bluuebunny/crossref_metadata_2025_split huggingface dataset:
DS21 Patients’ experience with one-stop skin cancer clinics
Authors: Lam Mun Wai , Jerrom Richard 
Published: June 2023

Abstract
Dermatological surgery has been well integrated into the daily work of a dermatologist, especially in the management of skin cancers. Therefore, dermatologists have to be well prepared to consent patients for their respective surgical procedures. Consent is a medicolegal and ethical requirement prior to any procedure. The General Medical Council has produced guidance outlining seven principles of decision-making and consent. With increasing referrals of suspected skin cancers to secondary care dermatology, it is increasingly common for one-stop clinics to be introduced to tackle the sheer volume—clinics where patients are seen and treated on the same day. There are concerns that such models can diminish patient understanding and the validity of consent. Mr Justice Kearns of the Supreme Court of Ireland stated: ‘As a general principle of good practice, if the treatment is not urgent, patients should be given plenty of time to think about their options before they consent to treatment and be encouraged to ask further questions’. Our department has recently introduced a one-stop skin cancer clinic, and we have conducted a survey to compare patient experiences in those who had same-day skin surgery and those who had a prebooked surgical appointment. The data were collected over a period of 3 months with a total of 80 respondents. All respondents expressed that they had complete understanding of their procedures, 23 of whom had same-day surgery. All 23 respondents who had same-day surgery were comfortable to have same-day surgery, with only six expressing that they felt anxious. When asked if the respondents preferred to have same-day surgery or surgery on other days, 21 of 23 respondents who had same-day surgery preferred to have it on the same day, whereas 34 of 57 of the respondents who had different-day surgery would rather have their surgery on the same day. A total of 69% preferred to have same-day surgery, with three expressing no preference. Our findings reveal that the majority of the respondents preferred to have their procedures on the same day as their clinic consultation and all expressed an adequate understanding of their procedure and felt that they have been given sufficient time to understand and weigh up their options. This suggests that patients have adequate understanding of their procedures, despite being consented and treated on the same day, while also improving their patient experience in a busy department.
DS23 Efficiency and performance of slide stainers during Mohs frozen section processing
Authors: Salence Brogan Kelly , Shams Mohammad , Sounthararajah Peter , Mallipeddi Raj 
Published: June 2023

Abstract
Mohs micrographic surgery (MMS) relies on good-quality, well-stained frozen sections for effective histological analysis. Slides should also be produced as quickly as possible. Automation of complementary devices in the laboratory ensures standardization and efficiency and improves the overall quality of performance. Our study evaluated the efficiency and performance of the Autostainer-XL (Leica) vs. the Linistat (Thermo Scientific) slide stainer within a busy MMS unit. The Autostainer-XL rapidly dries, loads and unloads slides automatically allowing the Mohs-trained biomedical scientist (BMS) to work in parallel on cryotomy. The Autostainer-XL stains slides with haematoxylin and eosin within 10 min and 50 s. In comparison, the Linistat was much slower and required the Mohs-trained BMS to fix the slides manually on a hotplate, place them in industrial methylated spirit, wash them in water and load individual slides into the Linistat, taking 16 min and 45 s to complete the staining process. Two blinded assessors retrospectively reviewed the same set of 50 Linistat-stained and 50 Autostainer-XL stained frozen section slides for consistency in staining. The scoring criteria were based on the modified UK National External Quality Assessment Service (NEQAS) Cellular Pathology Technique Mohs scheme assessment criteria. Each assessor allocated scores between 1 and 5 based on the scoring criteria. The mean quality scores were significantly higher for the Autostainer-XL compared with the Linistat (P &lt; 0.05). In our MMS unit, up to 12 patients undergo MMS daily with an average of seven slides required per patient at the first stage, leading to a high processing burden within the Mohs laboratory, particularly at the first stage. The Autostainer-XL increased productivity, with the ability to load 30 slides per rack, while the Linistat was only able to load six slides per rack. In practice, within our MMS unit, the Autostainer-XL reduced the time taken to produce all slides at the first layer by more than 1 h when compared with the Linistat slide stainer. When surveyed, 100% (n = 8/8) of Mohs-trained BMS in the laboratory preferred the Autostainer-XL than the Linistat, with comments suggesting that it was easy to use, quick, precise and an important device that can withstand the demands of a busy Mohs laboratory. The Autostainer-XL offers improved efficiency and performance, with reduced staining times, an ability to process a larger number of slides and fully customisable automation when compared with the Linistat (Thermo Scientific) slide stainer.
DS26 Review of 2-week suspected skin cancer activity shows a large increase in number of patients with basal cell carcinoma: implications for designing services and workforce planning
Authors: Schofield Julia , Scharrer Krisztina , Millbank Kimberley 
Published: June 2023

