tbuckley/cabot-search huggingface dataset:
DS05 Overtreatment of skin cancer: how can we ensure those treated for basal cell carcinoma receive more benefit than harm?
Authors: Zoe C Venables, Birgitta van Bodegraven, James B Powell
Journal: British Journal of Dermatology (2024)

Abstract For over a decade, international reports have highlighted how thousands of patients treated for basal cell carcinoma (BCC) die within a few years of a diagnosis, which questions how much benefit surgical treatment had. The current British Association of Dermatologists guidelines for basal cell carcinoma (BCC) have limited discussions on conservative, active surveillance, or no-treatment options. BCCs are often slow growing and minimally symptomatic, and therefore treatments such as curettage, cryotherapy, radiotherapy or topical therapy may be more appropriate in patients with limited life expectancy. Although associated with higher risk of recurrences, these treatments can be performed closer to home and may have lower associated morbidity than a complex excision. This abstract reports the incidence and survival following a first BCC diagnosis in England from the National Disease Registration Service Get Data Out (GDO) website, stratified by age. Survival is reported for first-ever tumours only, so subsequent tumours are excluded. For those aged ≥ 80 years, GDO reporting is separated by site; we chose facial BCC to represent survival outcomes in this age group. From 2013 to 2015 in England there were 271 473 first BCCs, of which 68 869 (25.4%) occurred in those aged ≥ 80 years. Kaplan–Meier overall survival rates at 3 and 5 years for patients of all ages following a first BCC were 90.3% [95% confidence interval (CI) 90.2–90.4] and 83.1% (95% CI 82.9–83.2), respectively. For those aged ≥ 80 years with a facial BCC, Kaplan–Meier overall survival rates at 3 and 5 years survival fell to 73.9% (95% CI 73.4–74.4) and 56.2% (95% CI 55.7–56.8), respectively, with similar findings at other sites. Net survival was consistently around 100% for various sites and age groups for first BCC; for example, in those aged 70–79 years with a facial BCC, 5-year net survival is 100.5% (95% CI 100.1–101). Net survival uses published life tables to compare survival of a person with a BCC to a person without a BCC accounting for variables including age, sex, deprivation and geography. The 5-year net survival for BCC was consistently around 100%. This implies that BCCs do not affect survival, and therefore, when considering BCC treatment, we must consider primarily the morbidity of no treatment vs. treatments. Overall survival analysis identified that 26.1% of patients aged ≥ 80 years with facial BCC die within 3 years and 43.8% die within 5 years of diagnosis. Better understanding this cohort of patients with limited life expectancy, who are less likely to benefit from treatment, is critical to patient care. Age alone is an incomplete predictor of limited life expectancy, but validated frailty scoring tools can assist in identifying patients who would benefit from a more informed conversation about the risks and benefits of treatment.
Poster presentationsCD10 Gunpowder dermatitis: is there such a thing?
Authors: Zahra Moledina, Kiran Singh, Angela Tewari
Journal: British Journal of Dermatology (2024)

