods to lower the carbon footprint of dermatological surgery. We performed a cross-sectional study in a single tertiary dermatology department, focusing on carbon dioxide (CO2) emissions associated with travel to and from skin surgery appointments from 1 January 2022 to 31 December 2022. Our dermatology department is located in an urban area and also receives referrals from rural locations. The distance from the patient’s home to the hospital was calculated in kilometres using Google Maps. Total CO2 emissions were calculated using an online calculator recommended by the Environmental Protection Agency of Ireland and were reported in metric tonnes of CO2. Fuel consumption was based on the average car with unknown fuel. In total, 2358 procedures were performed on 2184 patients, 54% of whom were male (n = 1180). The total distance travelled by patients was 109 787.94 km, averaging 50.27 km per patient (range 1.3–168). This generated 18.74 metric tonnes of CO2 emissions. Eighteen per cent (n = 389) of patients underwent surgical procedures on the same day as their outpatient clinic. Same-day surgery led to a reduction of 35 275 km, averaging 90.68 km per patient (range 1.3–120). This represented a reduction of 6.02 metric tonnes of CO2 emissions. This is equivalent to the CO2 emitted from six transatlantic flights. In our department, absorbable sutures are used, where possible, to reduce unnecessary travel to our department or to a general practice for suture removal. Results for benign lesions are communicated via letter, to minimize return to the clinic. This study highlights the reduction in CO2 emissions associated with same-day dermatological surgery. The limitations of this study include an assumption of travel to and from hospital appointments by car and of travel from the address stated in patient records. Dermatologists should consider the environmental impact of skin surgery and implement sustainable options when service planning.
DE03 Using the British Association of Dermatologists’ medical student app to promote a better representation of skin of colour in undergraduate education
Authors: Patel Chirag , Teo Daryl , Scorer Matthew , Helbling Ingrid
Published: June 2023

It was exactly 10 years ago, in Liverpool, that the ‘BAD medical student app’ was launched. At a time when digital learning was becoming popular, a platform that is accessible globally, on your phone, which provides evidenced-based information to aid medical students’ educational needs in undergraduate dermatology, was born. In the wake of the need for promoting fair medical education, the General Medical Council, in their ‘2021–25 corporate strategy’, stipulated a requirement for an increased focus on equality, diversity and inclusion in medical education. Furthermore, medical students lack training on how skin disease presents differently in patients who have darker skin tones (Adelekun A. Skin color in dermatology textbooks: an updated evaluation and analysis. J Am Acad Dermatol 2021; 84:194–6). A 2018 study of general medicine texts found that < 5% of images included dark skin tones. Louie and Wilkes (Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med 2018; 202:38–42) discovered that in general medicine texts commonly used by medical students, < 5% of the images included darker skin tones. The effects of the COVID-19 pandemic and the semipermanent transition to using virtual learning methods have required medical students to become more autonomous in supplementing what is learnt in lectures. Furthermore, the under-representation of skin of colour in primary medical texts will lead to students connecting diagnosis with a one-dimensional presentation and, in turn, hesitation in diagnosing skin diseases in darker skin tones. Understanding the existence of this limitation and recognizing the value of using the British Association of Dermatologists’ medical student app to reach out to medical students, we embarked upon a project to diversify education on cutaneous diseases in darker skin tones. The app, which contains didactic clinical information, as well as picture quizzes designed to challenge a student’s ability to make a spot diagnosis, has been expanded to include a larger proportion of images of darker skin tones. Where cutaneous diseases present significantly differently in lighter and darker skin tones, we have included contrasting images to illustrate this. We hope these structural changes to the app will complement higher initiatives to improve equity in skin-of-colour image representation in undergraduate medical education on cutaneous diseases.
DE06 Application of the virtual flipped classroom as low-fidelity simulation in dermatology undergraduate education
Authors: Golenya Rebecca , Campbell Fiona , Warburton Katharine , Guckian Jonathan
Published: June 2023

