bluuebunny/crossref_metadata_2025_split huggingface dataset:
DP19 Two patients with Kaposi sarcoma from the 2-week-wait clinic
Authors: Nocivin Irina , Babakinejad Parastoo , Hoque Shamali , Anand Rakesh , Giles Andrew , Morris Steven 
Published: June 2023

Abstract
We present two cases of Kaposi sarcoma (KS) in HIV-negative men who have sex with men (MSM) with no coexisting immunosuppressive treatment or conditions. They both presented with suspicious lesions on lower extremities, with no other mucocutaneous involvement. The initial clinical presentation of both patients was atypical, with uncharacteristic aspects of lesions on clinical examination and dermoscopy, which prompted further investigations. Skin biopsies were performed for both patients. Both cases had similar histological findings in keeping with KS: slit-like vascular spaces within the dermis, proliferation of capillary blood vessels with associated inflammatory infiltrate with lymphocytes and plasma cells and focal aggregates of spindle cells. Immunohistochemistry revealed endothelial cells displaying positive staining for human herpesvirus (HHV)-8. Immunodeficiency screening revealed no abnormalities, and repeat HIV screening was negative in both patients. These cases present an interesting occurrence of an increasingly encountered new subtype of KS seen in HIV-seronegative immunocompetent MSM. In addition to the four established variants of KS, this is an emerging variant that arises mostly in middle-aged MSM. HHV-8 has been identified as the aetiological agent in KS; indeed, the viral infection precedes the development of the disease. The fifth subtype is increasingly recognized: nonepidemic KS in MSM who are HIV-negative and have no other causes for immunodeficiency, as seen in our two cases. This subtype has been reported in the literature since the 1980s in this specific population. The clinical presentation resembles classic KS, with predominantly cutaneous involvement of the lower limbs, running a similar indolent course. There is a strong connection between HHV-8 infection and the development of KS; however, in countries where there is a low prevalence of the virus, in the general population, there is increased detection in the MSM group. Correlating the high detection rate of HHV-8 in MSM with its role in the development in KS, immunocompetent MSM are at risk of developing the condition. However, this subtype carries an overall good prognosis, with an indolent course and good response to similar therapeutic options used in the classic subtype.
DS11 A double-blinded randomized control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid
Authors: Goyal Aman , Mehta Hitaishi , Narang Tarun , Vinay K , Dogra Sunil 
Published: June 2023

Abstract
Intralesional steroids are the first line of treatment for keloids, and intralesional vitamin D has shown promise in the management of keloids in a few small studies. The aim was to compare the efficacy and safety of intralesional vitamin D with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors (VDRs) in the treatment of keloids. Sixty patients were randomly divided into two groups in 1 : 1 ratio. Patients in group A received intralesional vitamin D (200 000 IU, dose 0.2 mL cm−2); those in group B received intralesional triamcinolone acetonide (20 mg mL−1, dose 0.1 mL cm−2). Four monthly injections were given, and the patients were followed-up for a further 24 weeks. The Vancouver Scar Scale (VSS) was used for keloid evaluation. Pre- and post-treatment biopsies of 20 patients from both groups were taken to assess the correlation between the expression of VDR receptor levels before and after treatment. The mean VSS scores of patients in both groups were statistically significantly reduced over the course of the follow-up (P &lt; 0.001). Mean (SD) reduction in VSS at the end of treatment period was 5.17 (0.59) in patients in group A and 4.77 (0.77) in those in group B. The proportion of the patients showing &gt; 50% reduction in VSS score was higher in patients in group B vs. those in group A (77% vs. 50%; P = 0.032). Rates of recurrence were comparable between the two groups (P = 0.51). Hypopigmentation (80% vs. 37%; P &lt; 0.001) and atrophy (73% vs. 40%; P = 0.009) were more common in patients in group B than in those in group A. There was no significant difference in pre- and post-treatment values of tissue VDR expression in either group. Both triamcinolone and vitamin D are effective in the management of keloids. Although the reduction in VSS score was higher with corticosteroids than vitamin D, an intralesional injection of vitamin D had lower incidence of adverse effects such as atrophy and hypopigmentation.
DS13 A comparative study between recipient site preparation using manual dermabrasion and tattooing pen in autologous noncultured epidermal cell suspension procedure in stable vitiligo patients: a randomized double blinded study
Authors: Meena Akshay , Parsad Davinder , Sendhil Kumaran M , Vinay K 
Published: June 2023

