bluuebunny/crossref_metadata_2025_split huggingface dataset:
DP22 Cutaneous lymphoid hyperplasia: clinicopathological correlation and a therapeutic option
Authors: Alassaf Jehad , Alhyari Ramzi , Khasawneh Hayat , Wahidi Sanaa , Al-Ruhaibeh Maysoon , Abdallat Salah 
Published: June 2023

Abstract
Cutaneous reactive lymphoid hyperplasia, also known as cutaneous pseudolymphoma, is an uncommon entity in which there are skin lesions that histologically, and sometimes clinically, mimic cutaneous lymphoma but are not, both morphologically and immunohistochemically. Correlating clinical, pathological, immunohistochemical and, occasionally, molecular findings is essential for the diagnosis (Romero-Perez D, Blanes Martinez M, Encabo-Duran B. Pseudolinfomas cutaneous. Actas Dermosifiliogr 2016; 107:640–51). Although the majority of cases can be regarded as idiopathic, certain infections and inflammatory conditions can precipitate cutaneous reactive lymphoid hyperplasia, examples of which include Borrelia infection, insect bite reactions and folliculitis (Mitteldorf, C, Kempf, W. Cutaneous pseudolymphoma – a review on the spectrum and a proposal for a new classification. J Cutan Pathol 2020; 47:76–97). The first case was an 18-year-old woman who presented with deep dermal and subcutaneous nodules for the last 5 years that started on her limbs and were slightly itchy. The nodules were firm and deep, with minimal surface changes (hyperpigmentation and adherent scale) but did not ulcerate. She also had nodules involving her buccal mucosa, inner lips and soft tissue in the nasal bridge and a couple of deep nodules on the cheeks. Pathological examination showed a dense lymphocytic infiltrate with plasma cells admixed with other inflammatory cells involving the deep dermis with an extension to the dermal/subcutaneous junction. The pathological picture was in the spectrum of deep tumid lupus/lupus panniculitis overlap and cutaneous lymphoid hyperplasia. Immunohistochemical stains showed a mixture of inflammatory cells with CD3+ and CD20+ cells. Lip mucosal biopsy showed florid reactive lymphoid follicular hyperplasia. Her condition was resistant to multiple systemic treatments. Eventually, she underwent treatment with rituximab and had satisfactory results. The second patient is an elderly female who had multiple erythematous papules, plaques and nodules on her face. Pathological examination showed a dense dermal lymphocytic infiltrate with periadnexal predilection and reactive follicles that also were highlighted by CD20, with Bcl2 and CD3+ cells around germinal centres. She was diagnosed as having cutaneous reactive lymphoid hyperplasia. Topical calcineurin inhibitors were initiated, with a good response. In conclusion, this paper highlights the term cutaneous pseudolymphoma/cutaneous reactive lymphoid hyperplasia, presenting a few cases with clinicopathological correlation and exploring some uncommon treatment options.
DS16 Clinicopathological features of metastatic squamous cell carcinoma treated with Mohs micrographic surgery: a case series
Authors: Stefanovic Nicholas , Cosgrave Niall , Killion Lisa , Ormond Patrick , Moran Benvon , Irvine Alan , Barry Rupert 
Published: June 2023

