tbuckley/cabot-search huggingface dataset:
O13 42 590 fewer skin tumours diagnosed in England during the 2020 COVID pandemic: greatest reductions in melanoma <i>in situ</i>, stage I melanomas and basal cell carcinomas
Authors: Omsin Srimudkul, Zoe C Venables, Nick J Levell, Khaylen Mistry, Birgitta Van Bodegraven
Journal: British Journal of Dermatology (2024)

Abstract During the early COVID-19 pandemic, there was a decline in most cancer diagnoses. The aim of this study was to ascertain the extent and impact of this on skin cancer subtypes in England. This national retrospective cohort study identified all skin tumour cases diagnosed in 2019 and 2020 in England from the National Disease Registration Service ‘Get Data Out’ project. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) and Poisson regression analysis were used to compare crude incidence rates (CIR) per 100 000 person-years (PY) in 2020 vs. 2019. In 2019, there were 233 717 skin tumours registered in England; this reduced to 191 127 (IRR 0.81, 95% CI 0.80–0.81, P &amp;lt; 0.001) in 2020. A year prior to the pandemic, there were 15 355 (CIR 27.3 PY) melanomas, 7135 (CIR 12.7 PY) melanomas in situ, 48 112 (CIR 85.5 PY) cutaneous squamous cell carcinomas (cSCCs), 159 178 (CIR 283 PY) basal cell carcinomas (BCCs) and 363 (CIR 0.65 PY) Merkel cell carcinomas (MCCs). When comparing incidence rates for 2020 vs. 2019, significant reductions (P &amp;lt; 0.001) were seen in all tumours except MCC: melanoma (IRR 0.81, 95% CI 0.79–0.83), melanoma in situ (IRR 0.65, 95% CI 0.63–0.68), cSCC (IRR 0.94, 95% CI 0.93–0.96), BCC (IRR 0.78, 95% CI 0.78–0.79) and MCC (IRR 0.93, 95% CI 0.80–1.08). For melanoma by stage, there were 8940 (CIR 22.6 PY) stage I, 2441 (CIR 6.18 PY) stage II, 1004 (CIR 2.54 PY) stage III, 385 (CIR 0.97 PY) stage IV and 2187 (CIR 5.53 PY) stage ‘unknown’ in 2019. The IRR for 2020 vs. 2019 showed significant reductions (P &amp;lt; 0.001) for stage I (IRR 0.76, 95% CI 0.73–0.78) and stage ‘unknown’ melanomas (IRR 0.67, 95% CI 0.62–0.71), while changes were not significant for all other stages. During the 2020 COVID pandemic, there was a 19% reduction in diagnosed skin tumours in England. There was a differential impact between tumour types and stages, with the greatest reduction seen in melanoma in situ (−35%), stage I melanoma (−24%) and BCC (−22%), compared with MCC (−7%), cSCC (−6%) and stage II+ melanoma (+2%). The improvement to staging data in 2020 (−33% ‘unknown’ stage melanomas) limits interpretation, but these account for &amp;lt; 15% of cases of melanoma. It is hypothesized that symptomatic and slow-growing tumours were not prioritized by patients and/or clinicians, potentially resulting in worse patient outcomes and increased burden on health services. This indicates a need for more time to study the impact of delayed diagnosis on survival, better public education on skin cancer recognition, and improved service provision during national emergencies.
P058 Healthcare disparity affecting delayed diagnosis in acral lentiginous melanoma
Authors: Xinxin Wu, Samantha Lesch, Julia Griffin, Peter Silberstein
Journal: British Journal of Dermatology (2024)

Abstract Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous malignant melanoma that arises in patients with minimal correlation to ultraviolet radiation exposure, unlike many other melanoma subtypes (Arrington JH 3rd, Reed RJ, Ichinose H, Krementz ET. Plantar lentiginous melanoma: a distinctive variant of human cutaneous malignant melanoma. Am J Surg Pathol 1977; 1: 131–43). The 5-year overall survival rate for stage I disease is 98%, which can drop as low as 10% for stage IV. A concerning trend in diagnosis has shown that many patients present with this disease later in the disease process and are thus subject to high morbidity and mortality. Of additional concern is that ALM disproportionately affects non-White populations. A previous Surveillance, Epidemiology and End Results study (n = 1724) reported that Black patients, on average, presented with more advanced disease than their White counterparts (Huang K, Fan J, Misra S. Acral lentiginous melanoma: incidence and survival in the United States, 2006–2015, an ana­lysis of the SEER registry. J Surg Res 2020; 251: 329–39). This calls into question the role of socioeconomic inequities in the stage of disease at which patients are diagnosed. A retrospective cohort study of 3683 patients diagnosed with stage I and stage IV ALM between 2004 and 2020 in the National Cancer Database was compared via binary logistics regression to determine factors associated with later diagnosis. On multivariate analysis, Black race and male sex were associated with later stage at diagnosis (P = 0.001 and P &amp;lt; 0.001, respectively). Population density, insurance status, facility location, education level, income status, age and Hispanic status did not have statistically significant associations with patients diagnosed with stage I vs. stage IV ALM. These results illustrate that Black male patients disproportionately face disparities in the diagnosis of this subtype of melanoma. This study highlights the need for continued research on ALM and the factors that affect its prompt recognition, diagnosis and treatment.