Since the COVID-19 pandemic, the zeitgeist of teaching has evolved with virtual platforms becoming increasingly popular among both learners and institutions. Educators have had to adapt delivery methodologies to this constantly evolving digital landscape. The flipped classroom methodology is a methodology whereby learners receive information prior to the class. This enables learners to process information, increasing time for higher-level learning and problem-solving during session time. A previous scoping review demonstrated that this methodology has rarely been employed in dermatology teaching. We aimed to evaluate integration of a flipped classroom approach within a digital undergraduate setting, specifically assessing the impact on self-directed learning and written skills. Sessions involved the provision of three ready-made dermatology clinical cases, steeped in realism via inclusion of simulated referral letters, recording of patient actor histories and photographs of rashes. Students were instructed to document, request tests and prescribe as if they were a doctor, in their own time, and send requests to the educator. In total, 115 third-year medical students rotated through dermatology and were emailed online evaluation forms. Consent was sought prior to completion of the questionnaire. Sixty-three students responded. Ninety-seven per cent undertook the required prework. Ninety per cent of students felt motivated to undertake the prework, with 87.3% agreeing that the prework was an effective use of their time. Students agreed that their problem-solving skills (90.5%), analytic skills (90.5%), written skills (77.8%), self-directed learning ability (87.3%) and ability to communicate dermatology diagnoses (93.7%) improved. The session was received well by the students, as 94.9% agreed that the session was enjoyable and preferential to lecture-based material (82.5%). Qualitative data included themes of novelty, ability to visualize oneself as a doctor and intrinsic motivation. The flipped classroom methodology is rarely used within dermatology medical student teaching. This methodology was well received by students, and benefits included the development of independent learning and essential written skills. This format of a flipped classroom approach may provide benefits for professional identity formation in the context of digital environments that otherwise seem unrealistic to undergraduates.
GD06 The grass is always greener on the nearer side
Authors: Murphy Lisa , Tobin Anne-Marie
Published: June 2023

Climate change is becoming a significant matter of concern, and ways to reduce our impact on the environment are becoming an increasing priority. We assessed the difference in carbon emissions when patients attended our peripheral dermatology clinic rather than the tertiary centre. Our objective was to establish the reduction in carbon emissions when patients attended satellite clinics instead of a tertiary service. The addresses of patients attending clinics over a month-long period were compiled, and distances to both hospitals were measured. These were compared, and the difference was used to calculate the reduction in carbon emissions. The emissions produced by staff members were added to the total of emissions produced by patients travelling to peripheral clinics. In total, 245 patients were included in the study. The total distance travelled by patients for a round trip to the satellite clinic was 10 105.9 km, and the equivalent for the tertiary centre was 14 775 km. The mean distance travelled by patients to and from the peripheral clinic was 41.25 km. The mean distance travelled by patients to and from the tertiary hospital was 84.69 km. The amount of carbon emissions produced by the patients travelling to the peripheral hospital was 1.87 tonnes. The amount of carbon emissions of patients travelling to the tertiary hospital was 2.73 tonnes. This was a saving of 0.86 tonnes over a 1-month period. Annually, this amounts to a difference of 10.32 tonnes of carbon emissions. The provision of peripheral dermatology clinics has a significant positive impact on the environment and greatly reduces the distances travelled by patients. Our study suggests that satellite clinics could reduce carbon emissions by 10.32 tonnes annually. This equates to 138 flights from Dublin to London, or 12 900 takeaway coffees. This study has demonstrated that the provision of peripheral clinics can make healthcare more sustainable, by reducing the number of carbon emissions being produced.
GD08 Migrant dermatology
Authors: Costa Blasco Marta , Tobin Anne Marie
Published: June 2023