Abstract
The 2-week wait (2WW) suspected skin cancer referral pathway is for people with high-risk skin cancers in particular squamous cell carcinoma (SCC) and malignant melanoma (MM) but not for most basal cell carcinomas (BCC). Conversion rates reflecting the number of SCC and MM diagnosed via a 2WW pathway are around 8–12%. Prior to the COVID-19, pandemic people with straightforward low-risk BCCs would be referred on a routine pathway with an expectation that their management would be completed within 18 weeks. The postpandemic pressure on routine waiting lists has meant that managing patients with BCC in a timely fashion is challenging, and the impression is that these patients are now being referred on the 2WW pathway to avoid delays in treatment. The aim of this study was to review the 2WW referral activity between 2019 and 2022, particularly in relation to the number of patients with BCC. Data were obtained from the cancer team (Table 1). There has been a 68% increase in 2WW referral activity. The proportion of people discharged at first attendance and the MM and SCC conversion rate has remained fairly stable. Looking specifically at BCCs, there was an increase from 13.7% to 16.2%. The total number of tumours managed increased overall by 85% over the study period (Table 1). For BCC, the activity has doubled from 552 to 1108 patients (to the end of November 2022). These data confirm the large increase in the number of patients referred on the 2WW suspected skin cancer pathway. Although there is little change in the proportion of patients with different types of skin cancer being seen and managed, the total numbers reported here demonstrate a significant knock-on impact of additional workload for specialist teams, including the need for more skin surgery activity, histopathology and specialist skin cancer nursing services. This needs to be considered when developing skin lesion diagnostic and management pathways and confirms the importance of developing locally agreed BCC pathways and defining workforce requirements.Table 1Two-week wait (2WW) referral activity between 2019 and 2022Number of tumours managed2019202020212022 (to the end of November 2022)2WW referrals (n)4038480260636837Discharged at first attendance (%)56505454Melanoma (%)2.32.221.8SCC (%)5.98.47.65.8Conversion rate (SCC and MM) (%)8.210.69.69.6BCC (%)13.713.816.516.2Number of tumoursSCC237403461395Melanoma93104121124BCC5526629981108Total882116915801627
DS28 In search of salivation? Management of parotid duct injury following Mohs micrographic surgery
Authors: Bajwa Dalvir , Hunt William , Habaluyas Katrina , Fenwick Sarah , Tabor Dominic , Verykiou Stamatina , Brass David , Oliphant Thomas 
Published: June 2023

Abstract
Parotid duct injury is a rare complication of cutaneous surgery usually occurring after excision of deep infiltrating tumours on the cheek. The existing literature is limited to case reports. We present our experience of two cases encountered in our unit over the last 15 years. Our first patient was an 87-year-old man referred for Mohs excision of a biopsy-confirmed morphoeic basal cell carcinoma (BCC) on his right cheek. During tumour extirpation, it was necessary to sacrifice a short section of the parotid duct. This was confirmed by direct visualization of the duct and a visible salivary leak. Immediate referral was made to the plastic surgery department, who also noted ipsilateral weakness in the distribution of the buccal branch of the facial nerve. The parotid duct was repaired over a lacrimal stent secured to his buccal mucosa. The wound was reconstructed with a large rhombic transposition flap and the parotid gland infiltrated with botulinum toxin. Four weeks later, the salivary stent had spontaneously fallen out and fresh-looking saliva was noted emerging from the parotid ampulla. Our second patient was a 65-year-old man referred for Mohs excision of a 3-cm nodular BCC on the left cheek. During tumour extirpation, a short section of the parotid duct was resected, which was clearly visible in the Mohs layer. On this occasion, the patient was referred to colleagues in the maxillofacial surgery department who attended the dermatology surgical unit. Under local anaesthesia, the parotid duct was cannulated using an epidural catheter secured both intraorally and to the residual duct using an absorbable monofilament suture (intraoperative pictures will demonstrate the technique). The Mohs defect was reconstructed with a bilobed transposition flap. Hyoscine patches were supplied to help reduce salivary flow. Marked swelling of the parotid gland developed postoperatively, which settled without further intervention. After 4 weeks, the epidural catheter was removed, and saliva was noted to be flowing from the parotid ampulla. Weakness of the lip elevators was noted in keeping with facial nerve injury. Despite the infrequency of parotid duct injury, it is important that cutaneous surgeons/Mohs surgeons are aware of how to proceed in these cases. In cases where assistance is not available from other specialties, the technique could be undertaken by an appropriately trained dermatological surgeon/Mohs surgeon using local anaesthesia.
DE01 Swabs: a practical way to teach medical students about cutaneous infections
Authors: Mughal Avad 
Published: June 2023