P061 Squamoid eccrine ductal carcinomas: challenges in diagnosis and management
Authors: Amy Cunliffe, Somaia Elsheikh, Sunita Odedra, Sandeep Varma
Journal: British Journal of Dermatology (2024)

Abstract Squamoid eccrine ductal carcinomas (SEDCs) are rare adnexal carcinomas displaying both squamous and duct differentiation. We wish to remind clinicians of these recently described cancers, which can have aggressive behaviour (van der Horst MPJ, Garcia-Herrera A, Markiewicz D et al. Squamoid eccrine ductal carcinoma. Am J Surg Pathol 2016; 40: 755–60). We identified five cases in our department: four female patients and one male. All lesions developed on the face, in patients aged 69–83 years. The majority developed over one to several years, apart from one rapidly growing lesion, and measured between 5 and 40 mm. Clinical examination suggested squamous cell carcinoma (SCC) in two cases and basal cell carcinoma in three cases due to features such as puckering, rolled borders, telangiectasia, shine, ulceration and crust. Punch biopsies were performed in all five lesions; however, histological diagnosis of SEDC was suggested in only two. One of these patients underwent Mohs micrographic surgery (MMS), which successfully cleared the lesion after two stages. The second patient, diagnosed on biopsy, had a large 30-mm lesion with invasion into the lacrimal sac and left nasal bone. The patient opted for palliative radiotherapy rather than extensive surgery and subsequently developed a left-cheek metastasis and symptoms suggestive of metastatic disease. Three of our cases were diagnosed after wide local excision (WLE) based on the histological and immunological features. The punch biopsies had suggested either SCC or adenosquamous/adnexal infiltrative carcinoma. One of these patients required adjuvant radiotherapy due to perineural involvement (&amp;lt; 0.1 mm). The other two cases were incompletely excised on WLE and the patients were offered further surgery or radiotherapy. Histologically these lesions were poorly defined infiltrative neoplasms consisting of atypical squamoid cells extending into the deep dermis or subcutaneous tissue with ductal differentiation, pronounced cytological atypia and associated desmoplastic stroma. Tumour thickness measured 3–10.3 mm. Immunohistochemistry was positive for CK7, AE1/AE3, CK5/6, p63, CAM5.2, carcinoembryonic antigen and epithelial membrane antigen. These five cases highlight the challenges faced in the diagnosis of SEDC for both the dermatologist and the dermatopathologist. MMS is recommended (Lim MM, Macdonald JA. Squamoid eccrine ductal carcinoma: treatment and outcomes. Am J Dermatopathol 2022; 44: 249–53) and lesions misdiagnosed as SCC may receive less effective treatment; our three patients who underwent WLE have required further interventions. We also report one patient with locally aggressive and likely metastatic disease. Patients with SEDC benefit from early diagnosis, MMS and close follow-up to reduce the risk of recurrence and improve patient outcomes.