Abstract
Cutaneous squamous cell carcinoma (cSCC) is a keratinocyte tumour with inherent metastatic potential. Approximately 4% of cSCCs metastasize locoregionally and/or distally. Mohs micrographic surgery (MMS) is efficacious, with cure rates in selected cases of 95–99%. Diagnoses of cSCC treated at St James’s Hospital between the years 2010 and 2019 were identified via histopathology reports. Clinicopathological and treatment data in cases with metastatic disease were collected. Nodal metastasis was defined as biopsy-confirmed cSCC in locoregional lymph nodes and/or supporting radiological evidence. During the timeframe, 3455 cSCCs occurred in 2522 patients. Metastatic disease was identified in 116 patients, with complete data available in 105 cases. Six patients had undergone MMS to the primary tumour. Mean age at time of surgery was 75.6 years (range 65–85); five patients were male. Tumours were located on the cheek (n = 2), ear (n = 2), lower eyelid and nasal tip. Mean time to first metastasis was 6.67 months (range 2–16). Two patients were immunosuppressed at time of metastasis. All patients demonstrated high-risk cSCC features, with four patients demonstrating very-high-risk features as defined by the British Association of Dermatologists. One patient received adjuvant radiotherapy prior to detectable metastasis. All patients were discussed at either skin or head and neck multidisciplinary team (MDT) meetings. No patient received preoperative imaging. This series highlights the importance of risk stratification in cSCC management, irrespective of treatment modality. Consideration should be given to patient age and relative immune status, with dedicated locoregional imaging being guided by MDT discussion.
DS17 Postoperative wound complications following dermatological surgery: an audit leading to improved clinical practice, patient outcomes and informed consent
Authors: Kennedy Jake , Potluru Aparna , Farled Maria , Jones Ruth , Rice Shantini 
Published: June 2023

Abstract
In 2021, an apparent spike in wound complications presenting to our dressings clinic prompted a prospective audit of complications following dermatological surgery. The aim was to quantify the rate of and identify risk factors leading to postdermatological surgery complications for clinical governance and to improve clinical practice and patient outcomes. Secondary outcomes were to provide operators with individual annual complication rates. A further outcome pertinent to the Montgomery ruling was to use the data to refine preoperative patient information with precise detail on risk prior to surgery. Patients undergoing a dermatological surgery procedure between 1 April 2021 and 31 December 2022 across three hospital sites were included in this audit. Prospective data were collected via a departmental surgical complications proforma, supplemented by collating retrospective data from nurse-led wound review clinics via our electronic patient record system. Data were gathered on patient age and sex; operator grade; presenting problem (pain/dehiscence/infection/bleeding/other); surgical site; route of referral; microbacterial swab, cultured organism, antibiotic prescribing; anticoagulation; type of procedure; suture type; days to suture removal; and provision of pre- and postoperative patient information on skin surgery. Over a 21-month period &gt; 11 000 procedures were performed, with a median of 574 procedures per month. In total, 256 patients reported 331 complications: 124 were suspected infections (37.5%); 63 were reports of pain (19.0%), 62 of bleeding (18.7%) and 52 of dehiscence (15.7%); and 30 (9.1%) were other complications such as graft failure. Surprisingly, the majority of complications (41%) occurred on the head and neck. Of patients presenting with bleeding, most were not taking prescribed anticoagulants. Seventy-two per cent of positive swabs grew Staphylococcus aureus. In 2019, the British Association of Dermatologists (BAD) performed a national audit of process, based on measures of quality in a dermatology skin surgery service. Sixty-four per cent of 201 respondents from the BAD and British Association of Dermatological Surgery reported no formal mechanism for determining wound complications following skin surgery (https://cdn.bad.org.uk/uploads/2022/02/29200022/Skin-Surgery-National-Audit-Report-2019.pdf). In our experience, using a departmental proforma has enabled quantification of departmental postoperative complication rates against anatomical site, procedure, patient factors and level of operator, improving clinical practice, governance, informed consent and patient outcomes. It is hoped that our work might usefully contribute to the development of a national proforma for collating data on wound complications, which has wider implications for maintaining high standards of dermatological surgery practice across the UK.
DS18 Efficacy of intralesional sodium tetradecyl sulfate in pyogenic granuloma
Authors: Mathachan Sinu 
Published: June 2023

