bluuebunny/crossref_metadata_2025_split huggingface dataset:
P017 Localized penile bullous pemphigoid: a case report
Authors: Barry Rory , Boggs Jennifer , Mellerick Lisa , Barry Rupert 
Published: June 2024

Abstract
A 69-year-old man presented with a 3-month history of recurrent, itchy blisters on the penile shaft. Past medical history included ischaemic heart disease and hypertension. Medications included amlodipine, aspirin, atorvastatin, bendroflumethiazide and bisoprolol. Examination revealed discrete, deroofed bullae on a slightly eroded base on the penile shaft, with evidence of postinflammatory pigmentary changes. The penile glans and scrotum were unaffected. The remaining full-skin examination, including oral mucosa, was noncontributory. Histological analysis by punch biopsy showed skin with dermal eosinophils and scattered intraepidermal eosinophils. A rare eosinophil was seen at the base of the epidermis. No definite neutrophils were seen. No bulla was identified. Direct immunofluorescence analysis of perilesional skin showed strong linear C3, linear IgG and patchy linear IgA deposition on the dermoepidermal junction, suggestive of a bullous disease. Serum indirect immunofluorescence was negative for anti-BP180 and anti-BP230 antibodies, with normal full blood count and renal and liver profiles. Clinically, the working diagnosis was a localized bullous pemphigoid (BP), and the patient was prescribed clobetasol propionate ointment topically once daily for 4 weeks and oral doxycycline 100 mg once daily and nicotinamide 500 mg three times daily for 3 months. After 2 weeks the bullae had resolved, with no new bulla development. Two months following treatment initiation the patient remains symptom free, and clinically without disease recurrence and no reported adverse drug event. BP is the most common autoimmune subepidermal blistering skin disease, with autoantibodies targeting BP180 or BP230 proteins. BP usually presents in older patients, with an increased prevalence in those with a history of stroke, Parkinson disease and dementia. Clinical presentation typically describes painful, itchy, tense bullae of the skin, either localized or widespread across the trunk and proximal limbs. Genital BP is a rare subgroup of localized BP, typically affecting women and children. Differential diagnoses for BP include fixed drug eruptions, contact dermatitis, dermatitis herpetiformis, linear IgA disease and infective causes such as bullous tinea. From a literature search, this is the fifth case of BP localized solely to the male genitalia. Dermatologists should consider localized BP in male patients presenting with bullae on the penis with confirmation by skin biopsy and immunofluorescence analysis, to initiate prompt treatment and disease control and avoid significant morbidity for this patient group.
P027 Are skin cancer teaching ‘super clinics’ safe and effective? Results of a UK pilot study
Authors: Greenish Huw , Shirwac Hafsa Faarax , Morgan Hannah , Heath Harry , Carswell Sarah , Anderson Alexander D G 
Published: June 2024

Abstract
The ‘super clinic’ model is a response to skin cancer capacity pressures facing the NHS and the need to deliver educational opportunities and supervision to trainees, specialty and specialist (SAS) doctors and specialist nurses. This model involves a single specialist supervising multiple trainees and personally reviewing a high number of patients. It is unknown whether the rapid decision making inherent in this way of working affects clinical performance. This pilot study aimed to assess the implementation of an educational super clinic in an NHS hospital dermatology department and to compare performance against standard practice. Super clinics were run over a 6-month period in 2022. A single permanent associate specialist oversaw up to three trainees, each of whom had their own list of cases. Patients were referred via the suspected skin cancer pathway. After reviewing each patient, trainees presented relevant findings and a working diagnosis to the specialist, who examined the patient, then confirmed the diagnosis and agreed a management plan. All patients were offered a full skin check. Both standard and super clinics lasted 3–4 h. Electronic patient records and histology results were reviewed to establish ultimate diagnoses. The proportions of patients in whom histology was obtained and any form of skin cancer was ultimately diagnosed were compared with data from the same specialist’s standard 2-week-wait clinics during the study period. In total, 345 patients were seen in 12 super clinics (average 29 patients per clinic, maximum 41), while 589 patients were seen in standard clinics (14 patients per clinic) over the same period (no trainees present). Clinicians under supervision included two dermatology ST3 doctors, one dermatology trust grade doctor, one genitourinary medicine consultant, three ST1–2 doctors and two clinical nurse specialists. Histology was obtained in 174 of 345 (50%) patients in the super clinic group vs. 262 of 589 (44%) in the regular clinic group (P = 0.08). There was no significant difference in the number of patients ultimately diagnosed with a malignancy in the super clinics (100 of 345, 29%) vs. the regular clinics (159 of 589, 27%) (P = 0.51). The super clinic model facilitated face-to-face supervision and education for multiple trainees, while simultaneously more than doubling new patient capacity. Compared with standard clinics, there was no negative impact on the specialist’s diagnostic confidence (histology rate) or cancer pick up rate. These findings suggest that the super clinic model is both safe and effective.