P073 Prevalence, mortality and healthcare resource use for generalized pustular psoriasis compared with plaque psoriasis in England: a population-based cohort study
Authors: Monika Frysz, Smit Patel, Marie Li, Christopher Griffiths, Richard B Warren, Darren Ashcroft
Journal: British Journal of Dermatology (2024)

Abstract Generalized pustular psoriasis (GPP) is a rare, chronic inflammatory skin condition that is potentially life-threatening. Accumulating evidence suggests that GPP is distinct from the more common plaque psoriasis in terms of aetiology and clinical and dermatological features. The aim of this study was to describe the epidemiology, comorbidities, mortality and healthcare resource use (HCRU) in patients with GPP compared with those with plaque psoriasis in England. A retrospective cohort study of the Clinical Practice Research Datalink (CPRD) Aurum database linked with hospital and mortality data, between 2008 and 2019, was conducted, and HCRU between 2015 and 2019 was calculated. Prevalence rates, comorbidities and survival rates were estimated for GPP and plaque psoriasis. Diagnoses were based on CPRD medical codes and International Classification of Diseases 10th Revision codes (L40.1 for GPP, and L40.0 for plaque psoriasis). In total, 373 patients with GPP (62.5% female) and 224 223 patients with plaque psoriasis (49.4% female) were identified. The mean age (SD) was 55.9 years (18.6) for GPP, and 48.5 years (19.1) for patients with plaque psoriasis. A higher proportion of patients with GPP had at least one comorbidity, compared with plaque psoriasis (76.4% vs. 55.9%, respectively). From 2008 to 2019, the prevalence rates per 100 000 persons ranged from 1.61 to 3.0 for GPP, and from 1771 to 1904 for plaque psoriasis. In total, 78 of the 373 (20.9%) patients with GPP died during the study period, compared with 20 771 of 224 223 (9.3%) patients with plaque psoriasis. Compared with plaque psoriasis, survival rates were lower for patients with GPP, particularly those who were over 55 years old and those with a history of at least one comorbidity. Overall, 297 patients with GPP and 181 925 with plaque psoriasis were included in HCRU analysis. Hospitalizations, outpatient visits and accident and emergency visits were more frequent in patients with GPP compared with plaque psoriasis (78% vs. 47%, 92% vs. 75% and 71% vs. 52%, respectively). Our results support previous findings that GPP is a distinct disease from plaque psoriasis with a different epidemiology. Compared with plaque psoriasis, patients with GPP had higher mortality and were found to have higher disease burden, demonstrating a high unmet need in this patient group. The study was supported and funded by Boehringer Ingelheim. Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.
CD02 What is the relevance of epoxy resin in the baseline series?
Authors: Peter Phillips, Preshita Divekar
Journal: British Journal of Dermatology (2024)

Abstract Epoxy resin is used widely in adhesives, aircraft construction, boatbuilding, flooring and electrical encapsulation. It has been largely an occupational sensitizer in men. There have been recent reports of nonoccupational sensitization in women, due to exposure to crafting materials (Dios-Guillán V, Matellanes-Palacios M, Bou-Boluda L et al. Non-occupational, recreational epoxy resin contact allergy: report of two cases. Contact Dermatitis 2021; 85: 257–9) and the modern trend of ‘cosplaying’ (Samaran Q, Strizzolo R, Dereure O, Raison-Peyron N. Non-occupational allergic contact dermatitis to epoxy resin in a cosplayer. Contact Dermatitis 2023; 89: 122–4). We reviewed our patch test database for the 13-year period between 2009 and 2022, to identify patients with positive reactions to 1% epoxy resin tested routinely in the British Society for Cutaneous Allergy baseline series. Most patients had also been patch tested to at least one or two extended series including epoxy series. In total, 2445 patients (1701 female, 744 male) had been tested to epoxy resin. Fifteen patients (0.6%) (mean age 59.8 years, range 23–84) had tested positive (nine male, 1.2%; six female, 0.4%). The grade of reaction was +++ in two, ++ in eight and + in five. Of the fifteen, four were also sensitized to bisphenol F, two to 1,6-hexanediol diglycidyl ether and one each to BIS-GMA, 2-phenylglycidyl ether, triethylenetetramine, 1,4-butanediol diglycidyl ether, and phenol formaldehyde resin. Ten had dermatitis of the hands and/or forearms; four had involvement of the head and neck. The mean duration of dermatitis was 42 months (range 2–180). Eight had a history of atopy. Nine patients had known current or previous exposure to epoxy resins, four of whom had ongoing relevant exposure. Seven had occupational exposure (five male, two female). Two worked in boatbuilding or repair (wooden boatbuilder and boat painter), two in construction (decking builder and engineer) and two in art, and one was a lighthouse keeper and airport ground worker. An eighth patient had possible occupational exposure in gardening and a ninth had reacted to dental restorations. Both of the occupationally sensitized women had been exposed as artists working with epoxy resins. Relevance was unknown in six. The predominance of men in this audit is in accordance with previous publications. We found no patient of either sex sensitized through use of crafting kits. We could see no trend towards a reduction in the prevalence of sensitization to epoxy resin during this time period, nor a change in clinical relevance. The sensitization rate of 0.6% in unselected patients (1.2% male, 0.4% female) suggests that epoxy resin remains a relevant allergen, and we recommend that it remain in the baseline patch test series.