Conflict, war or economic hardship often causes refugees to flee their communities. The recognition of refugees as a diversified group from a medical aspect is one of importance as they have a range of health needs that differ from the native population. Based on a review of the published literature and cases we have reviewed in our dermatology department, we would like to outline an overview of the challenges associated with managing skin conditions for migrants and refugees, as well as key opportunities to improve care for this community. The initial barrier experienced is primarily related to communication difficulties. Healthcare providers meet obstacles in trying to communicate effectively with refugees as translation services are not always readily available and the waiting time involved for such services results in a further delay in patient management. It came to our attention that refugees often do not communicate all their issues or symptoms because of other complex social issues that take precedence over their symptoms. A separate, substantial issue arises given the lack of documentation regarding their medical background and previous and current treatments. Other challenges faced are the costs associated with accessing pharmaceutical products and not having primary care physicians. Furthermore, staying in temporary accommodation makes it more likely that they will not receive follow-up appointments, resulting in future missed appointments. Overall, refugees are a vulnerable cohort and a substantial multidepartment effort should be made to ease their integration into national healthcare ­systems.
H04 The sign of Leser–Trélat: an eponymous misnomer?
Authors: Salimi Maryam , Al-Kutubi Huda , Andrew Kashini , Patel Pooja , Orpin Stephen , Heagerty Adrian
Published: June 2023

The sign of Leser–Trélat is a paraneoplastic phenomenon consisting of a sudden eruption of seborrhoeic keratoses. It is credited to two surgeons, Edmund Leser (1853–1918) and Ulysse Trélat (1827–1890), who described cutaneous lesions associated with internal malignancies. Edmund Leser, the author of the Textbook of Special Surgery in 50 Lectures, initially studied law in Bonn before qualifying in medicine in Leipzig in 1880. He became Richard von Volkmann’s assistant at Martin Luther University. He was awarded his chair of surgery in 1894, 10 years after becoming a surgeon, and he practised in Goethe University, Frankfurt. Ulysse Trélat was born in Paris in 1827. His father was a republican political activist, Minister of Public Works and known as the founder of public hygiene in France. Ulysse Trélat was employed as an assistant anatomist in surgery at the ‘École Pratique’ 1 year before graduating high school in 1844. He finished his medical studies in 1854 and became a surgeon in 1857. In 1858, he was running the anatomy course in ‘École Pratique’. He replaced Paul Broca, well known for his research on Broca’s area in the frontal lobe, at Hospital Necker in 1880. In 1884, he was awarded a chair of surgery at ‘Hospital de la Charite’, replacing Leon Athanase Gosselin. Notable among his works is the description of the ‘Baizeau and Trélat method’ of surgical repair of cleft palate, and his book Clinique Chirurgicale. Leser and Trélat independently published papers describing skin lesions associated with mammary carcinoma and visceral malignancies. However, their description of cutaneous lesions was more in keeping with the appearance of senile angiomata or Campbell de Morgan spots. Therefore, the credit should go to Eugen Von Hollander (1867–1932), another German surgeon who accurately described the lesions in a paper published in 1900 titled ‘Contributions to the early diagnosis of intestinal carcinomas’. He observed skin changes associated with internal malignancies consisting of an eruption of flat, shiny, pigmented, glandular, epithelial growths similar to seborrhoeic warts or verrucae seniles in young patients with cancer. He hypothesized that there might be a link between abnormal epithelial proliferation in internal organs and skin keratinocyte proliferation. He is remembered for performing the first facelift, on a Polish aristocrat in 1912. The sign of Leser–Trélat is so deeply embedded in medical literature and the minds of modern practitioners that it is unlikely to ever be erased. However, the contribution of Eugen Von Hollander should not be forgotten.
H06 Beauty is pain: symmetries in the cosmetic practices of ancient Rome and the modern day
Authors: Elmansouri Ahmad
Published: June 2023