Abstract
It is well established that dermatology is poorly understood among medical students and doctors of all grades. The combination of time allocated to teaching of dermatology, as well as the high impact of the hidden curriculum reinforcing dermatology as difficult and mysterious, lends itself to perpetuation of the zeitgeist. Cutaneous infections have a particularly high cognitive load due to their relatively short presentation time and wide varieties of manifestations. Investigation of cutaneous infections is also problematic with incorrect sampling undertaken for different infections. Junior doctors frequently default to black charcoal swabs for all skin infections, often getting feedback as inappropriate investigation after the patient has been discharged or are being read by different doctors altogether due to shift working. For 8 years, we have been running a practical tutorial session on skin infections at Swansea University Medical School. Old venesection prosthetic arms are decorated with simulation bacterial, fungal and viral infections. The bacterial pus is cold custard (or ‘pustard’) on swollen reddened sections. Herpetic vesicles are simulated with bubble wrap injected with Hibiscrub®. Tinea is simulated by dry polyvinyl acetate glue surrounded by red marker. The students have access to black charcoal swabs, red viral swabs, scalpels and fungal scraping cards. They also have dry universal containers and investigation forms. The 10–12 year-2 students are tasked with diagnosing each infective presentation with a short history and medical photography to back up the prosthetic representation. They then have to select the most appropriate investigative method and information to give to the microbiology department. Some students only have access to black charcoal swabs and need to improvise working out how to use the universal containers for their investigations. The knowledge is then shared at the end of the 40-min tutorial. This is conducted a day before the skin infection lecture, to reduce the cognitive load of that lecture. There has been consistently good feedback for this session, which allows students to think in real time about common clinical scenarios, making best use of laboratory services and improvising investigative techniques, where appropriate resources may not be available. The prosthetics have worked well year on year. Many of our first students are now practising doctors locally, and their dermatology knowledge is manifest in referrals. By practising the techniques in simulation, they are comfortable doing so in working life.
DE02 Honing in on clinician needs: a grassroots development of an educational resource for dermatologists
Authors: Blyth Rachel , Jiyad Zainab , Ferguson Leila , Pinder Vanessa 
Published: June 2023

Abstract
Keeping up with the influx of scientific research papers can feel overwhelming, especially alongside busy clinical responsibilities. A PubMed search of the term ‘dermatology’ produced 29 565 results for 2021 alone, and, consequently, clinicians face spending hours a week scanning journals just to stay up to date. This is coupled with increasing clinical demand due to rising waiting lists and skin cancer pressures. Innovative solutions to the problem include regular newsletters, which have been proven to be an effective tool in medical education in other specialities (Kolli A, Nguyen A, Portney D et al. The Lens: can a weekly newsletter improve medical student knowledge of the ophthalmology literature? J Surg Educ 2021; 78:1905–14). To address this challenge in dermatology, we created a newsletter to make dermatology research more accessible. Two consultant dermatologists created a system whereby clinically relevant articles are chosen following a review of ∼30 journals. These are condensed into short clinical summaries, containing relevant findings, limitations and applicability, emulating a journal club style. This was initially distributed within our local hospital, but the team and readership have since expanded. From January 2022, in addition to the written newsletter, a freely available podcast for each newsletter was created giving an opportunity to learn on the move (e.g. while commuting). At 12 months, the newsletter has 206 subscribers, and the podcast has achieved 810 total plays (with download locations ranging from the USA to India). More recently, we have reached new audiences via Instagram, with 1700 views and 123 likes of the content thus far. A survey was distributed to current subscribers to determine the usefulness of the newsletter as an educational resource. Eighteen responses were received, and 100% agreed that they felt more informed on recent publications in dermatology from reading the newsletter (83% strongly agreed; 17% agreed). In addition to this, 100% felt that the articles chosen were relevant to their clinical practice (78% strongly agreed; 22% agreed). Feedback included comments such as ‘it is a great way to keep informed on recent publications that may be of interest’ and ‘super useful bite-sized information’. The General Medical Council guidance on Good Medical Practice requires doctors to ‘keep professional knowledge and skills up to date’. We feel the interest in our grassroots journal club publication and the survey results (with all our respondents feeling more informed on dermatological research, particularly with articles relevant to their clinical practice) highlight an unmet need for accessible educational resources to enable busy dermatologists to become aware rapidly and efficiently of the latest clinical developments.
H01 Chloracne: historical perspectives on an occupational disease, often the result of notorious environmental poisoning
Authors: Manley Alice , Labbouz Sofia , Gawkrodger David 
Published: June 2023

