tbuckley/cabot-search huggingface dataset:
BT28 Analysis of a single practitioner’s teledermatology processing decisions in an established teledermatology service over a 12-month period
Authors: William Tuckwell, Sarah Winter, Richard Motley
Journal: British Journal of Dermatology (2024)

Abstract In our department, teledermatology has been the default referral pathway from general practice since August 2016. In the 12 months to August 2022, 19 995 teledermatology referrals were processed by 10 consultant dermatologists (8 whole-time equivalents). This analysis reviewed the diagnoses and outcomes of 2667 consecutive teledermatology referrals, processed by one of these consultants, with a special interest in skin cancer, over that 12-month period. Data collected from the National Clinical Patient Database included the initial teledermatology referral and response and, where appropriate, details of subsequent clinic attendance and histology reports. Duplicate referrals (n = 64) and referrals redirected to colleagues (n = 82) were excluded from the analysis. In total, 157 (6%) referrals were rejected by the teledermatologist, either because they were submitted without a photograph (n = 41), the photograph was inadequate (n = 78), the incorrect photo was attached (n = 3), the history was insufficient (n = 21) or there were other factors such as request for services not offered or advice had already been provided (n = 14). Overall, 1391 (52%) referrals were returned to the general practitioner with diagnosis and/or management advice, and 973 (36%) patients were accepted onto the dermatology waiting list for subsequent review in clinic. Of these, 155 were accepted to rule out melanoma. During the period of assessment, 632 of the patients who had been accepted onto the waiting list had been reviewed in clinic: 96 (72%) of those with a telediagnosis of basal cell carcinoma (BCC) were confirmed to have BCC, 61 (30%) of those with a telediagnosis of squamous cell carcinoma (SCC) were confirmed to have SCC, 16 (57%) of those with a telediagnosis of melanoma were confirmed to have melanoma, and of those accepted to rule out melanoma, 14 (9%) were confirmed to have melanoma. Teledermatology provides a ‘snapshot’ of a skin disease with limited clinical information and photographs. The teledermatologist must decide whether the information provided is adequate to make a confident diagnosis and management plan. Our analysis showed that most teledermatology referrals were considered adequate for the purpose, and just over one-third needed to be seen in clinic. It also demonstrated the superior diagnostic accuracy of face-to-face consultations over teledermatology. Teledermatology is an excellent tool for dermatology triage, and in this analysis it reduced the need for face-to-face consultations by &amp;gt; 60%.
P014 Eosinophilic dermatosis of haematological malignancy: a chronic relapsing pruritic condition
Authors: Sophie Diong, Elisabeth Vandenberghe, Lisa Mellerick, Bairbre Wynne
Journal: British Journal of Dermatology (2024)

Abstract Eosinophilic dermatosis of haematological malignancy (EDHM) is a rare condition first reported in 1965. Although associated with a myriad of haematoproliferative conditions, it is most commonly linked with chronic lymphocytic leukaemia (CLL). With its typical lesions being intensely pruritic erythematous papules, nodules and bullae, it was initially thought to be a hypersensitivity reaction to insect bites. A 70-year-old man was referred for an 11-year history of an overexuberant response to insect bites. He gave a history of an intermittent blistering rash associated with intense generalized pruritus. He noted lesions occurring on both exposed and nonexposed body sites, and throughout the year. His background was significant for CLL, under surveillance, which was diagnosed a decade ago. Physical examination revealed erythematous papules and nodules on the neck, forehead and limbs, with an intact tense bulla at the left ankle. The morphology observed raised suspicion for Sweet syndrome, bullous pemphigoid, cutaneous T-cell lymphoma and EDHM. Laboratory investigations revealed an elevated lymphocyte count in keeping with his known diagnosis of CLL. Other results were within normal limits. Culture biopsy, and