Abstract
Data on sclerotherapy in pyogenic granuloma (PG) are sparse and limited to a few case reports and series (Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol 2019; 58:642–8). We present a series of 18 patients with PG treated with intralesional sodium tetradecyl sulphate (STDS). The aim of this study was to evaluate the efficacy, safety and recurrence rates of STDS sclerotherapy in the treatment of PG. Eighteen patients with PG (based on history and clinical features) of any age consenting to be part of the trial were included. Intralesional STDS 1% was injected slowly using an insulin syringe until the lesion blanched, and a maximum of 1 mL was used in one sitting. Patients were followed-up weekly; if the lesion did not show complete resolution, repeat injections were given up to a maximum of three sittings. A final assessment for relapses was done at 4, 8 and 16 weeks after treatment completion. All patients had complete clearance (100%) of the lesions with STDS 1% in one or two sittings. Noted side-effects included pain (n = 6), oedema (n = 4), purpuric staining (n = 2), paraesthesia (n = 1), ulceration (n = 2), necrosis (n = 2) and urticarial rash (n = 1). All side-effects resolved completely; two patients had to take analgesics and oral antibiotics. No bleeding episodes occurred in any patient after the first sitting. Further, none has shown recurrence over a follow-up period of 4 months. Eight patients developed mild atrophic scars as post-treatment sequelae. Sclerotherapy is a simple procedure; however, surprisingly, the literature on its use in PG, a very suitable indication for sclerotherapy by virtue of the pathology involved, is sparse. In this study, STDS successfully cleared the lesions in all patients without major complications or recurrence.
DS24 Prospective study comparing ex vivo confocal laser scanning microscopy and frozen section histopathology of 23 basal cell carcinomas treated with Mohs micrographic surgery
Authors: Demirel Sibel , Hill Rachel , Fleming Colin , Khalid Amina 
Published: June 2023

Abstract
Ex vivo confocal laser scanning microscopy (CLSM) is an emerging technique that is used for the rapid analysis of freshly excised tissue during Mohs micrographic surgery (MMS). Previous studies on fluorescence CLSM have shown 88% and 99% sensitivity and specificity, respectively, of diagnosing basal cell carcinomas (BCCs) vs. conventional histology. The fourth-generation Vivascope 2500 allows fresh tissue to be scanned after minimal preparation with acetic acid and acridine orange, creating digitally coloured mosaic images, mimicking conventional histological haematoxylin and eosin slides. The scanning speed of &lt; 3 min creates the potential to improve patient experiences, allowing multiple stages and repair in a single session, reducing overall operating times and improving efficiency. After a 2018 pilot study on a limited case series, we have begun the process of testing the real-world use of this technology. We present an initial prospective case series to assess BCC excision of stage 1 Mohs specimens using the Vivascope 2500 vs. conventional frozen section histology. Caldicot approval was sought. Over a 3-month period, 23 cases of stage 1 facial BCCs on one Mohs list were processed. Samples were obtained as standard bevelled Mohs excisions, and Mohs maps were created for all cases. There were three false-negative BCCs, of which two were infiltrative BCCs with small foci missed on the initial review on CLSM images and one superficial BCC not visible due to lack of epidermal capture. Of the four false-positive cases, the foci appearing to be BCC included inflammation in one, follicular structures in two and conjunctival glands misinterpreted as BCC in one eyelid case. Time taken to process specimens and read the digital images by CLSM was compared with the time taken to obtain and read frozen section slides. The shortest time recorded for CLSM and frozen sections was 6 min and 31 min, respectively. The longest time recorded for CLSM and frozen sections was 20 min and 57 min, respectively. In summary, CLSM shows promise in MMS for selected BCCs. Improved techniques to flatten the epidermis for better visualization and further experience with image reading and interpretation have the potential to minimize errors.
DE07 Enhancing social media engagement for Clinical and Experimental Dermatology: the educational journal of the British Association of Dermatologists: a quality improvement project
Authors: Li Danning , Charalambides Maria , Patel Chandn , Hutton Emelie , Shipman Alexa 
Published: June 2023

