bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD15 Ultraviolet overexposure in solar urticaria: beyond the rash
Authors: Ross Hannah , Parkin Donna , Ayer Jean 
Published: June 2024

Abstract
Solar urticaria is a rare photodermatosis characterized by an immediate type I hypersensitivity reaction, usually to ultraviolet (UV)A and visible light, and less commonly to ultraviolet B (UVB). Symptoms of itch and burning to exposed sites occur after seconds of sun exposure and are followed by erythema and often wealing of the skin. Patients can report associated systemic symptoms including headache, hypotension, nausea and syncope following significant exposure. We describe the rare case of a 54-year-old white British man with a diagnosis of solar urticaria who experienced vasomotor collapse following sunbed use. The patient had previously undergone monochromated light testing, which demonstrated exquisite photosensitivity to both UVB and UVA from 300 to 370 nm and severity in the visible range from 400 nm. Treatment options for solar urticaria are limited, with avoidance of sunlight, photoprotective measures and antihistamines being the mainstay of management. Omalizumab is a more recent therapy; however, access to this at present is limited to tertiary centres for this indication. Phototherapy can be considered to induce skin hardening; however, this is used only in a controlled setting with the choice of treatment dependent on the provoking wavelengths. Our patient used a commercial sunbed in a desperate effort to self-treat his solar urticaria. Shortly after use, while sitting upright in a car, he become unresponsive and displayed involuntary movements, urinary incontinence and tongue biting, resulting in assessment at a local emergency department. He went on to have an unremarkable magnetic resonance imaging scan of the brain and electroencephalogram. Later review resulted in a diagnosis of an anoxic seizure. This was felt to be caused by hypotension and reduced cerebral perfusion, secondary to sunbed use and further exacerbated by his upright seated position in the car passenger seat. The case highlights the complexity of solar urticaria and the potentially fatal consequences of significant UV and visible light exposure.
CD02 What is the relevance of epoxy resin in the baseline series?
Authors: Phillips Peter , Divekar Preshita 
Published: June 2024

Abstract
Epoxy resin is used widely in adhesives, aircraft construction, boatbuilding, flooring and electrical encapsulation. It has been largely an occupational sensitizer in men. There have been recent reports of nonoccupational sensitization in women, due to exposure to crafting materials (Dios-Guillán V, Matellanes-Palacios M, Bou-Boluda L et al. Non-occupational, recreational epoxy resin contact allergy: report of two cases. Contact Dermatitis 2021; 85: 257–9) and the modern trend of ‘cosplaying’ (Samaran Q, Strizzolo R, Dereure O, Raison-Peyron N. Non-occupational allergic contact dermatitis to epoxy resin in a cosplayer. Contact Dermatitis 2023; 89: 122–4). We reviewed our patch test database for the 13-year period between 2009 and 2022, to identify patients with positive reactions to 1% epoxy resin tested routinely in the British Society for Cutaneous Allergy baseline series. Most patients had also been patch tested to at least one or two extended series including epoxy series. In total, 2445 patients (1701 female, 744 male) had been tested to epoxy resin. Fifteen patients (0.6%) (mean age 59.8 years, range 23–84) had tested positive (nine male, 1.2%; six female, 0.4%). The grade of reaction was +++ in two, ++ in eight and + in five. Of the fifteen, four were also sensitized to bisphenol F, two to 1,6-hexanediol diglycidyl ether and one each to BIS-GMA, 2-phenylglycidyl ether, triethylenetetramine, 1,4-butanediol diglycidyl ether, and phenol formaldehyde resin. Ten had dermatitis of the hands and/or forearms; four had involvement of the head and neck. The mean duration of dermatitis was 42 months (range 2–180). Eight had a history of atopy. Nine patients had known current or previous exposure to epoxy resins, four of whom had ongoing relevant exposure. Seven had occupational exposure (five male, two female). Two worked in boatbuilding or repair (wooden boatbuilder and boat painter), two in construction (decking builder and engineer) and two in art, and one was a lighthouse keeper and airport ground worker. An eighth patient had possible occupational exposure in gardening and a ninth had reacted to dental restorations. Both of the occupationally sensitized women had been exposed as artists working with epoxy resins. Relevance was unknown in six. The predominance of men in this audit is in accordance with previous publications. We found no patient of either sex sensitized through use of crafting kits. We could see no trend towards a reduction in the prevalence of sensitization to epoxy resin during this time period, nor a change in clinical relevance. The sensitization rate of 0.6% in unselected patients (1.2% male, 0.4% female) suggests that epoxy resin remains a relevant allergen, and we recommend that it remain in the baseline patch test series.