In the 21st century, the application of toxins, hair removal and skin bleaching are just a small part of an industry standard set by an influential few. There is a surprising degree of symmetry between modern-day practices and those of our ancient ancestors. Although the first use of cosmetics can be traced back to ancient Egypt, the Roman Empire developed such intricate practices that they affected fashion, law and public health. Paleness of skin indicated higher social status in the Roman Empire (625 Bc–Ad 476): it suggested one could afford to remain indoors. Cerussa—sugar of lead—was used to this end. Firstly, vinegar was applied to white lead shavings. Once the lead had dissolved and dried, it was ground and formed into tablets. Despite popular belief, the Romans were aware of the dangers of lead just as we are aware of the toxic nature of mercury and other harmful bleaching agents used by people in modern times. Just as modern influencers are able to shape beauty trends, it is likely that ancient writers held similar sway. In Ad 77, Pliny the Elder wrote that one’s eyelashes fell out from excessive sex and, understandably, the affluent Roman would not want to be regarded in such a light. Eyeliner created from soot and ash was applied with a needle or stick to increase the appearance of thickness of eyelashes. The Italian word for makeup is trucco (trick), and this viewpoint was reflected in several accounts. The poet Juvenal recorded that ‘A woman buys scents and lotions with adultery in mind’. Unfortunately, there is an absence of accounts by women delineating the female attitude towards cosmetics at the time. The modern desire to remove bodily hairs is mirrored by ancient Roman practice. Romans in high society would normally remove hairs, using anything from tweezers to ancient razors made of flint, but they also used hair as a distinctive feature. The emperor Augustus grew his beard and hair out on hearing the devastating news of the defeat of Varus, to reflect his mental state. Much like the $380 billion-dollar cosmetic industry, luxury cosmetics attained by high society had economic consequences. In 189 Bc, when Rome experienced economic strain, the controversial law of LexOppia was introduced, limiting the maximum wealth of women and subsequently their use of these luxury cosmetics. A surprising number of similarities exist between modern cosmetic practices, trends and harms and ancient Roman ones.
H11 More cancer, better counting or better at diagnosis? The history of skin cancer registration
Authors: Apthorp Timothy , Venables Zoe C , Levell Nick J
Published: June 2023

Cancer registries help us to understand skin cancer cause, prevalence, treatment and prevention. They provide evidence to gain new healthcare resources. This paper studies the evolution of cancer registries and their relevance to dermatology. In the 16th century, ‘Bills of Mortality’, the first English healthcare registry, catalogued the number and causes of death in London parishes. Originally set up to track bubonic plague, it expanded to cover other diseases, including cancer. The 1728 London ‘General Census of Cancer’ was an early systemic study of cancer. In the 19th and early 20th centuries, hospital censuses often monitored cancers. These were superseded by population-based cancer registries, allowing continuous data collection. An early example is the Hamburg Cancer Registry (1926), which recorded names on a card-based registry and compared them with death certificates. The first national cancer registry was the Danish national cancer registry, formed in 1942. In the UK, the Scottish Cancer Registry was formed in 1958, the Welsh Cancer Intelligence & Surveillance Unit in 1972 and the Northern Ireland Cancer Registry in 1994. In England, eight regional registries were created, with the South West being the first in 1945. The Calman–Hine report (1995) highlighted a desire for a national cancer registry. In 2008, the National Cancer Intelligence Network enabled the assimilation and analysis of data sets from English registries. They merged in 2013, forming the National Cancer Registry and Analysis Service (NCRAS), England. Critically, the 2006 National Health Service act (section 251) allowed cancer data collection without formal consent. Although melanoma data were generally good quality, the inclusion and quality of nonmelanoma skin cancers (NMSCs) were historically less reliable, with improvement since 2013. Historically, the exclusion of NMSCs from published cancer data is common. Wales is the last UK registry to not routinely report NMSC. However, this is due to change in 2024. The ‘global burden of disease tool’ (1990) utilizes various sources, including cancer registry data, to model incidence, mortality and health implications of disease globally, including melanoma and NMSCs. In 2022, the British Association of Dermatologists joined with the NCRAS to develop the Get Data Out skin tool, an annually updated website featuring more granular epidemiological data on skin cancers. High-quality epidemiological data are essential to understanding skin cancer’s regional and chronological variations, and to ensure that resources for healthcare and research are allocated appropriately.
H18 James Clark White: a pioneer of American dermatology
Authors: Smith Lucy , Yesudian Paul Devakar
Published: June 2023