direct and indirect immunofluorescence studies were negative. Biopsies illustrated a dense pandermal perivascular lymphocytic inflammation, with an associated lymphocytic vasculitis. Numerous eosinophils were seen. Immunohistochemistry highlighted no convincing involvement by CLL. No clonal T-cell receptor gene rearrangements were identified. Given both the clinical and pathological features, a diagnosis of EDHM was made. Our patient responded to a course of weaning oral steroids commenced synchronously for a respiratory tract infection, alongside moderate-potency topical steroids. In the event of a future flare, steroid-sparing agents to be considered include dapsone and doxycycline, which have shown efficacy in the literature. EDHM can precede, antedate or occur concurrently with a CLL diagnosis. Although exaggerated arthropod responses are associated with CLL, EDHM is believed to be a separate process. Its pathogenesis remains unknown, but hypotheses include underlying malignancy-­related immune dysregulation, with a shift towards a T helper type 2 response and excess interleukin-4 and interleukin-5 production, which drive eosinophil recruitment and stimulation. This chronic relapsing dermatosis is characterized by clinical polymorphism and suggestive, but nonspecific, histopathological traits. Careful clinicopathological correlation is essential for diagnosis. Management options depend on the severity and frequency of flares. Varying responses to treatment are reported, but there is no gold-standard treatment. It is important that dermatologists are aware of EDHM as its diagnosis carries a potential negative prognostic outlook on the underlying haematological malignancy.
BT33 Ethical challenges with skin cancer and artificial intelligence integration
Authors: Sut Mo Zachary Chan, Faishal Dubash
Journal: British Journal of Dermatology (2024)

Abstract The integration of artificial intelligence (AI) in the field of dermatology promises a revolutionary transformation in our approach to this domain. However, the use of AI in dermatology is still in its early stages, and with limited scope of applications. While some of the existing research performed has highlighted the capabilities of AI in diagnosing lesions comparable with those of a dermatologist, the implementation of AI brings about its own ethical challenges that affect both the clinician and the patient. This article aims to explore the ethical issues and prospects surrounding AI implementation in dermatology by drawing insights from the current literature. A qualitative analysis was conducted on articles focusing on AI usage in medical care, with a specific emphasis on dermatology. The analysis unveils several ethical issues that emerge from the implementation of AI in dermatology: the obscure and subjective nature of AI leads to selective bias and unequal treatment based on skin tone differences. It also has the potential to erode patient autonomy by taking on a more paternalistic approach to medicine, increasing the risk of unwarranted harm to patients because of unnecessary biopsies, along with potential misalignment of treatment priorities between AI systems and patients. Issues of accountability arise as AI integration can challenge the epistemic authority and ownership of clinicians over their patients. Finally, the closed-loop system of training algorithms coupled with the lack of an open-access database due to privacy issues further increases the subjectiveness and inaccessibility of each algorithm. While AI’s integration in dermatology promises to streamline the diagnostic process, it also sparks ethical issues that affect the main stakeholders. These findings indicate the need for further development and enhancement of AI systems before they are capable of being implemented. Introduction of a transparent, explainable AI model would alleviate concerns regarding patient autonomy and treatment rationalization. Simultaneously, the establishment of a global open-access database will serve to mitigate selective bias. Furthermore, additional research comparing algorithms would be useful in establishing a standardized validation tool. As it stands, rather than replacing clinicians, AI should be used as a diagnostic adjunct in aiding clinical decisions.