CD12 A case of occupational acrylate allergy: a success story!
Authors: Khan Yasmin , Latheef Faheem 
Published: June 2024

Abstract
A 35-year-old nail and beauty technician presented with severe hand and finger dermatitis. She had a 5-year history of eczema on her neck and trunk, which had improved with avoidance of balsam of Peru, to which she had previously tested positive on patch testing. Unfortunately, the patient began experiencing debilitating hand symptoms 2 years ago, escalating into painful, cracked, excoriated and fissured hands. Further patch testing revealed positive reactions to acrylates, specifically 2-hydroxyethyl methacrylate, ethylene glycol dimethacrylate, 2-hydroxyethyl acrylate, and triethylene glycol diacrylate – common components in acrylic, gel and shellac nail products used daily in her profession. Advised on strict allergen avoidance, the patient hesitated, citing practicality concerns given her lack of alternative income sources and qualifications. Reluctant to undergo a period of avoidance, she grappled with accepting her occupation as a likely source of her hand dermatitis and was keen to explore alternative options. Occupational acrylate allergy poses challenges for nail technicians, with symptoms often proving difficult to control once sensitized. Rapid acrylate penetration through most glove types complicates protective measures. Nitrile gloves offer marginally longer protection compared with latex, while laminate 4H gloves provide superior defence but limit manual dexterity. A study exploring an in vivo model for glove efficacy used open chambers filled with the acrylate gels, which were applied to the back with tape, and gloves attached as a membrane between the gel and the skin [Ursberg AM, Bergendorff O, Thorsson AC, Isaksson M. Is there a good in vivo method to show whether gloves are sufficiently protective when a nail technician is exposed to (meth)acrylates? An in vivo pilot study. Contact Dermatitis 2016; 75: 62–5]. The glove materials were then tested at four exposure times. This study showed promise in ascertaining which gloves offered appropriate protection for an individual, but is limited in practicality due to its prolonged duration. Applying the results from the study to clinical practice, the patient was first treated with oral steroids to clear her hands, and was then recommended to double glove during procedures. She was advised to ensure that she spent no more than 20 min with each client, in order to reduce penetration time of the acrylate through the gloves. This, along with frequent handwashing in between clients and regular workspace cleaning, has allowed her to successfully continue her career for the last 3 years. This case underscores the importance of finding collaborative solutions with patients, even if not medically ideal, and offering practical approaches for individuals facing challenging allergens to avoid. This case also highlights the usefulness of applying basic science research to clinical practice for the benefit of patients.
DS05 Overtreatment of skin cancer: how can we ensure those treated for basal cell carcinoma receive more benefit than harm?
