bluuebunny/crossref_metadata_2025_split huggingface dataset:
P035 Quantifying the mutation burden of a therapeutic course of narrowband ultraviolet B (UVB) to help inform on the carcinogenicity of narrowband UVB
Authors: Coltart George , Fowler Joanna , Sood Roshan , Lai Chester , Nadarajah Noeline , Jones Philip , Healy Eugene 
Published: June 2024

Abstract
Narrowband ultraviolet B (NB-UVB) is recommended by NICE as a treatment for chronic plaque and guttate psoriasis that cannot be controlled with topical therapies. However, ultraviolet radiation is a carcinogen that causes DNA mutations in the skin, and in some cases results in skin cancer development. To date, there have been no studies determining how many mutations develop in human skin as a result of a therapeutic course of NB-UVB, and therefore we investigated the mutation burden of NB-UVB in the current study. Although whole-exome or whole-genome sequencing and target-enriched sequencing can detect mutations in large clones of mutated skin cells, these approaches do not detect mutations occurring only in single skin cells, hence we used a novel type of sequencing called Nanorate sequencing (which can identify mutations occurring in just a single molecule of DNA) in this study. We obtained 6-mm punch biopsies of normal skin (buttock and/or forearm) before and after a course of UV from patients (n = 16) undergoing NB-UVB treatment for psoriasis. Epidermis was microdissected from the dermis and the epidermal DNA was sequenced using nanorate sequencing. DNA from venous blood underwent whole-genome sequencing as germline control for accurate identification of mutations in the epidermal samples. The numbers of DNA mutations were compared between the skin samples taken before and after NB-UVB in order to quantify the mutation burden attributable to the course of NB-UVB. Minimal erythema doses ranged from 0.3 to 0.9 J cm−2 and the total dose received during the course of NB-UVB ranged from 14.8 to 133 J cm−2. There was a significant rise in the number of mutations in buttock and forearm skin due to the NB-UVB treatment, with median increases in single-base substitutions per megabase of 1.09 SBS/Mb (P = 0.001) and 3.77 SBS/Mb (P = 0.0098) in buttock and forearm epidermis, respectively. The change in number of mutations secondary to NB-UVB treatment was predominately due to UV signatures SBS7a and SBS7b, with the DBS1 (CC&gt;TT mutations) double-base substitution signature also identified in buttock and forearm skin samples. Comparison of the increase in mutation burden from NB-UVB with the mutation burden in keratinocyte cancers indicated that, for more susceptible patients, a course of NB-UVB therapy contributed as much as one-sixteenth of the total mutational burden of a cutaneous squamous cell cancer.
P049 Best foot forward: awareness of melanoma of the foot among podiatrists
Authors: Nolan Brian , O’Connor Cathal , Murphy Michelle 
Published: June 2024

Abstract
Melanoma of the foot can masquerade as ulcerative conditions, congealed blood and trauma. Thus, even for experienced clinicians, diagnosis can prove challenging. There is a paucity of evidence about the role that podiatrists, who are routinely exposed to patients’ lower limbs, play in melanoma detection. The aim of this study was to assess the awareness and knowledge of melanoma among podiatrists, and to investigate whether podiatrists examine and assess suspicious pigmented lesions of the foot. An anonymous 18-question survey was designed assessing podiatrists’ knowledge of melanoma of the lower limb, and exposure to suspicious pigmented lesions. Ethical approval was granted by the local research ethics committee. This survey investigated the frequency of examination of suspicious pigmented lesions, insight into what constitutes a suspicious pigmented lesion, actions taken upon detection of such lesions, and suggestions for helping to improve early detection of melanoma. The survey was distributed anonymously by the national podiatrists’ association to 400 registered members over a 3-month period. The survey generated 247 responses (62% response rate, n = 400). Most podiatrists (81%) had over 20 years’ experience, and saw an average of 30 patients weekly. Over two-thirds (68%, n = 167) had been asked to examine suspicious pigmented lesions on the lower limb, of whom almost two-thirds (61%, n = 102) reported being frequently asked to examine suspicious pigmented lesions. Over two-thirds of podiatrists (71%, n = 175) reported identifying a lesion that they felt could represent melanoma, of whom 79% advised presentation to the general practitioner (GP), 8% advised dermatology review, 6% took photographs for skin-mapping, 6% contacted the patient’s GP directly, and one took a biopsy. Most (81.9%) did not receive subsequent feedback from the patients or GP. Just over a third (34.4%, n = 83) reported not feeling comfortable contacting a GP surgery directly to refer a patient, while 55.8% (n = 135) did not feel comfortable discussing sunscreen and photoprotection with patients. Most (81.7%, n = 196) did not feel they received satisfactory undergraduate education in melanoma. Suggestions for improving early detection of melanoma of the foot among podiatrists included enhanced undergraduate training, a clear referral pathway for podiatrists, and feedback from their referrals to GP or dermatologists. There is a concerning gap between the reported frequency of suspicious pigmented lesions in podiatry practice and the lack of formal training in melanoma detection and assessment. Improved training, clearer referral guidelines, and enhanced interprofessional communication strategies may improve early detection of melanoma of the foot among podiatrists.
