bluuebunny/crossref_metadata_2025_split huggingface dataset:
P61 Cutaneous malignant melanoma diagnosed on nonvisible body sites and the importance of total body examination: a retrospective cohort study
Authors: Wolinska Anna , Bowe Stephanie , Murray Gregg , Collins Sinead , Feighery Cliona , Roche Muireann , Murad Aizuri 
Published: June 2023

Abstract
The incidence of cutaneous malignant melanoma (MM) is increasing worldwide. Regular self-skin examination can assist in the early detection of MM. However, identifying new or changing lesions on nonvisible body sites (NVBS) can be difficult. Research investigating MM on NVBS is limited. The aim of this study was to compare the features of MM on NVBS with visible body sites (VBS) to add data to this patient cohort. We performed a retrospective chart review to identify patients diagnosed with MM in our institution from 2019 to 2021. Clinicopathological features were extracted and analysed. NVBS was defined as areas including the posterior scalp, ears and neck, posterior shoulder, back, buttocks, posterior thigh and plantar aspect of the feet. Statistical analysis was performed using SPSS (IBM). A total of 162 patients were included in this study; 45.1% (n = 73) were male. Patients with MM on NVBS were statistically significantly younger (median age 59 years) compared with patients with MM on VBS (median age 66.5 years; P &lt; 0.05). Thirty-seven per cent (n = 60) of lesions were found on NVBS. Twenty-eight per cent (n = 17) of MMs on NVBS were identified incidentally on total body examination (TBE) in the clinic by a dermatologist. There was a statistically significantly higher number of patients with melanoma in situ on VBS (n = 44; 27.1%) compared with NVBS [n = 17; 10.5% (P &lt; 0.01)]. A higher proportion of patients with MM on NVBS had a Breslow thickness &gt; 1 mm (n = 23; 38.3%) vs. VBS (n = 30; 29.4%). This study demonstrates a higher number of MM diagnosed incidentally following TBE compared with previous research. Our study focused on a MM-specific cohort who may, potentially, have had lethal skin cancers missed in 28% of cases if TBE was not carried out. Our findings also show that patients are more likely to have noninvasive tumours detected on VBS but more advanced disease on NVBS, further emphasizing the importance of TBE. This study suggests that high-risk patients could benefit from specific surveillance programmes that encourage regular self-skin examination and periodic TBE by a consultant dermatologist to enable early detection and treatment of MM. This study was limited by its retrospective design and a small number of patients from a single institution. We recommend an increased emphasis on patient education on the importance of self-examination which, when complemented by physician-directed TBE, plays a valuable role in the early detection of MM on NVBS. This study provides guidance in designing pathways to target high-risk groups to avoid delays in the diagnosis of MM. Further research to explore trends of MM on NVBS may enable targeted education campaigns in the future.
P62 The environmental impact of skin cancer surgery
Authors: Fleming Sarah , Drumm Ciara , O’Donnell Ciara , Lynch Sorcha , Lally Aoife , Moriarty Blaithin 
Published: June 2023

Abstract
The climate crisis has been described as the greatest global health threat by the World Health Organization. In 2019, healthcare-related emissions accounted for 25 mega-tonnes CO2 equivalent (CO2e), 10% of which was related to staff and patient travel. In the UK, 3.5% of road use is related to the National Health Service. The healthcare sector must recognize its role in contributing to carbon emissions and commit to taking decisive action to reduce these. Health-care generates a significant proportion of global emissions; a 2021 report by the Lancet estimated that the healthcare sector contributes to 4.9% of greenhouse gas emissions. As the impact of these numbers is coming to the fore, sustainable health care is becoming a necessity. This study aimed to determine the reduction in CO2e from same-day surgery for patients at skin cancer clinics. CO2e from travel by patients undergoing surgical procedures in a 6-month period (July–December 