James Clark White, a chemist, botanist and eminent dermatologist, was a born to a shipbuilder in Boston in 1833 and from a young age was fascinated by the natural world around him. White proceeded to study medicine at Harvard and spent a further year at the University of Vienna. He was taught by renowned dermatologists, including Ferdinand Von Hebra, whose detailed drawings and lectures in dermatology were pivotal to White’s interest in the field. White’s varied background in both chemistry and botany translated into his prolific academic work on environmental dermatoses. His famous Dermatitis Venenata: An Account of External Irritants Upon the Skin was the first to provide a collective resource of contact dermatitis, before the pathogenesis of these conditions was truly understood. Another instrumental piece, ‘A case of keratosis (ichthyosis) follicularis’ is now recognized as the first description of Darier disease, which was subsequently named Darier–White disease. White authored eight books and over 100 original articles that covered many areas of cutaneous disease. White returned to Massachusetts General Hospital where, after spending a few years in general practice, he devoted his career to skin disease. He developed the dermatology department into a centre of excellence and was ultimately appointed the first chair of dermatology. A founding member of the American Dermatology Society, and twice its chairman, he progressed to become the first full professor of dermatology in the USA. White spearheaded dermatological education at Harvard, extending the specialty training from 2 to 4 years and introduced an exit examination for residents. White is regarded as part of the vanguard that elevated American dermatology to European standards in the late nineteenth century. In his personal time, White was ardent collector of fine wines and china. He devoted much time reading and listing species of birds and plants that he encountered around his residence in Belfast, Maine. He died in September 1916. His family also had distinguished careers, including his son Charles J. White, who took over his practice to also become a professor of dermatology at Harvard Medical School; and a grandson, also named James C. White, a professor of neurosurgery at the same institution. Almost two centuries after his birth, White’s lifelong dedication to dermatology has produced many works that remain relevant and inspire the dermatologists of today.
H21 Acne treatments through the ages
Authors: Doyle Claire
Published: June 2023

The search for an effective treatment for acne dates back to 1550 Bc with the Ebers Papyrus, one of the oldest medical documents in the world, mentioning the application of raw honey and sulfur to affected areas. King Tutankhamun is widely believed to have suffered from acne as his tomb was filled with popular acne treatments of the time such as sulfur, sour milk, Aloe vera, myrrh and salt to rid him of his affliction in the afterlife. Much like the Egyptians, ancient Greek texts mention honey and sulfur for the treatment of acne. A Greek physician named Theodosius suggested that patients wipe their spots with a towel while watching a star falling from the sky as he suggested this would result in their spots falling from their faces. The Romans, in addition to the aforementioned honey and sulfur, trialled crocodile meat, cypress oil, sour cheese, leek leaves and cinnamon in their attempts to find a successful treatment. Thomas Bateman wrote in A Practical Synopsis of Cutaneous Disease that a patient reported that bruised parsley cleared her acne. He was also an advocate of remedies used by ancient civilizations. At the turn of the 20th century, American physician W.A. Pusay wrote about the use of ionizing radiation in the treatment of acne. Radiation was widely used in the treatment of acne until the 1960s, when concerns regarding associated secondary carcinogenesis led to the treatment falling out of favour. In the first half of the 20th century, phototherapy was a popular treatment for acne, and quartz mercury vapour lamps, in particular, were used. The most significant advancement in the treatment of acne was the discovery of the utility of synthetic vitamin A. In the 1960s, pharmaceutical company Roche trialled the compound 13-cis-retinoic acid as a treatment for skin cancer. This was ineffective, but it was demonstrated that it was efficacious in the treatment of acne. A study published in 1979 in the New England Journal of Medicine demonstrated that 13 of 14 patients with acne conglobate experienced clearance of their acne. In 1982, the US Food and Drug Administration granted approval for 13-cis-retinoic acid, or isotretinoin, as a treatment for acne. It was introduced in Europe in 1983. Isotretinoin has been a life-changing advance in the treatment of this disease, but its teratogenic effects mean it must be prescribed with education and care.
PA01 Crusted nodules in returning travellers
Authors: Fox Natalya , White Jonathan , Jiyad Zainab , Ferguson Leila
Published: June 2023