Abstract
Vitiligo is a common acquired disorder of depigmentation that occurs as a result of melanocyte loss. Surgical therapies are indicated in patients with stable disease who fail to respond to medical therapies. This mostly includes autologous grafting techniques both tissue and cellular (both cultured and noncultured). Common techniques of recipient site preparation include dermabrasion, suction blistering, liquid nitrogen, electrofulguration and microneedling. The aim was to assess the difference in extent of repigmentation with manual dermabrasion and tattooing pen in a noncultured epidermal cell suspension on stable vitiligo patches. This was a prospective intraindividual comparative study. Thirty-six patients with stable vitiligo were recruited. Patients had a clinical diagnosis of segmental or nonsegmental vitiligo and had two independent patches of 3 × 3 cm or more present either symmetrically or unilaterally over the same body site or a single patch of 6 × 6 cm or more. Vitiligo lesions had been stable for ≥ 1 year. At week 24, the proportion of patients achieving &gt; 75% repigmentation with manual dermabrasion was 86%. In contrast, 61% of patients in the tattooing pen group achieved &gt; 75% repigmentation. At week 24, the proportion of patients achieving &gt; 50% repigmentation with manual dermabrasion was 89% vs. 72% of patients in the tattooing pen group. Eighty per cent of patches at acral sites in patients in the manual dermabrasion group achieved &gt; 75% repigmentation vs. 94% in nonacral patches, whereas in the tattooing pen group, 47% of patches at acral sites achieved &gt; 75% repigmentation vs. 73.3% in nonacral patches. In terms of colour matching, at 24 weeks, good colour matching with the surrounding normal skin was obtained in 80% of patches in both groups. There was a significant difference in efficacy between the two methods in favour of manual dermabrasion. Tattooing pen for melanocyte delivery has the advantage over manual dermabrasion in that it is less time consuming and also reduces cell loss. Recipient site preparation by manual dermabrasion showed a higher rate of infection vs. the tattooing pen at 4 weeks (25% vs. 6%). Recipient site preparation in terms of colour matching and halo phenomena was comparable in both the groups, with no significant difference seen. Patient satisfaction in terms of physician global assessment score and Vitiligo Quality of Life index (VitiQoL) was comparable for both methods, with no significant difference seen.
DS15 Metastatic cutaneous squamous cell carcinoma: how best to develop a skin cancer service for future populations
Authors: Rafferty Siobhan , Goh Alicia , Griffin Laoise , Tierney Emma , Ahmad Kashif 
Published: June 2023

Abstract
The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing in the White population. Despite a favourable prognosis in the majority, it remains a cause of morbidity and mortality, especially in immunosuppressed and elderly individuals. Large cSCCs can be challenging for surgical clearance, recurrence and metastatic disease, despite guidelines for the management and staging of cSCC. We sought to identify high-risk features of those who develop metastatic disease. Our centre typically manages 300 cSCCs annually, but only cSCCs discussed at our two multidisciplinary team (MDT) meetings (head and neck and skin cancer) at our level 4 hospital over a 3-year period (2019–2021) were included in a retrospective observational study. A total of 124 patients with high-risk cSCC (due to patient or tumour factors) were included. Male sex predominated. Sixteen cases had metastatic disease. Median age at diagnosis was 80 years in the total MDT group and 86.5 years in the metastasis group. Of 16 patients with metastases, eight had complete primary excisions. Five cases had incomplete primary excision (peripheral or deep margins involved), and three cases had a narrow margin of &lt; 1 mm. Primary tumour size was similar in both the MDT and metastasis groups (median size 17 vs. 20 mm). Head and neck sites predominated in both (88%). In the metastatic group, one had chronic lymphocytic leukaemia, but no other patients with immunosuppression were identified, and the majority (81%) suffered with multimorbidity (≥ 2 chronic illnesses). Nine patients with metastatic cSCC received radiotherapy, two systemic chemotherapies, five neck dissections and one immunotherapy. Most patients presenting with metastatic cSCC at our centre were &gt; 85 years old, a group sometimes known as ‘the oldest old’, and many had multimorbidity. This, coupled with tumour location, poses challenges for healthcare professionals in managing the initial cSCC aggressively and implementing a reasonable follow-up and surveillance schedule. In comparing both groups, advanced age was the predominant difference, with twice as many aged &gt; 85 years in the metastasis group vs. the MDT group. Immunosenescence is a process of immune dysfunction that occurs with age and includes remodelling of lymphoid organs, leading to changes in the immune function of the elderly and relates to the development of malignant tumours. It is estimated that 5 million people in the UK will be in this age group by 2050 (www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health–wellbeing/rb_feb13_understanding_the_oldest_old_improving_later_life.pdf). There is a need to continue to consider this dynamic group (those aged &gt; 85 years) and those with multimorbidity when strategies for the projected management of cSCC are being considered.
DS20 Longevity of patients following Mohs micrographic surgery for the treatment of basal cell carcinomas
Authors: Raahimi Mina M , Bonnick James , Stoneham Sophie , Keohane Stephen 
Published: June 2023