2020) were calculated. Data collected included age, diagnosis, site of lesion and total number of visits. The distance from the patient’s address was calculated using Google Maps. Total CO2e was calculated using an online calculator recommended by the Environmental Protection Agency of Ireland. A total of 299 patients had 319 procedures between July and December 2020. The median (SD) patient age was 68 (18.5) years (range 16–97). The total distance travelled by patients was 26 069 km, with a mean of 86 km travelled per patient (range 1.2–789). This generated 4.47 tonnes of CO2e emissions (range 0.0–0.6 tonnes). In total, 225/299 patients (75.2%) had surgery on the same day as their clinic appointment. They travelled a total average distance of 72 km (range 1.2–464), with a median of one hospital visit (range 1–2). Seventy-four of 299 patients (24.7%) had alternative day surgery, travelling an average distance of 129 km (range 8.4–789 km), with a median of two hospital visits (range 1–5). The mean CO2e for patients attending for same-day procedures was 0.017 tonnes (range 0–0.6) vs. 0.024 tonnes (range 0–0.16) for alternate-day procedures, a reduction of 0.007 tonnes (30%) per patient (P = 0.3). The introduction of same-day surgery for patients resulted in a 2.93-tonne (55%) reduction in CO2e, the equivalent to driving from the north to the south of Ireland 13 times (8000 km). We have demonstrated a reproducible innovative approach to the reduction of the carbon footprint generated by the management of skin cancer. With ever-increasing demands on the healthcare system, it is vital that we use innovative ways to reduce the carbon footprint generated. The actions of the healthcare sector now will affect the health and wellbeing of generations to come.
BG04 Oleogel-S10 (birch triterpenes) in the treatment of epidermolysis bullosa wounds: 24-month efficacy and safety data from the EASE study
Authors: Murrell Dedee , L. Bruckner Anna , Sprecher Eli , Kiritsi Dimitra , Maher Laura , Cunningham Tracy , Kern Johannes S. 
Published: June 2023

Abstract
Epidermolysis bullosa (EB) is a rare debilitating disorder characterized by skin fragility, blister formation and impaired wound healing. The abnormal wound healing seen in EB is a key driver for systemic disease and can lead to serious clinical complications, deformities and symptoms with a devastating impact on quality of life (QoL). The 90-day double-blind phase (DBP) of the phase III EASE study previously demonstrated accelerated wound healing for oleogel-S10 (birch triterpenes) vs. control gel in EB. Here, we report the safety and total wound burden results from the 24-month open-label phase (OLP), in which all patients received treatment with oleogel-S10. EB Disease Activity and Scarring Index (EBDASI) and body surface area percentage (BSAP) data are reported without visit windows to reflect a real-world situation more accurately, particularly considering the COVID-19 pandemic. The patient population was made up of those with dystrophic EB (n = 178; 86.8%) and junctional EB (n = 25; 12.2%). Further baseline characteristics are available in Table 1. In total, 141 patients (68.8%) completed the OLP. The mean (SD) treatment duration for all patients was 584.7 (246.1) days. Adverse events were reported in 77.1% of all patients in the OLP vs. 81.7% of those receiving oleogel-S10 in the DBP. Mean BSAP for patients treated with oleogel-S10 in the DBP reduced from 12.1% at study entry to 6.1% on completion of the EASE study. Similarly, the mean EBDASI skin activity score in the oleogel-S10 group improved from 19.6 to 15.1 at the end of the OLP. In addition, reductions in both BSAP and EBDASI from OLP baseline were observed in patients who transitioned from control gel to oleogel-S10 in the OLP. Oleogel-S10 has a reassuring long-term safety profile. Furthermore, the long-term impact of accelerated wound healing is evident through the sustained reduction in wound burden over time. This is encouraging given the regular reoccurrence of patients’ fragile wounds in the natural course of this chronic disease. Table 1Baseline characteristics
BI31 Hereditary haemochromatosis: a risk factor for nonmelanoma skin cancer?