We present the cases of two brothers, aged 10 and 13 years, who, on returning from a 6-week holiday in Sri Lanka, presented to the emergency department with painful, pruritic crusted nodules. Both children were usually fit and well, and up to date with their childhood immunizations; the older brother had a background of mild eczema. On examination, there were multiple widespread 1–2 cm well-defined, superficial excoriated ulcers with overhanding crusted edges. These were present over the arms, legs, back and feet of the younger brother, and the lower legs and feet of the older brother. There was no history of prodromal illness, and they remained afebrile throughout, with no evidence of lymphadenopathy or systemic illness. Bacterial wound swabs demonstrated Corynebacterium diphtheriae. Real-time polymerase chain reaction confirmed the presence of TOX, followed by the Elek test, which demonstrated the expression of the diphtheria toxin, confirming the diagnosis of cutaneous diphtheria due to a toxigenic strain. Both children were treated empirically with intravenous flucloxacillin and clindamycin as inpatients. Both were clinically well and discharged home on oral clindamycin and co-amoxiclav for a total of 10 further days. Public Health was informed of this notifiable disease, with contact tracing and appropriate family screening performed. Our patients isolated appropriately and made a full recovery, with negative swabs. Historically, most cases of diphtheria have been caused by C. diphtheriae (a Gram-positive nonencapsulated, nonsporulating, nonmotile bacillus) with an incubation period of 2–7 days, although other strains, notably Corynebacterium ulcerans, become increasingly prevalent. Despite diphtheria being classically described as a respiratory illness, Public Health England data found that nearly two-thirds of toxigenic C. diphtheriae infections were cutaneous in presentation. Concurrent respiratory infection and cutaneous infection are rare. Either form can be caused by toxigenic or nontoxigenic strains; the former may result in toxic complications (such as myocarditis, polyneuritis, septic arthritis, osteomyelitis and death); however, these are rare in cutaneous diphtheria, even if TOX-positive. Systems review of our patients did not highlight any of these features in our patients. Our patients exemplify classic features of cutaneous diphtheria and raise an important reminder to consider diphtheria in patients returning from endemic areas, despite vaccination schedules being in place.
PA17 Paediatric-onset mastocytosis: a retrospective review
Authors: Hiranput Siwaporn , Nallathamby Kasthuri , Smith Lucy , Yesudian Paul Devakar
Published: June 2023

Mastocytosis is characterized by an abnormal accumulation of mast cells in different organs. The skin is the most frequently affected site. Most cases of paediatric-onset mastocytosis are benign, localized to the skin and regress spontaneously. We retrospectively reviewed the case notes of paediatric patients with a diagnosis of mastocytosis in dermatology departments within our region between 2021 and 2022. Seventeen patients were identified. The disease was more prevalent in males (male-to-female ratio 1.8s : 1). The median age at onset was < 1 year (range birth–4 years). The lesions were described as solitary (n = 9), macular (n = 6) and maculopapular (n = 2). The torso was involved in 16 patients. Other body sites affected were the face (n = 2), scalp (n = 1), limbs (n = 5) and buttock (n = 2). Most patients were asymptomatic (n = 12). Symptoms, including abdominal pain (n = 3), pruritus (n = 2), musculoskeletal pain (n = 1), diarrhoea (n = 1), flushing (n = 1), headache (n = 1) and dizziness (n = 1), were reported. Darier sign was positive in 11 patients and negative in three (not documented in three). None of the patients had bone marrow examination. One patient underwent a skin biopsy, which confirmed mastocytosis in the skin; the remaining 16 patients were diagnosed with cutaneous mastocytosis based on the characteristic clinical features. The disease was classified into mastocytoma (n = 8) and urticaria pigmentosa (n = 9). Five patients with urticaria pigmentosa were assessed for lymphadenopathy and organomegaly: four had blood investigations, including serum tryptase (n = 4), full blood count (n = 2) and liver function tests (n = 2); one had an abdominal ultrasound. No abnormality was found. Patients with mastocytoma were not examined for lymphadenopathy or organomegaly, or had further investigations for systemic involvement. Eight patients were managed by watchful monitoring. Nine patients received active treatments, including topical steroids (n = 6), antihistamines (n = 6), oral sodium cromoglicate (n = 1), phototherapy (n = 1), epinephrine autoinjector (n = 1) and cosmetic camouflage (n = 1). Partial regression was observed in seven cases at a median follow-up of 3 years (range 1–14), and seven had persistent disease. Six patients remain under long-term follow-up, and eight were discharged with a median follow-up period of 1.5 years (range 1–14). Five patients were followed to adolescence (disease was persistent in three cases and there was partial regression in two cases; none had complete resolution). While serum tryptase levels do not appear to have a prognostic value in the paediatric population, we would recommend checking these in patients whose disease persists beyond adolescence as this may indicate progression to systemic mastocytosis.
PA19 A rare case of Buschke–Ollendorff syndrome
Authors: Sathanantham Kugili , Javed Aysha
Published: June 2023