Abstract We report a case of a 17-year-old boy who developed a facial rash on three consecutive occasions after firing a rifle. Patch testing to the British Standard Series was positive to cobalt chloride. Our patient described a clear history of the gun smoking and then him developing an itchy facial rash 2 h later. Over the next few hours, he developed worsening facial erythema and swelling. This was treated with antihistamines and topical steroids and resolved. A few months later, he developed a similar rash with facial oedema when firing his rifle. After just under 2 h there was facial erythema and oedema, and erythematous papules could be seen on the wrists. This was again treated in a similar manner and resolved. There was no oral or laryngeal involvement. Moreover, a third time, when he was cleaning his rifle, he developed a similar rash a few hours later. There have been no episodes of the rash occurring outside of relation to the rifle. It was felt that this could represent a contact allergy to the potassium nitrate found in gunpowder that would rebound back from the butt of the rifle to enable bullets to be fired from the cartridge. Our patient used blanks, which also contain gunpowder but without the firing bullets. The patient was tested to the European Standard Battery only. At day 4, the patient developed a 2++ reaction to cobalt only. Cobalt chloride is a common metal known to cause a delayed hypersensitivity reaction, affecting approximately 1–3% of the population (Midander K, Werner P, Isaksson M et al. Cobalt nanoparticles cause allergic contact dermatitis in humans. Br J Dermatol 2023; 188: 278–87). It is used to line the barrel of some rifles to reduce erosion and barrel wear (De Rosset WS, Montgomery JS. Cobalt-base alloy gun barrel study. Wear 2014; 316: 119–23). It is thought that our patient experienced immediate contact urticaria with a secondary id reaction to the cobalt. We have counselled him on other cobalt-containing products. There are currently no published reports of hypersensitivity reactions to cobalt through the use bullet-containing rifles.
BH09 Mycophenolate mofetil in the management of lichen planus pigmentosus in a woman with frontal fibrosing alopecia
Authors: Su Htwe, Susan Holmes
Journal: British Journal of Dermatology (2024)

Abstract A 50-year-old woman of south Asian descent presented with a 4-year history of hair loss, itching and follicular prominence at her frontal hairline, in association with increasingly sparse eyebrows and loss of body hair. She was otherwise well and on no medication. Clinical examination revealed typical features of frontal fibrosing alopecia (FFA), with associated papules on the forehead. In addition, striking hyperpigmentation was evident over the forehead, face and neck. This was felt to be in keeping with FFA-associated dyspigmentation–lichen planus (LP) pigmentosus. Initial management was lymecycline 408 mg once daily, tacrolimus 0.1% ointment twice daily plus mometasone furoate 0.1% two times weekly to the neck, and pimecrolimus cream twice a day to the face, as well as a sun protection factor 50 sunscreen. Hydroxychloroquine was avoided initially due to the potential side-effect of altered skin pigmentation with this drug. While the hairline recession remained unchanged, the pigmentary changes worsened despite treatment and affected areas became increasingly itchy. Lymecycline was stopped and hydroxychloroquine 200 mg once daily was started. After 12 months, the cutaneous pigmentation continued to worsen and was extending onto the arms and torso. A trial of low-dose isotretinoin (20 mg once daily) was considered as this has been reported to be of benefit in LP pigmentosus. However, after 6 months, there was no improvement. A trial of mycophenolate mofetil 500 mg twice daily was then commenced. After 3 months of treatment, skin itching had settled and no new areas of hyperpigmentation were noted. After 9 months, there had been a significant improvement in skin pigmentation, which has been maintained. The extent of frontal hairline recession has remained stable. While FFA was initially described exclusively in postmenopausal White women, it has since been reported in Hispanic, African, Afro-Caribbean and Asian individuals, premenopausal women, and men. Dyspigmentation associated with FFA has largely been a feature observed in patients with darker skin types, and it is not clear whether this pigmentation is part of the spectrum of FFA in individuals with darker skin or whether LP pigmentosus is occurring coincidently with FFA in patients with darker skin types. Low-dose isotretinoin has been reported as being of benefit in LP pigmentosus but was ineffective in this case. Mycophenolate mofetil is also reported to be of benefit in the management of LP pigmentosus, and led to a significant improvement in both pigmentation and itch in this case. This case highlights the therapeutic benefit of mycophenolate mofetil in in LP pigmentosus associated with FFA.
P079 The lifetime risk of vitiligo across sociodemographic groups: a UK population-based cohort study
Authors: Viktoria Eleftheriadou, Alia Ahmed, John Nesnas, Ranjit Nagra
Journal: British Journal of Dermatology (2024)