Abstract
Social media is an efficient method for direct communication between a journal, clinicians and patients. Increased social media engagement also increases the impact factor of medical journals (O’Kelly F, Nason GJ, Manecksha RP et al. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology. J Pediatr Urol 2017; 13:513). The aim of this quality improvement project was to assess the impact of three interventions on social media success (defined as reach, engagement or follower count) of the Clinical and Experimental Dermatology Instagram page (@ced_journal), founded in July 2020. Impact on reach, engagement and follower count was investigated after each intervention cycle. Cycle 1 (April–June 2022) investigated the impact of a checkerboard grid design to increase visual appeal, standardized journal branding and a consistent posting schedule. User analytics revealed a large proportion of Middle Eastern followers, and, therefore, cycle 2 (July–October 2022) used non-English hashtags to target these audiences. Cycle 3 (November–December 2022) investigated the boost in engagement through encouraging authors who had recently published in the journal to post their publication on their personal accounts and tag the journal. Qualitative data were gathered from the Meta Business Suite and directly from the Instagram page. Data were analysed using GraphPad. Cycle 1 resulted in mean increases in content reach by 568% (P &lt; 0.001), unique profile visits by 281% (P = 0.014) and number of new followers by 642% (P = 0.188). Cycle 2 demonstrated a mean increase in the number of new followers by 194% (P = 0.025) but did not significantly increase the reach (P = 0.414) or number of new profile visits (P = 0.410). There was no significant increase in reach (P = 0.229), unique profile visits (P = 0.055) or number of new followers (P = 0.397) in cycle 3. This study demonstrates improvements in social media success following cycles 1 and 2. Cycle 3 results emphasize the importance of novel interventions in further varying content to maintain and further increase engagement, as well as studying additional factors that influence engagement, such as standardized journal branding across all social media platforms. Overall, this study emphasizes the effectiveness of innovative and interactive education resources for disseminating dermatology research among scientific and nonscientific users, which can be adopted by other dermatology journals.
H07 Papyri and sarcophagi: a tour of dermatology in Ancient Egypt
Authors: Zaki Faaris 
Published: June 2023

Abstract
Long before medicine was demystified by the Renaissance, Enlightenment and modern thinkers with whom we are most familiar, the skin and its diseases were pondered on by the Ancient Egyptians. Through their writings and remains, modern scholars are able to assemble a picture of what dermatological conditions ailed the Egyptians and how they were contemporaneously perceived. The Ebers Papyrus (c. 1550 Bc), the largest record of Ancient Egyptian medicine, is noted for its vivid descriptions of lesions and grisly details of treatments. Some of the conditions mentioned therein are straightforwardly identified from their descriptions, whereas others are open to interpretation. Recent DNA evidence has also shed light on this topic, causing scholars to re-evaluate the presence of various conditions, such as leprosy and tuberculosis, in different parts of the ancient world. The Egyptians are perhaps most famed for the preservation of bodies through the process of mummification, which provides us with a unique glimpse into the nature of skin disease in the ancient world. Mummified skin tends to be shrunken, deeply pigmented and brittle. Even so, nails, hair and epidermal ridging are preserved. Prolonged rehydration and staining can reveal the stratum corneum, keratinocytes, melanin, collagen and elastic fibres, along with adnexal structures and subcutaneous tissue. Mummies with identifiable dermatological disease include Ramses V (d. 1145 Bc), whose face, neck, shoulders, lower abdomen and scrotum bear the marks of smallpox. The diagnosis was later confirmed by electron microscopy, which identified the variola viral corpuscle in his skin. Skin tumours have also been found in mummified remains, as have syndromic features of diseases, which predispose to multiple dermatological malignancies, such as Gorlin–Goltz syndrome, which is suspected in two fraternal mummies from around 3000 Bc. One specimen from c. 1300 Bc was identified as having a venous ulcer, which was subsequently confirmed when histology demonstrated perivascular haemosiderin deposition. Other tentative diagnoses have been made on appearance alone, including pustular dermatosis, impetigo and pemphigus foliaceus. Too often do we perceive medical history as starting in earnest during the last few centuries. The Ancient Egyptians have bequeathed to us a wealth of information, both historical and archaeological, which, combined with modern techniques, has allowed us to peer through the millennia into a dermatological world that can feel simultaneously alien and familiar. This presentation/poster will showcase what we understand of this world and what future research might hold in store.
H13 Leprosy and psoriasis: a heated controversy
Authors: Sarfraz Rabia , Butt Eman 
Published: June 2023