P055 A randomized single-blinded prospective study to compare simulated daylight photodynamic therapy with natural daylight photodynamic therapy for the treatment of multiple actinic keratoses
Authors: Drumm Ciara , Morgan Imelda , Kavanagh Ann , Gill Danielle , Buckley Julia , Reade Matthew , Loughman Eamon , McCavana Jackie , Ryan Aisling , Moriarty Blaithin , Lally Aoife 
Published: June 2024

Abstract
Actinic keratoses (AKs) are considered precursor lesions of cutaneous squamous cell carcinoma, with a reported conversion rate of 3–16%. Photodynamic therapy (PDT) is a widely approved therapy for AKs. Conventional PDT (c-PDT) using red light is limited by pain and a small treatment field. Daylight PDT (d-PDT), an approved alternative, is limited by geographical location and weather conditions. Simulated daylight PDT (sd-PDT) with light-emitting diode (LED) light sources is now commercially available due to robust evidence that these devices are effective, but the devices are limited by cost (∼€30 000). We hypothesized that sd-PDT with a 4000 K white-light LED floodlight, costing €961, is equally as effective and well tolerated as d-PDT in the treatment of AKs across treatment fields of up to 55 cm2 on the scalp. Twenty-two men with a mean age of 74.5 years (SD 7.0) and multiple scalp AKs were enrolled in this prospective, randomized, single-blinded study, which employed a split-scalp design to compare the effectiveness and adverse events of d-PDT and sd-PDT. Block randomization was used to determine which side of the scalp would be treated with d-PDT. Each patient received four treatments in total, two d-PDT and two sd-PDT, each a week apart. The AKs were counted, graded, mapped and photographed at baseline, at blinded 1- and 3-month reviews and at unblinded 6-, 9- and 12-month reviews. The primary endpoint was mean lesion-specific clearance, defined as the mean number and percentage of cleared AKs per treatment field at 3 months. At baseline, the mean (SD) number of AKs per field was 44 (17.4) for the d-PDT group and 45.5 (17.8) for the sd-PDT group (P = 0.4). The mean lesion-specific clearance (percentage reduction) in AKs per field was 35.3 (71.5%) for d-PDT and 35.0 (75.1%) for sd-PDT at 1 month (P &gt; 0.99), 33.6 (66.4%) for d-PDT and 30.3 (61.6%) for sd-PDT at 3 months (P = 0.6). Both d-PDT and sd-PDT were effective, with a significant reduction in AKs from baseline at 1 and 3 months (P &lt; 0.01). Pain was reported by 15 patients with d-PDT and 12 with sd-PDT (median maximum score out of 100, 3.5 vs. 4.5; P = 0.6). Erythema was observed in 17 after d-PDT and 15 after sd-PDT. On a scale of 0 (intolerable) to 10 (very tolerable), patients rated d-PDT as 10 and sd-PDT as 9.8 (P = 0.08). We conclude that sd-PDT with a 4000 K white-light LED floodlight is equally as effective and well tolerated as d-PDT and is an affordable treatment option not limited by pain, small treatment field, geographical location or weather conditions.