Authors: Barry Rory , Murray Gregg , Hazel Karl , Ryan John , Watchorn Richard 
Published: June 2023

Abstract
Hereditary haemochromatosis (HH) is an autosomal recessive disease resulting in excessive levels of iron. In a recent study, in a US population of 448 patients diagnosed with HH, a positive association between HH and nonmelanoma skin cancers (NMSCs) was observed (Pan CX, Yang K, Lau CB et al. Non-melanoma skin cancer in patients with hereditary hemochromatosis: a case–control study. J Am Acad Dermatol 2023; 88:692–4). The authors also reported that, among those who required more frequent venesection, the risk of basal cell carcinoma (BCC) was particularly elevated. In terms of the possible pathomechanism, the authors noted that oxidative stress represents a key component in the pathogenesis of both HH and BCC. Ireland has the highest prevalence of HH in the world, with research suggesting approximately 1 in 83 people is predisposed. For this reason, a study was undertaken to determine if a similar association could be observed in an Irish population. A single-centre retrospective cross-sectional analysis was undertaken on a database of patients with haemochromatosis attending the venesection department of a tertiary referral centre over 25 years (1997–2022). All histologically diagnosed NMSCs within this patient group were then recorded. Ethical approval was granted by the local hospital ethics committee. There were a total 1480 patients in the database, 65% Male (n = 956). Five were excluded due to insufficient data. Thus, 1475 patients were analysed, 64% male (n = 949). The mean current age was 60 years (range: 19–100). Only 52/1475 patients (3.5%) had a histologically diagnosed NMSC, 52% male (n = 27). HH genetic mutation: C282Y homozygous (n = 29); H63D homozygous (n = 5); C282Y/H63D compound heterozygous (n = 11); and data not recorded (n = 7). Mean ferritin at HH diagnosis 575 (range: 0–8413). Forty-three patients were diagnosed with a BCC, 58% male (n = 25), with a total of 94 BCCs. Mean age was 67 years at first NMSC diagnosis. Histological classification: nodular (n = 48); superficial (n = 19); unclassified (n = 18); infiltrative (n = 5); micronodular (n = 3); and basosquamous (n = 1). Eleven patients were diagnosed with a squamous cell carcinoma (SCC), with a total of 21 SCCs. This study had limitations. It was a single-centre, retrospective study analysing only histologically confirmed NMSCs. It is acknowledged that a small proportion of NMSCs may be diagnosed clinically, specifically superficial BCCs without histological confirmation. Only records with histology available in our institution were recorded, and it is possible that NMSCs were excised in other institutions, potentially leading to an under-representation of NMSC incidence. The proportion of patients diagnosed with NMSCs in this cohort was relatively low, in contrast to the findings reported by Pan et al. This study indicates that HH is unlikely to represent an independent risk factor.
CD14 Mouth ulcer mayhem secondary to dental fillings
Authors: Ananthan Lokapriya , Godor Dorottya , Stone Natalie 
Published: June 2023

Abstract
Dental amalgam contains mercury, which may cause an uncommon lichenoid allergic contact dermatitis (ACD) affecting the oral mucosa in direct contact with the amalgam filling. Distinguishing a lichenoid amalgam reaction from oral lichen planus is challenging, both clinically and histopathologically. This case illustrates the important role that patch testing to dental materials can play in providing a simple answer in the management of resistant cases of mouth ulceration, protecting patients from exposure to potentially toxic immunosuppressive treatments. A 64-year-old woman presented with a 5-year history of oral ulceration affecting the buccal mucosa and tongue bilaterally. These ulcers were persistent, very painful and bled intermittently, causing a significant adverse effect on her quality of life. She worked as a manager at a local wildlife sanctuary, and hobbies included walking, writing and artwork. An incisional biopsy taken from an ulcer in the left buccal mucosa demonstrated a dense lichenoid inflammatory cell infiltrate. The oral surgical team treated her for presumed ulcerative oral lichen planus with multiple treatments, including topical steroids, high doses of oral prednisolone, hydroxychloroquine, mycophenolate mofetil and azathioprine. She gained only very minimal benefit. The oral surgeons then requested dermatological advice for the next potential treatment option, which was suggested to be rituximab. At this point, the surgeons noticed that the ulcers seemed to be most prominent at sites of the patient’s longstanding amalgam fillings and she was referred for patch testing. Patch tests were performed to the British Standard series, medicaments series and oral and dental series. Positive reactions were noted to both amalgam (D2+/D4+) and mercury (D2+/D4+). The patient had her amalgam fillings replaced with white acrylate fillings, and her oral ulceration completely healed without the need for any further immunosuppression. Clinically and histologically, lichenoid ACD secondary to dental fillings can be indistinguishable from idiopathic oral erosive lichen planus. However, the proximity of ulceration to dental filling materials should always raise the possibility of a lichenoid ACD and trigger referral for patch testing, preferably prior to systemic medications being tried. This case highlights the importance of patch testing in patients with localized, asymmetrical, difficult-to-treat oral ulcers adjacent to amalgam fillings, which could spare the patient from exposure to potentially harmful immunosuppressive treatments.