Abstract
First described by the Heidelberg dermatologist Siegfried Bettman in 1897 as an occupational disease in chemical workers cleaning out towers filled with hydrochloric acid, chloracne—not a true acne, despite showing comedones, cysts and pustules, but the manifestation of systemic poisoning by halogenated aromatic compounds—has been the subject of several controversial environmental disasters for over a century (www.biusante.parisdescartes.fr/sfhd/wp-ontent/uploads/2021/05/chloracne.pdf). These disasters include the 1949 Monsanto plant explosion at Nitro, West Virginia, with 226 affected; the 1976 Seveso disaster, which released tetrachlorodibenzo-p-dioxin (TCDD) over a civilian population of around 100 000 (193 definite cases); and mass poisoning by cooking oils contaminated with polychlorinated biphenyls in Kyushu, Japan, in 1968 (&gt; 2000 affected) and Taiwan in 1979 (&gt; 2000 poisoned). Cases have even occurred in England. An explosion at the Coalite and Chemical Products Company works at Bolsover in 1968 released dioxin, leading to 79 cases of chloracne (https://api.parliament.uk/historic-hansard/lords/1980/mar/14/dioxin-escape-at-bolsover-april-1968). An outbreak in 1992 affected 17 workers in North Derbyshire at a plant manufacturing the herbicide dichloroaniline. Another incident occurred in 1997, when seven pharmaceutical chemists who manufactured triazoloquinoxalines, not previously known to be chloracnegenic but 100 times more powerful than dioxins, were affected. Perhaps the most notorious chloracne poisoning, with TCDD, was that of the Ukrainian president Viktor Yushchenko in 2004. Unless exposure is overwhelming, as it was in Seveso, chloracne takes a few weeks to manifest, and systemic changes can be found in the blood count and liver functions tests. Resolution typically takes about 3 years, although skin changes can be permanent. Dermatologists should be vigilant for new cases, especially at the time of industrial accidents, as the chloracnegenic potential of new chemicals is not always apparent.
H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)
Authors: Ralph James 
Published: June 2023

Abstract
Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.
H22 Barking up the right tree: history of quinine
Authors: Yip Alphonsus , Sivarajah Sinthiya , Natkunarajah Janakan 
Published: June 2023

Abstract
Quinine is considered to be one of the most important medical discoveries of the 17th century through its use in treating malaria. Since then, its applications have expanded, and quinine continues to be one of the most widely used drugs in dermatology. Quinine is found in the bark of the Cinchona tree found in the jungles of the Andean region of South America. The exact nature of its discovery remains unclear; however, there are tales of the Spanish Countess of Chinchon being cured of a recurring fever by using liquid containing Cinchona bark. This prompted her to return to Spain in 1638 with the seeds and precious bark; in 1742, botanist Carl Linnaeus named the tree Cinchona in her honour. During the early 17th century, the bark was ground into a powder and mixed with wine. In 1820, French scientists Pierre Pelletier and Joseph Caventou developed the processes to extract quinine from Cinchona bark, improving the potency of the medicine. In the 19th century, as the role of quinine in treating malaria spread, Europeans in the British colonies started planting Cinchona trees to avoid importing large amounts of the drug. Owing to its bitter taste, quinine was mixed with sugar and soda, creating the first tonic water. The tonic water was mixed with gin to make the bitterness of quinine more palatable. Winston Churchill claimed that this drink ‘saved more Englishmen’s lives, and minds, than all the doctors in the Empire’ (Simonetti O, Contini C, Martini M. The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed. Infez Med 2022; 30:619–26). The first documented use of quinine to treat dermatological conditions was produced by Payne in 1894, who reported the successful treatment of skin lesions in discoid lupus erythematosus (Payne J. A postgraduate lecture on lupus erythematosus Clin J 1894; 4:223–9). In 1951, a case series in the Lancet of 20 patients with lupus erythematosus and rheumatoid arthritis who were successfully treated with quinacrine, led to the extensive use of antimalarials to treat skin and joint conditions (Page F. Treatment of lupus erythematosus with mepacrine. Lancet 1951; 258:755–8). This was later succeeded by chloroquine: a synthetic analogue was first synthesized in the 1930s by Hans Andersag. However, it was noted to have significant toxicities, which led to the production of hydroxychloroquine, a similar drug with a much-improved side-effect profile. After 400 years, quinine and its synthetic derivatives continue to play a major role in managing dermatological conditions.