P059 Cutaneous sarcomas: a 5-year review of treatment outcomes and literature
Authors: Chung Jenny , Macedo Chrystalla , Sinha Rishika 
Published: June 2024

Abstract
Cutaneous sarcomas comprise 5% of skin cancers yet carry great morbidity and mortality. They include atypical fibroxanthoma (AFX), pleomorphic dermal sarcoma (PDS), leiomyosarcoma (LMS), dermatofibrosarcoma protuberans (DFSP) and angiosarcoma (AS) (Stoneham S, Hunter A, Raahimi M et al. Cutaneous sarcoma: a review and practical approach to management. Clin Exp Dermatol 2023; 48: 866–72). Standardized agreed national guidelines for the management of these rare tumours are lacking, and we rely on guidance from sarcoma specialists (Dangoor A, Seddon B, Gerrand C et al. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6: 20). However, these tumours are lower grade, and do not carry the same local and metastatic recurrence risk as noncutaneous sarcomas. The aim of this study at a tertiary UK centre was to review the treatment and follow-up outcomes of patients with sarcoma managed locally. All patients with biopsy-proven cutaneous sarcomas discussed at our skin cancer multidisciplinary team (MDT) from March 2020 to January 2024 were retrospectively reviewed. Patient demographics, and histology were gathered along with the treatments offered, recurrence and follow-up outcome. All patients were restaged using the American Joint Committee on Cancer soft tissue sarcoma criteria. In total 40 patients met the criteria; their mean age at diagnosis was 70 years (range 24–91) and 25% were immunosuppressed. The cohort was followed up for an average of 11.3 weeks (range 1–36). The diagnoses included PDS (35%), AFX (20%), LMS (20%), DFSP (15%) and AS (5%); all but one had T1 or T2 disease. Overall, 97% of patients received surgery first line, with a clearance rate of 85% (29 of 34). Two patients had recurrence: one with PDS, requiring further surgery, and one with AS, who was managed at a sarcoma unit. There were no metastases reported or deaths due to disease. Most patients (80%) remain in clinical remission. Appropriate imaging and follow-up recommendations were made in most cases, according to their diagnosis. In summary, many of the patients with cutaneous sarcoma in the study had superficial disease. Despite our conservative surgical margins offered and a short duration of follow-up, we observed a 5% recurrence rate with no metastases. This study highlights the importance of an MDT approach to cutaneous sarcomas, which helps draw expertise from different specialties. Our lower recurrence rate and metastases compared with literature suggests that patients with cutaneous sarcoma could be safely managed in local skin cancer MDTs. We propose national guidance to help similar skin cancer MDTs and clinicians to standardize and reduce variation in care, as well as to provide an evidence base on which to recommend monitoring of this rare group of tumours.
P061 Squamoid eccrine ductal carcinomas: challenges in diagnosis and management
Authors: Cunliffe Amy , Elsheikh Somaia , Odedra Sunita , Varma Sandeep 
Published: June 2024

Abstract
Squamoid eccrine ductal carcinomas (SEDCs) are rare adnexal carcinomas displaying both squamous and duct differentiation. We wish to remind clinicians of these recently described cancers, which can have aggressive behaviour (van der Horst MPJ, Garcia-Herrera A, Markiewicz D et al. Squamoid eccrine ductal carcinoma. Am J Surg Pathol 2016; 40: 755–60). We identified five cases in our department: four female patients and one male. All lesions developed on the face, in patients aged 69–83 years. The majority developed over one to several years, apart from one rapidly growing lesion, and measured between 5 and 40 mm. Clinical examination suggested squamous cell carcinoma (SCC) in two cases and basal cell carcinoma in three cases due to features such as puckering, rolled borders, telangiectasia, shine, ulceration and crust. Punch biopsies were performed in all five lesions; however, histological diagnosis of SEDC was suggested in only two. One of these patients underwent Mohs micrographic surgery (MMS), which successfully cleared the lesion after two stages. The second patient, diagnosed on biopsy, had a large 30-mm lesion with invasion into the lacrimal sac and left nasal bone. The patient opted for palliative radiotherapy rather than extensive surgery and subsequently developed a left-cheek metastasis and symptoms suggestive of metastatic disease. Three of our cases were diagnosed after wide local excision (WLE) based on the histological and immunological features. The punch biopsies had suggested either SCC or adenosquamous/adnexal infiltrative carcinoma. One of these patients required adjuvant radiotherapy due to perineural involvement (&lt; 0.1 mm). The other two cases were incompletely excised on WLE and the patients were offered further surgery or radiotherapy. Histologically these lesions were poorly defined infiltrative neoplasms consisting of atypical squamoid cells extending into the deep dermis or subcutaneous tissue with ductal differentiation, pronounced cytological atypia and associated desmoplastic stroma. Tumour thickness measured 3–10.3 mm. Immunohistochemistry was positive for CK7, AE1/AE3, CK5/6, p63, CAM5.2, carcinoembryonic antigen and epithelial membrane antigen. These five cases highlight the challenges faced in the diagnosis of SEDC for both the dermatologist and the dermatopathologist. MMS is recommended (Lim MM, Macdonald JA. Squamoid eccrine ductal carcinoma: treatment and outcomes. Am J Dermatopathol 2022; 44: 249–53) and lesions misdiagnosed as SCC may receive less effective treatment; our three patients who underwent WLE have required further interventions. We also report one patient with locally aggressive and likely metastatic disease. Patients with SEDC benefit from early diagnosis, MMS and close follow-up to reduce the risk of recurrence and improve patient outcomes.