P050 Certificate of Eligibility for Specialist Registration (CESR) (portfolio pathway) satisfaction survey for dermatology trainees: a comparison of current CESR vs. national trainees, within a large UK teaching hospital
Authors: Hughes Sam , Lakhan Manpreet , Morris-Jones Rachael 
Published: June 2024

Abstract
Over the past 10 years, the UK has seen a consistent rise in the number of dermatology trainees pursuing alternative training pathways to the traditional national training scheme. During this period, the number of trainees awarded a Certificate of Eligibility for Specialist Registration (CESR) more than tripled. This trend appears to be multifactorial, driven by a shortage of national training numbers (NTNs), geographical preferences and a rising number of vacant consultant posts nationally. The CESR route was renamed the ‘portfolio pathway’ in November 2023. It is equivalent to a Certificate of Completion of Training in dermatology. Since 2018, this large teaching hospital has created a CESR training programme that mirrors the NTN programme. In June 2023, a survey was distributed to all dermatology registrars (ST3–ST6) working within the dermatology department. The responses comprised six CESR trainees and 13 NTNs. Modelled on the General Medical Council’s annual National Training Survey, questions were written with grading on a Likert scale, capturing information including training and research opportunities, access to teaching, personal wellbeing and rota design. There were two sections: section 1 was completed by both CESR and national trainees, in order to obtain a direct comparison of training experience, while section 2 was completed exclusively by CESR trainees. Section one revealed that no trainee felt that there was a notable difference in training opportunities or access to teaching, or that there was a perceived difference in clinical competency. All CESR trainees felt that they were treated equally to national trainees, with 50% rating their job satisfaction as ‘very good’, compared with 31% of national trainees. In regard to audits and quality improvement project opportunities, both cohorts felt that the geographical continuity offered with a CESR contract was advantageous, enabling CESR trainees to commit to long-term projects. Conversely, 50% of CESR trainees felt that research opportunities were limited by the 5-year timeframe of the CESR application process. ‘Geographical stability’ was the primary motivator for 50% of trainees pursuing a CESR contract and/or rejecting an NTN. That said, when applying for consultant positions, 67% felt disadvantaged by not having an NTN. This is the first CESR (portfolio pathway) satisfaction survey for dermatology trainees in this hospital. We have collated the experiences of our current CESR trainees, assessing the pros and cons of the pathway, while highlighting the beneficial role of a formalized survey to both monitor and improve their experience. We feel this is imperative, in light of rising number of trainees and the need for dermatologists to be trained via the CESR pathway.