BT32 Teledermatology service evaluation compared with standard face-to-face review for 2-week-wait skin cancer referrals
Authors: Niamh Byrne, Charlotte Wong, Andre Khoo
Journal: British Journal of Dermatology (2024)

Abstract Teledermatology has been shown to be accurate in the diagnosis of skin cancer. The number of skin cancer referrals to secondary care has surged and dermatology departments are under increasing pressure to meet cancer pathway targets. The aim of this study was to compare service outcomes for teledermatology vs. conventional face-to-face review. We performed a retrospective review of adult patients referred by general practitioners for suspected skin cancer via the 2-week-wait pathway from August 2022 to February 2023. Patients were assessed either by conventional face-to-face appointment or via teledermatology. Teledermatology patients completed a questionnaire and were seen by a photographer in the community who took regional, macroscopic and dermoscopic images. The primary outcomes were times from referral to first clinical appointment and to surgery (if applicable), surgical intervention rate, and histological diagnoses (if applicable). Statistical analysis was performed using Prism software (GraphPad Software, La Jolla, CA, USA). Comparisons between groups were performed with the Mann–Whitney U-test and Fisher exact, as appropriate. P-values &amp;lt; 0.05 were considered statistically significant. In total, 50 consecutive patients assessed by a single clinician via teledermatology were compared with 100 randomly selected patients assessed by the same clinician via face-to-face review. More than half of patients were female in both groups (52% teledermatology vs. 58% face-to-face). The teledermatology group was older ,with a mean age of 56.7 years (SD 18.5) vs. 40 years (SD 20.5), P &amp;lt; 0.001. The median waiting time for a clinical appointment was slightly longer in the teledermatology group [16.5 days (SD 8.5) vs. 14 days (SD 5.4) for face to face (P &amp;lt; 0.001)]. The median waiting time from receipt of referral to surgery was similar in both groups [38 days (SD 17.3) for teledermatology vs. 32 days (SD 12.5) for face to face (P = 0.4)]. The median waiting time from decision to treat to surgery was similar in both groups [21 days (SD 17.3) for teledermatology vs. 20 days (SD 11.7) for face to face (P = 0.9)]. There was no significant difference in the diagnostic biopsy/therapeutic excision rate (34% for teledermatology vs. 27% for face to face, P = 0.37), or in the proportion of benign, dysplastic and malignant lesions biopsied or excised (P = 0.75). Over one-third of patients reviewed by teledermatology were discharged without the need to attend hospital. In conclusion, this model of teledermatology offers a robust way to assess suspected cancer, with biopsy rates and eventual diagnoses comparable with conventional models. The use of professional medical photography may delay initial review, but higher-quality images are associated with improved diagnostic accuracy.
BT37 Can patients with psoriasis and eczema support their self-management by being involved in care decision making?
Authors: Taha Aldeen
Journal: British Journal of Dermatology (2024)

Abstract Eczema and psoriasis are often associated with psychological and metabolic comorbidities. They usually require long-term medical care. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in decision making and self-management. The objective of this study was to explore the acceptability and potential of a self-developed questionnaire (study tool) in addressing the needs, comorbidities and feedback of patients with psoriasis and eczema, to support their involvement in decision making and self-management of their chronic conditions. A mixed-methods study was conducted that included a postal survey on adult male and female patients with psoriasis and eczema. The study tool contained the Dermatology Life Quality Index and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semistructured face-to-face interviews with a sample of the patients who had participated in the survey. The final study involved sharing the research findings along with a prototype of the proposed online version of the study tool with a group of healthcare professionals. Of the 114 patients who participated in the postal survey, 108 (94.7%) expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63.2%) participants. Thirty-three (28.9%) participants reported that they could not cope with their chronic illness. Eighteen (15.8%) had anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25.4%) participants addressed their needs for support at home, and 16 (14.0%) of them asked for support at work. In the interviews, all the participants (22, 100%) welcomed the use of the study tool on a regular basis to support their needs and feedback. Nineteen (86%) of them preferred using an online version of the tool (portal system) as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final study, the healthcare experts agreed that the proposed online version of the study tool (portal) would be a convenient platform for such patients to address their unmet needs, comorbidities and feedback. It can be designed to provide access to supportive services including links to patient information on skin diseases, local mental health services, patient forums and other relevant support groups and charities. In conclusion, the study tool has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. All the interviewees welcomed regular use of the study tool. The use of an online version of the tool can have the potential to fill important gaps in patient self-management and in health service improvement.