P063 Understanding the landscape of Kaposi sarcoma hospitalizations in the USA: demographic associations stratified by AIDS/HIV status
Authors: Mendoza Roy , Espinoza Norma , Saoub Jessica , Kieron Leslie , Ge Shaokui 
Published: June 2024

Abstract
Kaposi sarcoma (KS), a low-grade vascular tumour associated with human herpesvirus 8 (KSHV/HHV8), has demonstrated a notable increase among Black men despite an overall decreasing trend in the USA. Given the lack of information regarding the national rates of KS in the USA, this study aims to characterize the national inpatient burden of individuals affected by KS, exploring demographic disparities on a broader scale. We queried the National Inpatient Sample (NIS), a subset of the Healthcare Cost and Utilization Project database containing US hospital discharge data, from 2016 to 2019 to identify all patients aged ≥ 18 years with a diagnosis of KS. We used the data to estimate the national representation and KS-relevant hospital admissions compared with the national civilian population. Stratifying by HIV/AIDS status (AIDS-related KS vs. non-AIDS-related KS), we examined the demographic associations of inpatients with KS using a Wald χ2-test. We determined the incidence rate ratios of admission for KS-related concerns using a Poisson regression model. All statistical analyses were performed with SAS 9.4 (SAS Institute Inc., Cary, NC, USA). In total, 12 246 patients with KS were estimated from the NIS. Overall, the inpatients with KS were predominantly male (91.1%), Black (41.4%) and in the 18–44-year age group (47.7%). AIDS-related KS constituted the majority of patients with KS (10 065, 82.2%), predominantly affecting Black individuals (45.7%) compared with patients classified as White, Hispanic and other (30.2%, 17.6% and 6.5%, respectively). Male patients were more often affected, at a 16 : 1 male-to-female ratio, the largest recorded thus far. Black patients with AIDS had a significantly higher risk of hospitalization. Non-AIDS-related KS comprised 17.8% of cases, primarily among White (51.4%) and male (77.5%) patients, and those aged 65–84 years (49.3%). Despite the differences by KS type, Black patients and those aged ≥ 85 years with non-AIDS-related KS still faced a heightened risk of hospitalization. This study underscores the distinct demographic patterns of inpatients with KS by HIV/AIDS status. For AIDS-related KS, focused efforts are required for Black individuals – addressing their elevated risk, initiating early therapeutic intervention, and promoting adherence to antiretroviral therapy. In cases of non-AIDS-related KS, attention must be given to the older age groups, especially those with a history of immunosuppression. These findings advocate for specialized dermatological strategies considering demographic nuances, contributing to more effective and targeted care for patients with KS.