P053 Synchronous melanoma: a single-centre 5-year retrospective study
Authors: Yong Ji Fung , O’Connell Michael , Durack Alana , Paul Lyndsey 
Published: June 2024

Abstract
Synchronous melanoma (SM) is defined as at least two melanomas diagnosed at the same time, or a second within 3 months of diagnosing the first melanoma. Previous studies have shown that 0.5% of all patients with cutaneous melanoma have synchronous second primaries. A retrospective study of melanoma data in one of the eight designated cancer centres in the Republic of Ireland was undertaken. We reviewed the demographics, risk factors and melanoma types in all the cases of SM discussed at the melanoma multidisciplinary team (MDT) meeting for the last 5 years. Melanoma MDT lists, and histopathology and clinical records were reviewed from July 2018 to July 2023 inclusive, for SMs. This study included invasive malignant melanoma (MM), lentigo maligna (LM) and melanoma in situ (MIS). In total, 1082 patients were diagnosed with cutaneous melanomas over the 5-year period. Of these patients, 42 (3.9%) with SMs were identified (26 male, 16 female). Ages ranged from 44 to 93 years. Thirty patients (71%) had SMs diagnosed at the same time, with the rest diagnosed within a 3-month period. Nine cases (21%) had a previous history of melanoma, with four having previous SMs. Other risk factors noted included history of immunosuppression (10%, n = 4), first-degree relatives with a history of melanoma (7%, n = 3) and history of previous nonmelanoma skin cancer (5%, n = 2). Of the 42 patients, four (10%) had more than two individual melanomas identified on the same occasion (three patients had three melanomas and one had five). Of these four patients, two had a first-degree family history of cutaneous melanomas and were referred for genetic testing, with results pending. Of the total number of SMs (n = 91), 29% (26) were invasive MM, 24% (22) were LM and 47% (43) were MIS. Most lesions (33%, n = 30) were located on the trunk, with 19 (58%) on the back. Twenty patients (48%) had synchronous in situ lesions (LM/MIS), 20 (48%) had LM/MIS with an invasive melanoma (pathological stage 1A to 4B) and two (5%) had synchronous stage 1a and 1b melanomas. In total, 93% of cases (n = 39) attended dermatology services for follow-up. To the best of our knowledge, this is the largest reported case series to date of SM. A higher incidence of SMs in our cancer centre is noted compared with the literature (3.8% vs. 0.5%). It highlights the importance of a full skin check, especially once a melanoma has been identified, to ensure further melanomas are not missed. For patients diagnosed with SMs, who also have first-degree family history of cutaneous melanoma, genetic testing should be considered to look for germline mutations and genetic variants.
P062 A multicentre retrospective observational study reviewing the management of severely dysplastic naevi
Authors: Agarwal Vani , Dave Siddarth , Bali Radhika , Khalil Nada , Bala Laksha , Carton James , Sinha Rishika , Macedo Chrystalla , P. Patel Neil , Fearfield Louise 
Published: June 2024

Abstract
The aim of this study was to evaluate management of severely dysplastic naevi (SDN) across two NHS trusts over 5 years. A natural language search was performed on the local histopathology system (Copath) to identify all SDN excised between 1 January 2018 and 1 January 2023. Duplicates, cases from external trusts, and histology reports mentioning ‘melanoma in situ’ (MIS) were excluded. Many cases had a spectrum of dysplastic changes mentioned in the report; in such cases the most severe diagnosis was used. Electronic medical records were reviewed to ascertain the surgical excision margin, histological margin, multidisciplinary team (MDT) discussion, management and duration of follow-up. In total, 136 cases were identified, of which 82 met the inclusion criteria. Trust A had 43 included cases and Trust B had 39 included cases. Overall, 58% (n = 25) of Trust A and 97% (n = 38) of Trust B cases were excised with a 2-mm surgical margin, while 81% (n = 35) of Trust A cases and 85% (n = 33) of Trust B cases were excised with at least a 1-mm histological margin. In total, 44% (n = 19) of Trust A and 51% (n = 20) of Trust B cases were discussed at skin cancer MDT. The diagnoses of two cases at Trust A were upgraded to MIS, and one case at Trust B was upgraded to a pT1a melanoma after MDT review. Overall, 74% (n = 32) of cases at Trust A were offered wide local excision (WLE); of these, 78% (n = 25) were to achieve 5-mm clearance. In total, 18% (n = 7) of cases at Trust B were offered WLE; of these, 29% (n = 2) were to achieve 5-mm clearance. Monitoring was recommended in 2% (n = 1) of Trust A cases and 26% (n = 10) of Trust B cases. Our results demonstrate that management of SDN can differ substantially between trusts. Trust A managed the majority (58%) of cases as MIS, whereas Trust B took a more conservative approach. There was no significant difference in outcome. There are currently no consensus guidelines on the management of SDN in the UK or internationally. Surveys from Australia, Canada, the USA and the UK have shown variation in clinical practice. Review of the current literature supports the re-excision of incompletely excised SDN and monitoring (as opposed to re-excision) of completely excised SDN, as the risk of progression to melanoma appears low. Our results highlight the need for consensus guidelines to manage these cases to provide optimal and consistent patient care, as well as minimizing unnecessary and potentially disfiguring surgery.