P062 A multicentre retrospective observational study reviewing the management of severely dysplastic naevi
Authors: Vani Agarwal, Siddarth Dave, Radhika Bali, Nada Khalil, Laksha Bala, James Carton, Rishika Sinha, Chrystalla Macedo, Neil P. Patel, Louise Fearfield
Journal: British Journal of Dermatology (2024)

Abstract The aim of this study was to evaluate management of severely dysplastic naevi (SDN) across two NHS trusts over 5 years. A natural language search was performed on the local histopathology system (Copath) to identify all SDN excised between 1 January 2018 and 1 January 2023. Duplicates, cases from external trusts, and histology reports mentioning ‘melanoma in situ’ (MIS) were excluded. Many cases had a spectrum of dysplastic changes mentioned in the report; in such cases the most severe diagnosis was used. Electronic medical records were reviewed to ascertain the surgical excision margin, histological margin, multidisciplinary team (MDT) discussion, management and duration of follow-up. In total, 136 cases were identified, of which 82 met the inclusion criteria. Trust A had 43 included cases and Trust B had 39 included cases. Overall, 58% (n = 25) of Trust A and 97% (n = 38) of Trust B cases were excised with a 2-mm surgical margin, while 81% (n = 35) of Trust A cases and 85% (n = 33) of Trust B cases were excised with at least a 1-mm histological margin. In total, 44% (n = 19) of Trust A and 51% (n = 20) of Trust B cases were discussed at skin cancer MDT. The diagnoses of two cases at Trust A were upgraded to MIS, and one case at Trust B was upgraded to a pT1a melanoma after MDT review. Overall, 74% (n = 32) of cases at Trust A were offered wide local excision (WLE); of these, 78% (n = 25) were to achieve 5-mm clearance. In total, 18% (n = 7) of cases at Trust B were offered WLE; of these, 29% (n = 2) were to achieve 5-mm clearance. Monitoring was recommended in 2% (n = 1) of Trust A cases and 26% (n = 10) of Trust B cases. Our results demonstrate that management of SDN can differ substantially between trusts. Trust A managed the majority (58%) of cases as MIS, whereas Trust B took a more conservative approach. There was no significant difference in outcome. There are currently no consensus guidelines on the management of SDN in the UK or internationally. Surveys from Australia, Canada, the USA and the UK have shown variation in clinical practice. Review of the current literature supports the re-excision of incompletely excised SDN and monitoring (as opposed to re-excision) of completely excised SDN, as the risk of progression to melanoma appears low. Our results highlight the need for consensus guidelines to manage these cases to provide optimal and consistent patient care, as well as minimizing unnecessary and potentially disfiguring surgery.