Authors: Venables Zoe C , van Bodegraven Birgitta , Powell James B 
Published: June 2024

Abstract
For over a decade, international reports have highlighted how thousands of patients treated for basal cell carcinoma (BCC) die within a few years of a diagnosis, which questions how much benefit surgical treatment had. The current British Association of Dermatologists guidelines for basal cell carcinoma (BCC) have limited discussions on conservative, active surveillance, or no-treatment options. BCCs are often slow growing and minimally symptomatic, and therefore treatments such as curettage, cryotherapy, radiotherapy or topical therapy may be more appropriate in patients with limited life expectancy. Although associated with higher risk of recurrences, these treatments can be performed closer to home and may have lower associated morbidity than a complex excision. This abstract reports the incidence and survival following a first BCC diagnosis in England from the National Disease Registration Service Get Data Out (GDO) website, stratified by age. Survival is reported for first-ever tumours only, so subsequent tumours are excluded. For those aged ≥ 80 years, GDO reporting is separated by site; we chose facial BCC to represent survival outcomes in this age group. From 2013 to 2015 in England there were 271 473 first BCCs, of which 68 869 (25.4%) occurred in those aged ≥ 80 years. Kaplan–Meier overall survival rates at 3 and 5 years for patients of all ages following a first BCC were 90.3% [95% confidence interval (CI) 90.2–90.4] and 83.1% (95% CI 82.9–83.2), respectively. For those aged ≥ 80 years with a facial BCC, Kaplan–Meier overall survival rates at 3 and 5 years survival fell to 73.9% (95% CI 73.4–74.4) and 56.2% (95% CI 55.7–56.8), respectively, with similar findings at other sites. Net survival was consistently around 100% for various sites and age groups for first BCC; for example, in those aged 70–79 years with a facial BCC, 5-year net survival is 100.5% (95% CI 100.1–101). Net survival uses published life tables to compare survival of a person with a BCC to a person without a BCC accounting for variables including age, sex, deprivation and geography. The 5-year net survival for BCC was consistently around 100%. This implies that BCCs do not affect survival, and therefore, when considering BCC treatment, we must consider primarily the morbidity of no treatment vs. treatments. Overall survival analysis identified that 26.1% of patients aged ≥ 80 years with facial BCC die within 3 years and 43.8% die within 5 years of diagnosis. Better understanding this cohort of patients with limited life expectancy, who are less likely to benefit from treatment, is critical to patient care. Age alone is an incomplete predictor of limited life expectancy, but validated frailty scoring tools can assist in identifying patients who would benefit from a more informed conversation about the risks and benefits of treatment.
DS08 (P054) National incidence and survival of extramammary Paget disease 2013–2020 in England: reporting a total of 740 cases
Authors: Karkara Shweta , Khan Farishta , van Bodegraven Birgitta , Venables Zoe C 
Published: June 2024

Abstract
Extramammary Paget disease (EMPD) is a rare disease affecting the rich apocrine gland-bearing areas commonly involving the genital and perianal skin. It was first described in 1889 by Radcliffe Crocker. Clinical features of EMPD are insidious and nonspecific, frequently resulting in delayed diagnosis. Diagnosis of EMPD is important due to its association with an underlying malignancy, most commonly urothelial or anorectal, but it may also be cervical, prostatic, ovarian or endometrial in 10–30% cases. Until recently, there were limited national epidemiological data on incidence and survival. National data on EMPD incidence and 5-year survival in England from 2013 to 2020 were extracted from report-level data published openly by the ‘Get Data Out’ National Disease Registration Service programme. Crude incidence rates are reported per 100 000 person-years (PY). Survival is reported as overall Kaplan–Meier survival and net survival with associated 95% confidence intervals (CIs). Data for 2020 vs. 2019 incidence rate ratios with 95% CIs were calculated using the exact Poisson method. In total, 740 new cases of EMPD were diagnosed between 2013 and 2020, with a mean of 93 cases per year. The average crude incidence rate of EMPD per year was 0.17 per 100 000 PY (95% CI 0.14–0.21). The crude incidence rate in 2013 was 0.16 per 100 000 PY (95% CI 0.13–0.20), which increased nonsignificantly in 2019 to 0.20 per 100 000 (95% CI 0.16–0.24). During 2020, the first year of the COVID-19 pandemic, incidence decreased to 0.14 per 100 000 (95% CI 0.11–0.18). The incidence rate ratio between 2020 and 2019 was 0.73 (95% CI 0.54–0.98), with a P-value of 0.03. The 5-year overall Kaplan–Meier survival was 74.1% (95% CI 63.4–82.1) for EMPD diagnosed in 2013. Important limitations include lack of published data on site, age group, depth of invasion and associated comorbidities including malignancies due to small numbers. The reported net survival for EMPD is comparable with that for melanoma and prostate and breast cancer, presumably a result of its association with other underlying malignancies. The increase in crude incidence rates likely represents the ageing population, and one might expect age-standardized rates to be relatively static. The apparent decrease in the crude incidence rate of EMPD during 2020 demonstrates the impact of the pandemic on skin cancer services, as also shown for melanoma and other cancers. A study in The Netherlands assessed 178 cases of invasive and 48 cases of in situ EMPD and found an overall relative 5-year survival of 72% for invasive tumours and an incidence rate of 0.11 per 100 000 PY for EMPD. These data are important in better understanding the trends and outcomes of this rare and poorly understood tumour.