Abstract
Basal cell carcinomas (BCCs) are slow-growing, nonaggressive skin cancers (metastatic rate &lt; 0.1%). They are common, especially in the elderly population (Sreekantaswamy S, Endo J, Chen A et al. Aging and the treatment of basal cell carcinoma. Clin Dermatol 2019; 37:373–8). Basal cell carcinoma guidelines recommend Mohs micrographic surgery (MMS) for primary high-risk BCCs and high-risk recurrent BCCs suitable for surgery (Mosterd K, Krekels GA, Nieman FH et al. Surgical excision vs. Mohs’ micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years’ follow-up. Lancet Oncol 2008; 9:1149–56). Mohs micrographic surgery allows for the removal of the tumour in stages with rapid processing of specimens using frozen section analysis. Complete surgical margins are analysed in near real time. It has, compared with other treatments, lower recurrence rates (&lt; 1%) and often better cosmetic outcomes, but it has higher costs and longer operating times (Sreekantaswamy et al.; Mosterd et al.). Factors that need to be considered when deciding on treatment options are comorbidities, performance status and the risk of causing harm if left untreated. The term ‘lag time to benefit’ entails not only looking at how effective a specific treatment is, but also when a treatment will become beneficial in relation to the patient’s life expectancy (Sreekantaswamy et al.). In patients with a limited life expectancy, nonsurgical treatment can be an appropriate and possibly even the preferred choice (Sreekantaswamy et al.). A retrospective single-centre review of all available BCC MMS patient data from January 2011 to December 2017 was performed. Patients from out of area or with tumour syndromes were excluded. Survival rates following MMS were recorded. Of the 2518 patients reviewed, 1905 met the inclusion criteria. In total, 357 (18.7%) were aged ≥ 80 years; at 5 years post-MMS, 24% and 30.7% of the 80–89-year-old females and males had died, respectively, suggesting they had a higher life expectancy than the same general demographic. It would be interesting to compare these results with survival rates following other treatments, such as conventional excision or curettage and cautery. Limitations include missing documentation (n = 258) and not all internal logs being tracked appropriately (19.6% were not tracked, n = 615/3133). We propose a patient-centred, tailored approach to the treatment of BCCs. Based on the fundamental ethical principles, informed and effective shared decision-making is vital; patient values, preferences and experiences should also be considered.
DS22 Pregnancy-associated melanoma: a case series
Authors: Lawlor Kate , Hadjieconomou Sofia , Katugampola Ruwani , Mills Caroline , Li Vincent , Rajan Suchitra 
Published: June 2023

Abstract
There are currently no guidelines in the UK regarding the management of pregnancy-associated melanoma (PAM). It is estimated that one-third of women diagnosed with melanoma are of child-bearing age and numbers are rising (Still R, Brennecke S. Melanoma in pregnancy. Obstet Med 2017; 10:107–12). A recent survey of all dermatologists in our region revealed five cases of PAM. We await the results of a similar survey disseminated to all UK dermatologists. Case 1 was a 22-year-old woman of 16 weeks’ gestation who presented with a 6-week history of a changing mole on her face. Histology confirmed a nodular malignant melanoma [Breslow thickness (BT) 3.5 mm]. A healthy baby was born at full term. Case 2 was a 36-year-old nulliparous woman who presented with a changing lesion on her right calf. Histology confirmed a malignant melanoma (BT 3.6 mm). At the 2-week follow-up, she was 4 weeks pregnant. A healthy baby was born at 38 weeks. Case 3 was a 33-year-old nulliparous woman who had a superficial spreading malignant melanoma (BT 2 mm) excised from her left scapula. Twenty-three months after this diagnosis, pulmonary metastases were evident on computed tomography (CT). Three months later, she became pregnant. A healthy baby was born at term. Case 4 was a 30-year-old nulliparous woman who had a malignant melanoma (BT 3 mm) excised from her right scapula. A sentinel lymph node biopsy (SLNB) was negative, and staging CT showed no evidence of metastatic disease. She received a course of interferon treatment. Three years after initial presentation, at 24 weeks’ gestation, she developed a painful swelling on her right axilla that was confirmed to be metastatic melanoma. A healthy baby was born at 35 weeks. Case 5 was a 27-year-old woman who had a melanocytic lesion that was shave excised by her general practitioner. Subsequent excision confirmed superficial spreading malignant melanoma (BT 1.5 mm, stage 1B). At the time of wide local excision and SLNB 1 month later, the patient was 6/40 gestation. Sentinel lymph node biopsy was negative so no further staging scans were required. A healthy baby was born at term. There are conflicting data on whether PAM carries a poorer prognosis than equivalent disease in nonpregnant women. However, melanoma is one of several cancers that can metastasize to the placenta. Therefore, a diagnosis of PAM complicates decisions regarding staging and treatment (Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166:240–53).
DE05 Designing and implementing dermatology procedural video education for trainees
Authors: Bui Justin , Aziz Sally , McGrath Conn , Connolly Aveen , Aleksyeyenko Serhiy , Jackson Karina , Moorhead Lucy , Radia Bhaveet , Samperi Marcus , Pink Andrew , Smith Catherine , Sears Alison , Patalay Rakesh , Mahil Satveer 
Published: June 2023