P067 A novel validated patient decision aid to enhance shared decision making for the management of actinic keratosis
Authors: Brent Geoffrey , Beardmore Caroline , Mayers Kate , Barea Alberto , Samarasinghe Venura , Pinder Vanessa , Soo Julia , Akhras Victoria , Jiyad Zainab 
Published: June 2024

Abstract
Actinic keratoses (AKs) are common premalignant lesions relating to chronic ultraviolet exposure. Several management options exist, including active surveillance, multiple topical therapies, cryotherapy, curettage and cautery, and photodynamic therapy, each with their own risks, benefits and efficacy. Best practice currently involves shared decision making between patient and clinician, particularly when there are numerous management options. Patient decision aids (PDAs) can be beneficial in the shared decision-making process. Between December 2022 and August 2023 we developed and validated a PDA for the management of AKs, in concordance with the International Patient Decision Aids Standards. A two-page leaflet was created with key information on the standard management options, such as what the treatment involves, side-effects and efficacy. Alpha testing of the draft PDA was conducted initially, with positive feedback from clinicians and patients. Beta testing was then undertaken, in which the PDA was used in consultations with 21 consecutive patients across three separate hospital trusts in dermatology clinics. Included patients were over 18 years of age and diagnosed clinically or histologically with one or more AKs. Patients were excluded if there was any suspicion of squamous cell carcinoma, or if they had tender or hypertrophic AKs. Two validated outcome measures, the Decisional Conflict Scale (DCS) and the nine-item Shared Decision Making Questionnaire (SDM-Q-9), were used for all patients. The majority of patients (75%) indicated a high level of decisional conflict prior to using the PDA, with a total mean DCS score of 53.0 (95% confidence interval 43.2–62.8), where a higher value corresponds with increasing decisional conflict. Following use of the PDA, the total mean DCS score improved to 13.0 (95% confidence interval 8.0–17.9). This represents a significant reduction in DCS score (P &lt; 0.001), with the majority of responses as ‘strongly agree’ and ‘agree’ that the PDA facilitated their management decision. The total SDM-Q-9 score was 791/900 (87.9%), which indicates a high level of shared decision making following use of the PDA. As AKs can be managed in numerous ways, information given to patients can be overwhelming, making the decision more challenging for patients. A PDA given to the patient can reduce decisional conflict and improve the shared decision-making process. We suggest that this validated PDA can be used in various settings to facilitate informed care: during primary care consultations, in secondary care in both specialist nurse and doctor-led clinics, and also at the interface between primary and secondary care when responding to Advice and Guidance queries.