DS19 Assessing the attitudes to biobanking of patients attending a pigmented lesion clinic and healthcare staff employed in an academic hospital: a quantitative study
Authors: Bowe Stephanie , Quigley Claire , Victory Liana , Yoo Li Jie Helena , Storan Eoin 
Published: June 2024

Abstract
A biobank is a collection of biospecimens or biological samples and corresponding patient data points, which are used for the purposes of medical research. Patient participation and support are imperative to biobank research. We aimed to quantitatively assess the attitudes to biobanking of Irish patients attending a pigmented lesion clinic in an Irish dermatology centre and staff working at an academic teaching hospital. A questionnaire was distributed to healthcare staff working in an academic hospital and members of the Irish Association of Dermatologists via their hospital email address. Patients who attended the pigmented lesion clinic between January and April 2023, and patients who had previously been diagnosed with melanoma between January 2019 and January 2021 were asked to complete the questionnaire. Respondents from a market research company, Bounce Insights, were sent a modified questionnaire via a survey platform. A research grant was obtained from Amgen to incorporate the Bounce Insights market research group. In total there were 426 respondents, with the following ages: &lt; 18 years (31, 7%), 18–35 years (105, 25%), 36–65 years (191, 45%) and &gt; 65 years (99, 23%). There were 166 (39%) male and 260 (61%) female patients. Of the 426 total respondents there were 180 (42%) previous healthcare workers. The number of total participants who were aware of biobanks was 130 (31%), with 283 (66%) replying ‘no’ and 13 (3%) ‘not sure’. Around 20% of participants (84) had donated a biospecimen previously. Healthcare workers reported a positive response in 84% of cases (102), but only 46% (72) of the Bounce marketing respondents felt similarly (P ≤ 0.001). Over 60% of healthcare staff, 16% of all patients and 21% of the Bounce marketing group were aware of biobanks. In total, 83% (352) of all respondents were willing to donate a biospecimen following a medical procedure, but 78% (331) were willing to donate an additional blood sample. That number fell to 57% (242) when respondents were asked if they would donate an additional tissue sample purely for the purposes of research. The number who would encourage a family member to donate a biospecimen was 241 (56.6%, ‘yes’), with 41 (9.6%) replying ‘no’ and 144 (33.8%) ‘not sure’. Interestingly, age was related to individuals’ initial impression of biobanks [χ2 (6, n = 426) = 32, P ≤ 0.001], to a willingness to donate a biospecimen (P = 0.04) and to a desire to be informed if their specimen was disposed of (P ≤ 0.001). In conclusion, in Ireland, the majority of patients, healthcare workers and other members of the public are willing to donate biospecimens for the purposes of research.