Bristol Cup PostersP001 A descriptive, observational and cross-sectional study of clinicoepidemiological, dermoscopic and histopathological aspects of primary localized cutaneous amyloidosis and its effect on the quality of life of the patient
Authors: Meghana Rane, Sunanda Mahajan
Journal: British Journal of Dermatology (2024)

Abstract The aims of this study were to examine the clinicoepidemiological factors related to primary localized cutaneous amyloidosis; to investigate its dermoscopic and histopathological findings; to determine the clinicohistopathological and dermoscopic correlation; and to study its effect on the quality of life of the patients (Al-Ratrout JT, Satti MB. Primary localized cutaneous amyloidosis: a clinicopathological study from Saudi Arabia. Int J Dermatol 1997; 36: 428–34; Rasi A, Khatami A, Javaheri SM. Macular amyloidosis: an assessment of prevalence, sex and age. Int J Dermatol 2004; 43: 898–9). An open, prospective, descriptive and observational study was conducted in patients with primary cutaneous localized amyloidosis suspected clinically. It was carried out for a period of 18 months, with 100 patients in the study. Only patients who gave written informed consent for the study were included. Pregnant and lactating patients were also excluded. Clinical examination with clinical photographs, skin biopsy and dermoscopy of the same lesions was done using a disposable handheld biopsy punch under local anaesthesia. The final diagnosis was then made after compiling all of the clinical, dermoscopic and histopathological features. Microsoft Excel and SPSS version 19 (IBM, Armonk, NY, USA) were used for statistical analysis. Of the 100 patients included in the study, 56 had macular amyloidosis, 33 had lichenoid amyloidosis, eight had biphasic amyloidosis, two had dyschromic amyloidosis and had primary amyloidosis of the concha. The most common age group was 40–60 years, and the condition was more common in women. A history of use of scrubbing and rubbing while bathing was reported in 45 patients: 33 (73%) of these had macular amyloidosis, nine (20%) had lichenoid amyloidosis, two (4%) had mixed amyloidosis and one (2%) had dyschromic amyloidosis. Pruritus was seen in 92 patients (92%). Dermoscopy of amyloidosis showed a hub-and-spoke pattern and amorphous pigmented globules; 11 patients showed nonspecific pigmented globules and seven showed scales and a central scar pattern. On histopathology of macular amyloidosis, 94 patients showed amyloid deposits stained positively with Congo red. The mean Dermatology Life Quality Index was 3 in macular amyloidosis, and 4 in lichenoid and biphasic amyloidosis. Studies using confocal laser scanning microscopy and direct immunofluorescence could further provide insight and can allow better outcomes. Primary cutaneous amyloidosis has a small-to-moderate effect on the quality of life of patients as it is pruritic and disfiguring. Dermoscopy is a valuable tool to diagnose characteristic features and thus helps to make quick and accurate diagnosis and avoid skin biopsies, as shown in this study.
BI03 The presence of VEXAS-related <i>UBA1</i> mutation in a patient with myelodysplastic syndrome
Authors: Evangelia Vetsiou, Arvindh Sekaran, Sarah McDonald, Charles Crawley, Andre Khoo
Journal: British Journal of Dermatology (2024)

Abstract A 56-year-old female patient with a background of myelo­dysplastic syndrome (MDS) was admitted with a febrile illness and a solitary, bullous skin lesion on her right inner thigh. This lesion started as a scaly patch 1 week prior to admission before developing into a large tense bulla with associated lymphadenopathy in the groin. The patient had a background of MDS, which was being treated with donor lymphocyte infusions, having relapsed from a previous allogeneic bone marrow transplant. Initial treatment was with intravenous antibiotics. While ultrasound did not reveal any clear underlying abscess, surgical debridement was performed due to the patient’s deteriorating clinical state and concerns about an infective focus within the wound. Histological analysis showed a neutrophilic infiltrate, raising suspicion of pyoderma gangrenosum or other neutrophilic dermatoses. A UBA1 mutation of uncertain significance was detected in the perivascular histiocytes, raising the possibility of VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Following debridement and exclusion of an infective aetiology, the wound was managed with vacuum-assisted wound closure and a slowly weaning course of 40 mg oral prednisolone over 4 months. The patient subsequently underwent a second allogeneic bone marrow transplant, complicated by sepsis and requiring admission to critical care. During this hospitalization, she developed haemorrhagic lesions that were also considered to be due to an inflammatory process driven by her MDS. These were resolved following initiation of cyclophosphamide immunosuppression after her transplant. The cutaneous manifestations of MDS encompass neutrophilic dermatoses, cutaneous vasculitis and granulomatous skin lesions. Recognition of these manifestations has therapeutic and prognostic importance, as they can precede a diagnosis of MDS and be an indicator of poor prognosis. Differentiating classic MDS from VEXAS syndrome is critical, as the latter lacks additional molecular abnormalities and exhibits less cytological heterogeneity. However, a complex interplay exists between MDS and systemic autoimmune/autoinflammatory diseases (AID), with an undefined pathophysiological mechanism. In this case, we describe the development of known AID associated with underlying MDS in the presence of a VEXAS-related UBA1 mutation, which is responding favourably to stem cell transplant and immunosuppression. The patient is currently in recovery without further skin manifestations.