Abstract
In the Old Testament, the term ‘Lepra’ was used to describe many skin diseases, including psoriasis, eczema, vitiligo, alopecia areata and boils. The word ‘leprosy’ was derived from this and was previously used as a generic term that included multiple inflammatory dermatological diseases. It was a disorder of great religious significance during ancient times, with intense stigmatization—‘lepers’ were pronounced unclean by priests. Hippocrates (460–377 Bc), the Greek ‘father of medicine’, can be credited with being the first to separate medicine from religious superstition. However, there was little differentiation between leprosy and psoriasis, two distinct diseases we know today. He used the word ‘psora’ to describe itch, and ‘lopoi’ to describe the dry and scaly features of skin conditions, thus continuing the confusion between leprosy and psoriasis. The failure to differentiate psoriasis as its own clinical entity from leprosy meant that for many centuries, patients with psoriasis also suffered the same cruel fate as those with leprosy in society. Those suffering from leprosy were wrongly believed to be highly contagious and were forced to carry a bell or clapper to announce their approach to those who were considered healthy. They were required to wear distinctive clothing so that they were easy to recognize by the public, and were not permitted to talk to or even touch a healthy person. They were outcast in society and could only mix with other ‘lepers’. In 1313, Philip the Fair of France horrifically ordered all those outcasts to be burned at the stake. In 1809, Robert Willan (1757–1812), an English doctor, marvellously developed a simple classification of skin diseases that offered a clear description of the different types of psoriasis. This was a crucial milestone in the recognition of psoriasis as a separate skin disease from leprosy. However, while he was the first person to describe psoriasis as a separate condition, he failed to eliminate leprosy completely as an associated disease. He used the term ‘lepra vulgaris’ to discuss modern psoriasis, which once again further perpetuated the confusion between psoriasis and leprosy. Ultimately, it was Ferdinand von Hebra (1816–1880), an Austrian physician, who permanently shed the term ‘lepra’ from the description of psoriasis in the 1800s, finally allowing the two diseases to be separate.
H17 Traditional medicine: a warts-and-all tale
Authors: Murphy Lisa , Tobin Anne-Marie 
Published: June 2023

Abstract
A viral wart is a common benign lesion caused by infection with human papillomavirus. They typically present in children; however, they are also often seen in adults, particularly in immunosuppressed patients. Modern treatments for viral warts include cryotherapy, cantharone, cautery and curettage, and topical chemotherapeutic agents. However, historically, a variety of methods were employed to treat viral warts: animal-based, plant-based, mineral-based and magicoreligious. These can be further categorized based on the principles of chance and transference (Barron C, Soverino T. Snails, water in a stone, and Holy Wells: an examination of wart cures from the Irish Schools’ Folklore Collection, 1937–38. Folklore 2020; 131:386–412). One popular method that combined both the principles of chance and transference involved finding a snail by chance and then rubbing it on the warts, and skewering the snail to kill it. The concept behind this method was that the warts would be transferred to the snails and then the warts would subsequently decay with them. Another animal-based cure involved stealing a piece of meat, usually bacon, and rubbing the meat into the wart before burying the meat. In terms of mineral-based cures, there were many popular methods. The most commonly encountered treatments included holy water, forge water (often from a blacksmith), water from a stone or ‘wart rocks’. People would also attend ‘wart wells’ and make offerings of stones. The use of water was the most widespread mineral-based cure. Plant-based cures were also prevalent, with the milk of a dandelion, the juice of a potato, rushes and straw being just a few examples. Plant-based cures were often combined with aspects of religion. One cure involved cutting a potato in two, and rubbing the cut part to the wart in the name of the Father, Son and Holy Spirit. The potato was then put away in an old wall; when it shrivelled up, it was believed the wart would disappear. There were also ritualistic methods. Certain healers could perform prayers, and it was believed that when a funeral would pass, one should lift clay three times from under the right foot and rub it on the warts. They would then need to throw it away after the funeral. As the corpse wasted away, the warts would decay, too. While the natural trajectory was that these warts would have self-resolved irrespective of the cures used, our ancestors were proactive and employed many different methods to treat this common ailment.