DP02 Expression of AMBRA1 and loricrin in the epidermis overlying benign cutaneous naevi, including blue and dysplastic naevi, is similar to that seen in normal skin, but expression may rarely be altered in melanoma in situ
Authors: Husain Akhtar , Lovat Penny , Richardson Grant , Ness Thomas , Jones Claire , Graham Catherine , Labus Marie , Sloan Philip 
Published: June 2024

Abstract
The epidermal expression of AMBRA1 and loricrin overlying primary melanomas has recently been validated as a prognostic biomarker able to identify genuinely low risk nonulcerated American Joint Committee on Cancer stage I/II tumours. We have previously shown that the loss of these biomarkers is due to secretion of transforming growth factor-β2 by the underlying tumour cells, and hypothesize that this mechanism is used by melanomas at risk of metastasis to facilitate premalignant dissemination. The aim of the present study was to evaluate the potential for the combined expression of AMBRA1 and loricrin to characterize a range of melanocytic naevi and melanoma in situ as benign or malignant. Formalin-fixed paraffin-embedded tissue sections were obtained derived from a representative selection of benign naevi and melanoma in situ from the cellular pathology archive of Newcastle upon Tyne Hospitals NHS Foundation Trust. These comprised 5 intradermal naevus, 16 dysplastic naevus (severe/moderate), 5 junctional naevus, 5 compound naevus, 6 common blue naevus, 5 cellular blue naevus, 2 combined naevus, 1 melanocytoma and 26 melanoma in situ. All sections were subjected to automated immunohistochemical analysis for AMBRA1 and loricrin expression. Staining patterns and expression were evaluated using consensus scoring by the study cellular pathologists (A.H., P.S.). All of the benign and dysplastic melanocytic naevi examined showed maintenance of both AMBRA1 and loricrin in the epidermis overlying the lesion, in line with their expression in normal skin. A maintained pattern was also seen in 24 of 26 cases of melanoma in situ, but two cases displayed focal losses of both AMBRA1 and loricrin. On review, both cases showed no evidence of melanoma in further levels and there was no clinical progression. The maintained pattern of AMBRA1 and loricrin was expected in the melanocytic naevi and is consistent with their benign nature. However, loss of expression of AMBRA1 and loricrin in two cases of melanoma in situ was unexpected, suggesting that some cases of melanoma in situ may contain melanocytes with malignant potential. Collectively these data warrant the further investigation of AMBRA1 and loricrin expression in a larger cohort to investigate their potential as biomarkers to distinguish between benign melanocytic lesions and those at risk of malignant progression. This study is funded by the Innovate UK Combined Investor Partnerships Award Round 11 (reference 10083008-1586) awarded to AMLo Biosciences.
DP03 Melanoma detection in whole-slide images using a convolutional neural network for objective prognostic biomarker generation
Authors: Clarke Emily L , Magee Derek , Newton-Bishop Julia , Merchant William , Hall Marlous , Insall Robert , Maher Nigel G , Scolyer Richard A , Farnworth Grace , Ali Anisah , Saldanha Gerald , Bamford Mark , Sitcova Eva , Kujal Petr , O’Shea Sally , Treanor Darren 
Published: June 2024

Abstract
The current melanoma staging system is predictive of 74% of the variance in survival, with prognostic biomarkers subject to high levels of interobserver and intraobserver variation. Melanoma morphology appears to be of greater significance than in other solid tumours, with Breslow thickness remaining the strongest prognostic indicator. The application of convolutional neural networks (CNNs) to whole-slide images (WSIs) may reveal new insights into tumour morphology and therefore patient prognosis. This work outlines the development and evaluation of a CNN for invasive cutaneous melanoma detection in WSIs, to enable the creation of objective prognostic biomarkers based on the tissue morphology. In total, 1157 WSIs containing cutaneous melanoma from five sources have been used in the initial development and evaluation of a custom-designed two-class tumour segmentation network with a fully convolutional architecture. The CNN detected and located invasive melanoma tissue of no specific type with an average per-pixel sensitivity and specificity of 97.6% and 99.9%, respectively across, the five test sets (three external). There were no statistical differences between tumour dimensions generated by the CNN compared with manual annotation. Similarly, there were no statistically significant differences between CNN-generated tumour dimensions across three scanning platforms. Furthermore, we have identified that this CNN can be used to calculate the ‘digital Breslow thickness’, which is a strong independent prognostic predictor of overall survival and melanoma-specific survival, across three test sets with follow-up data (hazard ratio 1.26, 95% confidence interval 1.19–1.34, P &lt; 0.001). We have also shown that the ‘nodularity index’ determined by the tumour shape, independently of size, is predictive of survival; the rounder the tumour the worse the outcome (hazard ratio 0.71, 95% confidence interval 0.60–0.83, P &lt; 0.001). We have developed and performed initial evaluation of a CNN that accurately detects invasive cutaneous melanoma in WSIs, enabling an objective evaluation of tumour morphology. This CNN has afforded the development of the first objective biomarkers based on the tumour’s architectural morphology. The utility of these biomarkers will be further evaluated on WSIs from additional institutions – this work is currently underway.