BI09 Skin cancer burden and dermatological follow-up in solid-organ transplant recipients: a regional study
Authors: Georgia Gilbert, Girish Gupta, Ruth Jones
Journal: British Journal of Dermatology (2024)

Abstract Skin cancer is the most common malignancy affecting solid-organ transplant recipients (SOTRs). This places a significant burden on dermatology and transplant services. The National Institute for Health and Care Excellence recommends that SOTRs with high-risk skin lesions should be reviewed in a dedicated skin surveillance clinic [National Institute for Health and Care Excellence. Improving outcomes for people with skin tumours including melanoma. Available at: https://www.nice.org.uk/guidance/csg8 (last accessed 24 March 2024)], although service provision varies throughout the UK. There is currently no routine skin surveillance service in the region assessed in this study. In anticipation of the British Association of Dermatologists’ expert consensus guidelines for skin cancer surveillance in SOTRs, we aimed to analyse the skin cancer burden and skin surveillance practice within our region. As of November 2023, there were 749 living SOTRs in the region. Patient demographics, transplant type(s), immunosuppression regimens, skin cancer burden, dermatological follow-up and provision of skin cancer prevention advice were retrospectively collected from medical records. After exclusions were made, 648 patients were included for analysis. Pearson’s correlation, χ²-tests and t-tests were used to assess between-group differences. Overall, 15.4% of SOTRs had a skin cancer diagnosis [n = 100; squamous cell carcinoma (SCC) n = 54, basal cell carcinoma n = 59, melanoma n = 6] since transplantation. We found that 17.2% of SOTRs were under regular dermatological follow-up for skin surveillance (n = 112). In terms of SCC frequency, 26 patients had 1 lesion and 27 patients had 2 or more lesions. A total of 68 patients (10.5%) were noted to have extensive actinic keratoses. Older age (P = 0.01), male sex (P = 0.03) and increased time on immunosuppression (P = 0.03) were correlated with presence of skin cancer. The most common immunosuppressant regimen was mycophenolate mofetil (MMF), tacrolimus and prednisolone. The use of MMF seemed to be correlated to SCC burden (P = 0.009), but this is difficult to interpret in the context of multiple immunosuppressant agent use. Only 7.3% (n = 47) of SOTRs were prescribed suncream and 3.7% (n = 24) were offered acitretin. Our study highlights that there is a lack of consistency with regard to optimal skin cancer prevention follow-up and advice, in a region that does not have a routine dermatological skin surveillance service for SOTRs. Limited service resources highlight the importance of collaborative consensus guidelines on best practice for the prevention of skin cancer in SOTRs. Therefore, we have instituted a set of recommendations within our region including guidance regarding prescribed sunscreen use, pathways on how best to access dermatology for SOTRs presenting with skin lesions, and follow-up based on stratification of risk factors.