DP01 Survey on the management of dysplastic naevus
Authors: Hussain Fazleenah , Bakshi Arti , Yesudian Paul Devakar , Cohen Stuart N 
Published: June 2023

Abstract
Although dysplastic naevus (DN) is a frequent diagnosis, there is significant controversy on its definition and gradation and its relationship to melanoma risk. Therefore, there is no consensus over optimal management, and surveys from Australia, Canada and the USA have shown variation in clinical practice. Dysplastic naevus with involved histological margins has not been shown to progress to melanoma. To assess UK management of DN depending on the grade of atypia and reported excision margin, we circulated a questionnaire via email to dermatologists in Scotland, north Wales, Liverpool and Manchester. Seventy-two responded, of whom 46 (64%) were consultants. The cohort was generally highly experienced, with 10 (14%) responders with 1–5 years’ dermatology experience, 15 (21%) with 6–10 years, 27 (37%) with 11–20 years and 20 (28%) with &gt; 20 years’ experience. Management of DN varied greatly. For mild DN excised with &lt; 1-mm margin, 59 (82%) agreed that no further management was required. Opinions were divided when margins were involved in mild DN, with 14 (19%) agreeing that no further management was required, 42 (58%) choosing to re-excise and six (8%) to re-excising only any residual pigmentation. Most dermatologists reassured patients with moderately DN with margins &lt; 1 mm (49, 68%); 18 (25%) preferred to re-excise. For moderate DN with involved margins, six respondents (8%) felt that no further management was necessary and 54 (75%) would re-excise. For severe DN with margins &gt; 1 mm, 16 (22%) would still re-excise and six (8%) would agree management in the multidisciplinary team meeting (MDT). For severe DN with margins &lt; 1 mm, 41 (57%) would re-excise and seven (10%) would agree management in the MDT. Lastly, for severe DN with involved margins, 62 (86%) would re-excise and seven (10%) would agree management in the MDT. This study has shown comparable results with those from Australia and the USA, whereby most dermatologists would re-excise moderate and severe DN with involved margins. Significant numbers indicated that they would re-excise in the case of close histological margins: this is unnecessary, and more standardized management may reduce expenditure. Limitations of the study include the usual potential sources of bias in a questionnaire survey; it should be noted that reported behaviour may differ from actual practice. However, this is the first UK study on this common clinical scenario. The move to report DN as low- or high-grade may help to reduce variation, but our survey suggests that some patients are currently undergoing unnecessary procedures.