P068 A history of mycosis fungoides: from Alibert to mogamulizumab
Authors: Johnson Nicholas A , Venables Zoe C , Mistry Khaylen , Levell Nick J 
Published: June 2024

Abstract
In 1806, French physician Baron Jean-Louis Alibert treated a 56-year-old man with a desquamating rash and skin tumours. Alibert considered this to be a variant of yaws. In 1829 Alibert named the condition mycosis fungoides (MF), meaning ‘mushroom-like fungal disease’. Over 100 years later, French dermatologist Albert Sézary published papers from 1938 to 1949 detailing a mysterious disease that caused erythroderma and ‘cellules monstrueuses’, describing cutaneous ‘monster cells’. In 1961, these clinical findings were collated together into ‘Sézary syndrome’. There was widespread confusion between these conditions, i.e. fungal infections and yaws. In the 1870s English dermatologist William Tilbury Fox published a dermatology atlas detailing cases similar to what we know now as MF, with the name ‘fibroma fungoides’. The atlas described MF as a type of fungus, before giving a description of yaws and painting a clinical picture that differed from that of a lymphoma. In 1975, Pierre-Antoine-Ernest Bazin and associates suggested the classification system and term we now recognize as cutaneous T-cell lymphoma (CTCL). Neoplastic cells have been thought to arise from chronic activation of T cells via antigen-presenting cells, yet the antigen to trigger this response remains unknown. Several potential bacterial, viral, fungal and iatrogenic causes have been studied, but no reliable triggers have been discovered. In 2018, the World Health Organization and European Organisation for Research and Treatment of Cancer officially recognized four types of MF. These are the classic Alibert–Bazin type (representing 88.6% of cases) and its three subtypes; folliculotropic MF (11.4%), Pagetoid reticulosis, and granulomatous slack skin (both with a combined 1% prevalence). CTCL has an incidence of approximately 0.2–0.6 per 100 000 person-years, with MF being the most common subtype. MF is twice as common in male as in female patients. It is twice as common in those of Black ethnic background than in White and Asian ethnicities. Development of immunohistochemistry and polymerase chain reaction for the T-cell receptor gene in the 1980s improved the diagnosis of CTCL. However, diagnosis of MF remains challenging due to its heterogeneous presentation, often mimicking inflammatory dermatoses. Advanced diseases therapies have evolved from cytotoxic chemotherapy in the 1970s to novel monoclonal antibodies such as mogamulizumab, targeting proteins on T-cell lymphoma cells (CCR4). Reflection on the past two centuries from Alibert to mogamulizumab offers insight into the challenges that accompany the aetiology, diagnosis, classification and management of MF.
P071 Are Welsh primary schools sunproofed? Results of a national survey: sun protection practices in primary schools in Wales
Authors: Abbott Rachel , Tod Daniel , Lanyon Kirsty , Driscoll Timothy , Prathap Swetha , Watkins Alan , Peconi Julie 
Published: June 2024

Abstract
Skin cancer rates are on the rise globally. School sun safety programmes are recommended by the World Health Organization to reduce the risk of future skin cancer at the population level; however, these are encouraged but not mandated in Wales. Our study aimed to explore current sun protection practices and sun safety education in primary schools in Wales, and whether these are linked to the existence of a formal sun safety policy. To do this, we distributed an online survey to all 1241 Welsh primary schools asking about sun safety practices, education and formal policies. In total, 471 (38.0%) schools responded to our survey, with the characteristics of responding schools generally matching the profile of schools in Wales. A minority (22, 4.7%) of responding schools reported they had sufficient shade for most activities. In the spring and summer terms almost two-thirds of schools encourage hat wearing (304, 64.8% of available data) and suncream (296, 63.2%). While nearly all schools reported that parents were encouraged to apply suncream to students before school (449, 95.7%), there was wide variation in other suncream application practices. Less than one-third of schools (129, 29.0%) reported that they include sun protection education in the curriculum in every year group, with 11.7% (52) including this in certain years only. Schools with a formal sun safety policy were more likely to report more comprehensive sun protection practices, including having sufficient shade [odds ratio (OR) 1.51, 95% confidence interval (CI) 1.04–2.19; P = 0.03], having spare hats for pupils to wear (OR 1.59, 95% CI 1.07–2.37; P = 0.02), providing guidance for staff (OR 5.87, 95% CI 3.05–11.3; P &lt; 0.001), encouraging them to model sun safe behaviours (OR 1.82, 95% CI 1.18–2.80; P = 0.007) and teaching sun protection education as part of the curriculum in every year group (OR 2.56, 95% CI 1.76–3.71; P &lt; 0.001). The existence of a formal policy did not seem to affect a school’s practice with respect to suncream. While in most cases, the existence of a formal policy suggests more comprehensive sun protection practices and education in schools in Wales, sun protection measures and education need improvement across the primary school sector to reverse rising skin cancer rates.