We present a case of Buschke–Ollendorff syndrome (BOS) in a 6-year-old girl. The BOS is rare genodermatosis distinguished by the presence of short stature and skeletal and connective tissue defects. This patient first attended the dermatology department with a history of small asymptomatic dermal papules and nodules noted overlying the skin on her abdomen since the age of 2 years. They became more numerous and evolved over her right buttock and left posterior calf. Subsequent investigation with ultrasound imaging illustrated that these lesions were elasotomas and, on a separate occasions, also suggested the possibility of a lipoma or collagenoma, and ruled out a sarcoma or malignancy. Skeletal survey of the upper limbs, hands, pelvis, lower limb and both feet highlighted the presence of well-defined sclerotic lesions involving the periarticular regions. This condition was again confirmed by clinical geneticists who advised that future family planning and confirmatory testing would identify the presence of LEMD3, responsible for this autosomal dominant condition. There was no history of genetic disorder within the family, but it was noted that the patients and both parents had a short stature, which is another hallmark feature of this condition. On successive reviews, the patient continued to display gradual enlargement of her elastomas and developed other cutaneous manifestations, including congenital naevi. This case report contributes to the appreciation of the clinical manifestation of this uncommon condition.
PA23 Primary cutaneous Ewing sarcoma in a 14-year-old boy
Authors: O’Sullivan Gavin , Salih Hamisha , Davidson Anne , Wynne Catherine , Taylor Mark , George Susannah
Published: June 2023

A 14-year-old boy presented with a 7-month history of a nodule on the right shoulder. It was initially pink and pea-sized but developed black areas as it grew. It was nontender but bled occasionally. He was otherwise well and took no regular medications. He was originally from the Philippines, having moved to the UK 2 years previously. His mother had a history of breast cancer. This was suspected to be a pyogenic granuloma and treated with a shave biopsy. Histology showed largely patternless sheets of small, blue, round cells, with diffuse and strong membranous reactivity for CD99 on immunohistochemistry. Further molecular analysis revealed EWSR1–FLI1 fusion, confirming Ewing sarcoma. Staging imaging showed no metastatic disease. Following further surgery, he was treated as per the Euro-Ewing protocol with vincristine (V), doxorubicin (D), cyclophosphamide (C), ifosfamide (I), etoposide (E; nine induction cycles: alternate VDC/IE followed by five consolidation cycles IE/VC). Ewing sarcoma most commonly arises from bone and is the second most common bone malignancy in children with an incidence of 2.93 per million. Primary cutaneous Ewing sarcoma is extremely rare, with most of the literature consisting of case reports. A 2015 retrospective review of 56 cases of cutaneous/subcutaneous Ewing sarcoma from the UK and France found that most cases were on the extremities (48%) or trunk (39%). Primary cutaneous Ewing sarcoma tends to occur in late-adolescent or young-adult females, whereas bone disease affects younger patients with a male predominance. Current treatment is similar to treatment for Ewing arising from bone. However, primary cutaneous Ewing sarcoma has a more favourable prognosis, with a 5-year overall survival rate of 93.8%. In summary, cutaneous Ewing sarcoma is a very rare malignancy, particularly in the paediatric population. It is important to consider this in the differential diagnosis of erythematous nodular lesions in children, in order to minimize delays in treatment.