DP05 (P53) Incidence of Merkel cell carcinoma in the Republic of Ireland (1994–2019)
Authors: Doyle Claire , Blasco Marta Costa , McFeeley Orla , Beatty Paula , O’Mahoney Sarah , Murphy Lisa , Andrawis Madonna , Tobin Anne Marie 
Published: June 2023

Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cutaneous malignancy most commonly observed in those aged over 65 years. Merkel cell carcinoma is twice as common in males as in females and is 25 times more common in those with fair skin than in those with darker skin types. Solid organ transplant recipients have a 24-fold increased risk of developing MCC. There was a 95% increase in the incidence of MCC in the USA from 2000 to 2013, with further increases predicted. The aim of this study was to investigate the trends of incidence of MCC in the Republic of Ireland. Age-standardized rates were calculated using the 2013 European standard population. There were 447 histologically confirmed MCCs diagnosed between 1994 and 2019. Forty-nine per cent of cases (n = 220) were in males. Median age was 80 years (range 15–19 to 95+). The median age for males was 78 years and the median age for females was 82 years. On average, there were seven cases of MCC diagnosed annually between 1994 and 1998 vs. 27 cases of MCC annually diagnosed between 2015 and 2019—almost a quadrupling of case numbers. The age-adjusted incidence rate of MCC for both male and females is detailed in Table 1. Previous literature has indicated that MCC is twice as common in males than in females. Our cohort differed in that there was a slight female predominance in patients diagnosed with MCC. This is in keeping with published literature from Northern European groups, which have also demonstrated a female predominance in MCC. While the absolute number of MCC diagnosed in Ireland has increased in both males and females, the age-adjusted incidence rate is increasing in males, but there has not been a significant change in females. Other Northern European groups have also demonstrated an increase in the incidence of MCC in males that was not observed in females. This study adds to the body of epidemiological data on MCC. Table 1Age-adjusted incidence rates of Merkel cell carcinoma (MCC)Cases of MCCAge-standardized rate (per 100 000 person-years)SE95% confidence intervalMales 1994–1999230.520.130.27–0.77 2000–2004210.370.080.21–0.53 2005–2009350.790.150.50–1.08 2010–2014661.190.160.88–1.50 2015–2019751.050.120.81–1.29Females 1994–1999260.360.070.22–0.50 2000–2004440.670.100.47–0.87 2005–2009540.790.110.57–1.01 2010–2014450.570.090.39–0.75 2015–2019580.650.090.47–0.83
DS03 Lentigo maligna: is it time to put down the scalpel?
Authors: Paul Navreet , Lecamwasam Kami , Fadhil May , Garioch Jennifer 
Published: June 2023

Abstract
Lentigo maligna (LM) is a subtype of melanoma in situ that often proves to be a diagnostic and therapeutic challenge. Treatment aims to prevent progression to an invasive tumour called lentigo maligna melanoma (LMM). In the UK, common treatment modalities include conventional excision, staged re-excisions, slow Mohs surgery or expectant monitoring. Although considered the ‘gold standard’, surgical excision of LM can be disfiguring as it frequently affects cosmetically sensitive areas requiring complex surgical reconstructions. Topical imiquimod 5% presents a pragmatic alternative treatment modality without the need for surgery. In vivo reflectance confocal microscopy (RCM) allows real-time noninvasive delineation of LM. Evidence suggests this is an effective diagnostic tool for pre- and post-treatment evaluation (Brand FL, Jafari SM, Hunger RE. Confocal microscopy and lentigo maligna: an in vivo pilot study for the assessment of response to imiquimod therapy. Dermatology 2019; 235:150–5). We retrospectively analysed 35 cases of histologically confirmed LM that completed treatment with imiquimod between 2018 and 2022. The average patient age at diagnosis was 73.9 years, with a female : male ratio of 18 : 17. Following assessment with RCM, patients were prescribed a protocol of topical imiquimod 5% once a day, 5 days per week for 12 weeks, along with instructions to apply this 10 mm beyond the mapped area or a cosmetic unit (Australia and New Zealand Melanoma Trials Group RADICAL trial). Patients were counselled about expected side-effects; all completed the course and achieved significant inflammation and superficial ulceration. To ensure a response was achieved, the following stepwise interventions were used: application increased to 7 days per week, occlusion with a dressing and addition of a topical retinoid. Repeat RCM was performed 6 months after treatment completion. At this point, 30 of 35 (86%) patients responded with no evidence of residual LM on RCM. Three cases required a second course of treatment. Two of these were shown to be clear on RCM, while the third is clinically clear and awaiting RCM confirmation. A fourth patient was lost to follow-up. A further patient has failed two courses and is about to embark on a third round of treatment. In total, 16 cases completed the 12-month review and maintained clearance. We demonstrate that imiquimod is an effective treatment for LM, potentially avoiding extensive surgery and complex reconstruction. Reflectance confocal microscopy can be used to delineate the extent of the LM and assess the post-treatment response. Our preliminary data suggest a significant proportion of LM cases achieved clearance with no recurrences to date. Follow-up of these patients will help evaluate the long-term efficacy of imiquimod, but our data suggest this treatment protocol provides a promising alternative to surgical intervention.