Abstract The lifetime risk for vitiligo has not previously been estimated using large-scale population data. It is also not clear how the lifetime risk for vitiligo differs by sex, ethnicity and levels of socioeconomic deprivation. We aimed to estimate the lifetime incidence of vitiligo in the UK, overall and across sociodemographic subgroups. Incident cases of vitiligo were identified using a large database (Optimum Patient Care Database) of routinely collected primary care records in the UK between 1 January 2004 and 31 December 2020. Lifetime incidence of vitiligo was estimated at age 80 years using modified time-to-event models, adjusted for competing risk of death, with age as the timescale. Lifetime incidence was estimated for the study population overall and stratified by ethnicity, sex and deprivation. We identified 9460 adults and children newly diagnosed with vitiligo during the study period. The overall cumulative lifetime incidence in the population was 0.92% at age 80 years [95% confidence interval (CI) 0.90–0.94]. Lifetime incidence was similar in female (0.94%, 95% CI 0.92–0.97) and male patients (0.89%, 95% CI 0.86–0.92). There were substantial differences in lifetime incidence across ethnic groups: Asian (3.58%, 95% CI 3.38–3.78), Black (2.18%, 95% CI 1.85–2.50), mixed (2.03%, 95% CI 1.58–2.47), other (1.05%, 95% CI 0.94–1.17) and White ethnicity (0.73%, 95% CI 0.71–0.76). There were also substantial differences in the lifetime incidence across sociodemographic subgroup, with higher lifetime risk in the most deprived quintile (1.25%, 95% CI 1.20–1.31) compared with the least deprived quintile (0.81%, 95% CI 0.77–0.86). However, these differences appear to result from a higher proportion of people from non-White ethnicities in the lower socioeconomic subgroups. In post hoc analysis when restricting the sociodemographic analysis to those of White ethnicity only, the socioeconomic differences were negligible. Our estimates of lifetime incidence suggest that 1 in 109 people will develop vitiligo over their lifetime. Clinicians should be aware of the markedly increased incidence of vitiligo in people of non-White ethnicity, in particular for those of Asian ethnicity (1 in 28 people). The negative impact of vitiligo on mental health, work and healthcare utilization highlights the importance of monitoring people with vitiligo to identify those who need additional support. The study protocol for this retrospective observational study was registered a priori with ClinicalTrials.gov (identifier: NCT06097494). This research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and funded by Pfizer.
BH10 Unequal National Health Service wig provision: toupée or no toupée, that is the question?
Authors: Marianne de Brito, Amy Johnson, Sue Schilling, Leila Asfour, Nick J Levell
Journal: British Journal of Dermatology (2024)

Abstract The psychological impact of alopecia on patients’ quality of life can be significant. Patients may experience loss of confidence, discrimination, social anxiety and other mental health disorders as a result. In the absence of effective and well-tolerated treatments available in the National Health Service (NHS) to treat the underlying cause of the alopecia, wigs can provide an opportunity for patients to live confidently, free of stigma and visible differences. The Alopecia UK Charter for Best Practice for Wigs Provision aimed to support fair and equitable wig provision across the UK, work that was supported by NHS England and NHS Improvement. We investigated wig provision across nonprivate patients in the UK via an online survey. We circulated a three-question, 1-minute survey to dermatology doctors and healthcare professionals seeing nonprivate patients within NHS trusts (England), health boards (Wales and Scotland) or health and social care trusts (Northern Ireland). This was via the Alopecia UK stand at the British Association of Dermatologists (BAD) Annual Meeting 2023, to the circulation of the British Hair and Nail Society membership and events, and via the BAD newsletter. We received 73 responses. Overall, for nonprivate patients with severe alopecia, most reported that wig provision would be straightforward (52%), but a large minority reported variable difficulty, due to patient or other factors (33%), and 5% reported it would be impossible. The remaining 10% did not know. There were respondents from all regions of the UK, with most from England: 59 (Northern Ireland: 2, Scotland: 3, Wales: 7, not stated: 2). The best-represented regions in England were the Midlands (14), the North West (14), North East and Yorkshire (10) and London (9), but there were responses from all regions. There was widespread variation in access to wig provision by different regions. All respondents from Scotland (3 of 3) and the South West (2 of 2) reported wig provision was straightforward, while all respondents from Northern Ireland (2 of 2) reported variable difficulty. At least 50% of the respondents from the East of England, London, Midlands, South East and North West reported wig provision was not straightforward. The findings of this survey reveal widespread variation in ease of access to wig provision throughout different regions of the UK. This demonstrates a lack of equality between patients with alopecia in different regions of the UK and impacts on patient choice. This goes against the Alopecia UK Charter for Best Practice for Wigs Provision. We hope that these findings will have implications at health policy level to improve and standardize access for all patients with alopecia who want and need a wig.
P043 Readability assessment of <i>British Journal of Dermatology</i> plain language summaries
Authors: Rory Barry, Susan O’Gorman
Journal: British Journal of Dermatology (2024)