P090 A randomized study to compare the efficacy of topical tofacitinib vs. topical tacrolimus in treatment of patients with unstable vitiligo
Authors: Mehta Hitaishi , Bishnoi Anuradha , Vinay K , Kumaran Sendhil , Parsad Davinder 
Published: June 2024

Abstract
Topical tacrolimus 0.1% is a widely accepted treatment for localized vitiligo. However, emerging Janus kinase inhibitors like tofacitinib show promise. Existing evidence for topical tofacitinib largely comes from open-label, uncontrolled studies and case reports, often in combination with other therapies. This prospective, 16-week, single-blinded, split-body study evaluated the efficacy and tolerability of topical tofacitinib 2% ointment vs. topical tacrolimus 0.1% ointment applied twice daily in a cohort of 25 patients with limited vitiligo. Participants aged ≥ 5 years with a diagnosis of nonsegmental vitiligo, limited to ≤ 10% body surface area, and at least two symmetrical vitiligo patches that had been active in last 12 months were included. After informed consent was obtained, vitiliginous patches on either side of the body were randomized to receive either topical tofacitinib or topical tacrolimus. The total duration of therapy was 16 weeks, and patients were followed up every 4 weeks. The primary outcome was Vitiligo Noticeability Scale (VNS) of two symmetrical target patches at week 16 as reported by patients, with a VNS of 4 (‘a lot less noticeable’) or 5 (‘no longer noticeable’) considered as treatment success. Secondary outcomes included clinician-reported percentage repigmentation, time to attainment of treatment success and incidence of adverse effects. The study cohort, comprising 25 patients analysed for 50 vitiligo patches, had a mean age of 22.4 years (range 5–59). The topical tofacitinib group achieved a VNS of 4 or 5 (considered treatment success) in 14 patients (56%), compared with 11 (44%) in the tacrolimus group (P = 0.40). Clinicians observed significant repigmentation exceeding 75% in 15 patients within the tofacitinib group and 13 patients within the tacrolimus group (P = 0.57). The mean (SD) time to attain treatment success was 12.4 (3.8) weeks for tacrolimus and 10.0 (4.4) weeks for tofacitinib. Strikingly, tofacitinib demonstrated treatment success as early as 4 weeks in three patients, whereas no such rapid success was observed in the tacrolimus group. Adverse effects, predominantly mild, included transient erythema (n = 1) and burning sensations (n = 5) with tacrolimus, while tofacitinib led to application-site pain and pruritus in one patient each (P = 0.12). Limitations of our study include the small sample size, short treatment duration and single-blinded study design. In summation, this study unveils the efficacy of both topical tofacitinib and tacrolimus in repigmenting vitiligo lesions. Tofacitinib exhibits a higher, though statistically nonsignificant, treatment success rate and a swifter onset of repigmentation, indicating its potential as a robust therapeutic option for limited vitiligo.
P099 Use of roflumilast in erosive oral inflammatory conditions
Authors: Botrugno Rachel , Rajlawat Bijaya , Finn Daniel , Yesudian Paul Devakar 
Published: June 2024

Abstract
Roflumilast is a phosphodiesterase type 4 (PDE4) inhibitor commonly used in respiratory medicine to manage chronic obstructive lung disease. Recently, there have been case reports of its effectiveness in oral mucosal conditions. We review five patients with different erosive mucosal lesions who responded to this medication. All patients were commenced on 250 μg daily, increasing to 500 μg if indicated. Case 1 is a 57-year-old woman who presented to the dermatology/oral medicine (DOM) clinic with long-standing recurrent aphthous stomatitis from her late teens. Treatment with colchicine and dapsone in combination was ineffective. Roflumilast was added and colchicine was stopped following a positive response. Case 2 is a 78-year-old woman seen in DOM in 2021 with erosive oral lichen planus. She did not respond to oral hydroxychloroquine, mycophenolate mofetil, azathioprine and multiple tapering courses of systemic steroids. Roflumilast was commenced recently, and the patient has not reported any flares since. Case 3 is a 26-year-old man with recurrent erythema multiforme predominantly involving the oral mucosa with erosive changes. He was treated with dapsone, prophylactic valaciclovir, and multiple courses of tapering prednisolone. Response was noted but breakthrough flares continued to occur. Roflumilast was commenced 6 months ago with no flares noted since. Case 4 is a 67-year-old woman who presented to dermatology in 2022 with severe oral erosive lichen planus of 4 years’ duration. Treatment with courses of oral prednisolone, hydroxychloroquine and acitretin were ineffective. Roflumilast was introduced, with excellent remission of all the erosions for the last 7 months. Case 5 is a 34-year-old woman who presented to DOM in August 2021 with recurrent deep, severe aphthous stomatitis. She was previously prescribed mycophenolate mofetil and reducing oral systemic steroids by dermatology for severe pyoderma gangrenosum; however, it did not help the oral ulcers. Hydroxychloroquine, colchicine and azathioprine were ineffective for the aphthous stomatitis. Roflumilast was commenced, resulting in clearance of the oral ulcers. Roflumilast acts by inhibiting PDE4, which in turn increases cyclic adenosine monophosphate, and this causes inflammatory modulators such as interleukins and tumour necrosis factor-α to be downregulated. These inflammatory mediators play a role in oral erosive conditions such as oral lichen planus and recurrent aphthous stomatitis. PDE4 inhibitors, including roflumilast and apremilast, have shown promising results in managing oral ulceration in patients with Behçet disease and aphthous ulcers. We advocate the use of roflumilast for oral erosive conditions when standard systemic agents are ineffective or cause side-effects.