Abstract
Surgical exposure can be varied during specialty training in dermatology. During the COVID-19 pandemic, this was compounded by the reduction in face-to-face teaching, adding a further barrier for trainees trying to access practical skills training. We sought to enable uniform, accessible and inclusive teaching of common biopsy techniques to improve the confidence and proficiency of dermatology trainees in performing these procedures, through a virtual self-directed format. We produced a series of concise educational videos detailing the biopsy consent process and instructional videos on techniques for punch biopsy, shave biopsy, incisional biopsy and simple excisions. Each video was ∼10 min in length with demonstration of the technique on porcine skin in real-time and step-by-step narration. The videos were developed according to up-to-date recommendations of best practice, including those from the British Society of Dermatological Surgery. We used multidisciplinary expert input from Mohs surgeons, specialist nurse practitioners, dermatopathologists, clinicians with expertise in medical education, learning innovation advisors and media experts. We highlighted important learning points for trainees during the videos such as common biopsy indications and complications, practical pitfalls and techniques to enhance biopsy efficiency, diagnostic yield and cosmetic outcome. Our educational videos were launched initially at a large teaching hospital in the UK and watched by 25 dermatology trainees, with plans for upcoming open-access via our education website. The effectiveness of our learning material was evaluated through a preintervention survey of trainees to gauge prior exposure to dermatology surgery, followed by a postintervention survey. We found evidence of a lack of exposure to procedural dermatology among trainees in the preintervention survey, with improvements in trainee confidence reported following the educational videos. Delivering procedural videos through an accessible online resource is beneficial for dermatology trainees and allied healthcare professionals performing biopsies and diversifies the modality of procedural dermatology education. An online video format provides self-directed education that has flexibility and enables repeated access to reinforce learning, which complements and enhances in-person practical teaching.
GD01 (P25) Considering the burden of scabies alongside a mass drug administration treatment programme in an indigenous community in northern Australia
Authors: Cox Victoria , Dowden Michelle , Williams Crystal , Engelman Daniel , Yan Jennifer , Ralph Anna , Currie Bart , Francis Joshua 
Published: June 2023

Abstract
Scabies is estimated to affect 455 million people worldwide and is one of 20 neglected tropical diseases recognized by the World Health Organization (WHO). It is caused by a parasitic mite infestation that is hyperendemic in low-resource regions, and the disease burden in northern Australia is believed to be among the highest in the world. However, few recent prevalence assessments have been conducted in northern Australia and it is not known whether historical assessments are still representative of the disease burden. Therefore, it is difficult to advocate for the allocation of government funding and resources without accurate information on the burden of disease. Considering the effectiveness of an ivermectin-based mass drug administration (MDA) treatment programme in northern Australia is important to explore a control strategy, following successful large trials conducted in the Pacific and recommendations from the WHO. The aim was to consider the burden of scabies and other skin conditions in an indigenous community in northern Australia, from undertaking a simplified skin assessment of all consenting community residents. An observational cross-sectional study design was used for this purpose. Five field teams covered different regions in Maningrida. The teams were comprised of a medical practitioner from the investigative team who worked alongside a local healthcare worker and an Aboriginal healthcare worker. All community residents who gave verbal consent were administered ivermectin, or topical permethrin cream if ivermectin was contraindicated, as part of a MDA programme, which was locally developed and implemented by the Mala’la Health Service. Simplified skin examinations (n = 1306) were conducted in Maningrida during Healthy Skin Week from 14 to 18 November 2022, with verbal consent from 99% of community residents approached for recruitment to undergo a simplified skin assessment and administration of ivermectin as part of the MDA treatment programme. The point prevalence for scabies was 25.2% (330 individuals). Ninety-three people (7.1%) were diagnosed with impetigo, and ∼40% of community residents had evidence of skin disease. No study participants were diagnosed with crusted scabies. Scabies is endemic in indigenous communities in northern Australia. This was the first prevalence assessment to be conducted in the Northern Territory since the East Arnhem Healthy Skin Project, which concluded in 2007, and the first MDA treatment programme conducted by an aboriginal medical service as a local health intervention. The consideration of effective rapid mapping and regional control strategies is essential to tailor a public health response that addresses the high burden of skin disease in northern Australia.