P090 A randomized study to compare the efficacy of topical tofacitinib vs. topical tacrolimus in treatment of patients with unstable vitiligo
Authors: Hitaishi Mehta, Anuradha Bishnoi, K Vinay, Sendhil Kumaran, Davinder Parsad
Journal: British Journal of Dermatology (2024)

Abstract Topical tacrolimus 0.1% is a widely accepted treatment for localized vitiligo. However, emerging Janus kinase inhibitors like tofacitinib show promise. Existing evidence for topical tofacitinib largely comes from open-label, uncontrolled studies and case reports, often in combination with other therapies. This prospective, 16-week, single-blinded, split-body study evaluated the efficacy and tolerability of topical tofacitinib 2% ointment vs. topical tacrolimus 0.1% ointment applied twice daily in a cohort of 25 patients with limited vitiligo. Participants aged ≥ 5 years with a diagnosis of nonsegmental vitiligo, limited to ≤ 10% body surface area, and at least two symmetrical vitiligo patches that had been active in last 12 months were included. After informed consent was obtained, vitiliginous patches on either side of the body were randomized to receive either topical tofacitinib or topical tacrolimus. The total duration of therapy was 16 weeks, and patients were followed up every 4 weeks. The primary outcome was Vitiligo Noticeability Scale (VNS) of two symmetrical target patches at week 16 as reported by patients, with a VNS of 4 (‘a lot less noticeable’) or 5 (‘no longer noticeable’) considered as treatment success. Secondary outcomes included clinician-reported percentage repigmentation, time to attainment of treatment success and incidence of adverse effects. The study cohort, comprising 25 patients analysed for 50 vitiligo patches, had a mean age of 22.4 years (range 5–59). The topical tofacitinib group achieved a VNS of 4 or 5 (considered treatment success) in 14 patients (56%), compared with 11 (44%) in the tacrolimus group (P = 0.40). Clinicians observed significant repigmentation exceeding 75% in 15 patients within the tofacitinib group and 13 patients within the tacrolimus group (P = 0.57). The mean (SD) time to attain treatment success was 12.4 (3.8) weeks for tacrolimus and 10.0 (4.4) weeks for tofacitinib. Strikingly, tofacitinib demonstrated treatment success as early as 4 weeks in three patients, whereas no such rapid success was observed in the tacrolimus group. Adverse effects, predominantly mild, included transient erythema (n = 1) and burning sensations (n = 5) with tacrolimus, while tofacitinib led to application-site pain and pruritus in one patient each (P = 0.12). Limitations of our study include the small sample size, short treatment duration and single-blinded study design. In summation, this study unveils the efficacy of both topical tofacitinib and tacrolimus in repigmenting vitiligo lesions. Tofacitinib exhibits a higher, though statistically nonsignificant, treatment success rate and a swifter onset of repigmentation, indicating its potential as a robust therapeutic option for limited vitiligo.
P063 Understanding the landscape of Kaposi sarcoma hospitalizations in the USA: demographic associations stratified by AIDS/HIV status
Authors: Roy Mendoza, Norma Espinoza, Jessica Saoub, Leslie Kieron, Shaokui Ge
Journal: British Journal of Dermatology (2024)

Abstract Kaposi sarcoma (KS), a low-grade vascular tumour associated with human herpesvirus 8 (KSHV/HHV8), has demonstrated a notable increase among Black men despite an overall decreasing trend in the USA. Given the lack of information regarding the national rates of KS in the USA, this study aims to characterize the national inpatient burden of individuals affected by KS, exploring demographic disparities on a broader scale. We queried the National Inpatient Sample (NIS), a subset of the Healthcare Cost and Utilization Project database containing US hospital discharge data, from 2016 to 2019 to identify all patients aged ≥ 18 years with a diagnosis of KS. We used the data to estimate the national representation and KS-relevant hospital admissions compared with the national civilian population. Stratifying by HIV/AIDS status (AIDS-related KS vs. non-AIDS-related KS), we examined the demographic associations of inpatients with KS using a Wald χ2-test. We determined the incidence rate ratios of admission for KS-related concerns using a Poisson regression model. All statistical analyses were performed with SAS 9.4 (SAS Institute Inc., Cary, NC, USA). In total, 12 246 patients with KS were estimated from the NIS. Overall, the inpatients with KS were predominantly male (91.1%), Black (41.4%) and in the 18–44-year age group (47.7%). AIDS-related KS constituted the majority of patients with KS (10 065, 82.2%), predominantly affecting Black individuals (45.7%) compared with patients classified as White, Hispanic and other (30.2%, 17.6% and 6.5%, respectively). Male patients were more often affected, at a 16 : 1 male-to-female ratio, the largest recorded thus far. Black patients with AIDS had a significantly higher risk of hospitalization. Non-AIDS-related KS comprised 17.8% of cases, primarily among White (51.4%) and male (77.5%) patients, and those aged 65–84 years (49.3%). Despite the differences by KS type, Black patients and those aged ≥ 85 years with non-AIDS-related KS still faced a heightened risk of hospitalization. This study underscores the distinct demographic patterns of inpatients with KS by HIV/AIDS status. For AIDS-related KS, focused efforts are required for Black individuals – addressing their elevated risk, initiating early therapeutic intervention, and promoting adherence to antiretroviral therapy. In cases of non-AIDS-related KS, attention must be given to the older age groups, especially those with a history of immunosuppression. These findings advocate for specialized dermatological strategies considering demographic nuances, contributing to more effective and targeted care for patients with KS.