Abstract Plain language summaries (PLSs) are being increasingly implemented and required by regulatory bodies to improve accessibility of scientific research for the general population. In 2014, the British Journal of Dermatology (BJD) introduced freely available PLSs to improve patient access to high-quality dermatology research. Over 40% of adults in England do not have adequate literacy skills for health information. As such, when developing PLSs, the NHS recommend targeting a reading age of 9–11 years, up to 14 years in particularly complex medical information. While social media may remain more accessible, the misinformation risk underlines the important role of scientific journals in engaging the lay community in high-quality published research. Based on NHS guidelines, we assessed the readability level of published PLSs in the last 12 issues of the BJD, from 1 December 2022 to 16 November 2023. Multiple established readability metrics were used, including Flesch–Kincaid (FK), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (GFI), FORCAST, and Flesch Reading Ease (FRE). Only English-language PLSs were included for analysis. Ninety-nine English-language PLSs were published in those 12 BJD issues. According to FK, the mean readability US grade level was 13.0 [95% confidence interval (CI) 12.7–13.4]. A US grade level is one integer less than the UK year system (e.g. US grade 6 = UK year 7). As such, a US grade level of 13 corresponds to an age range of 18–20 years, or a college-level student. SMOG, an NHS-recommended readability instrument, evaluates text for 100% comprehensibility. Evaluating BJD PLSs using SMOG, the mean US grade level was 11.9 (95% CI 11.5–12.2), indicative of a 17–18-year reading age in the UK. The GFI analysis gave a mean US grade level of 16.2 (95% CI 15.7–16.6) for the PLSs, equating to a reading age of 22 years. The average grade level from FORCAST assessment was 11.5 (95% CI 11.4–11.7), giving a reading age of 17 years. Finally, using FRE testing, the mean output was 41.5 (95% CI 39.4–43.6), corresponding to the ‘difficult’ category in the Flesch read­ability chart, a reading age of 18 years or above. This research suggests that the BJD PLSs are not appropriately written for dermatology patients, according to the England population literacy level and NHS guidelines. Readability formulas, while potentially limited through lack of comprehension and reading ease assessment, provide authors guidance of appropriate literacy level PLS. By encouraging authors to use readability resources and PLS guidelines the BJD may improve patient engagement with the journal.
P028 The importance of clinical metadata when triaging patients for face-to-face assessment and possible biopsy in a teledermatology pathway
Authors: Shafiqul Islam, Joseph Walls, Per Hall, Haider Raza, John Gan, Alba Garcia, Gordon Wishart
Journal: British Journal of Dermatology (2024)

Abstract The 7-point checklist (7PCL) is recommended by NICE to select patients with pigmented lesions and possible melanoma for urgent referral. This research investigates the potential of using machine learning (ML) models that utilize patient metadata from a teledermatology pathway including 7PCL for suspicious skin lesion detection, and compares the performance gain for each meta-feature added with the 7PCL. We analysed clinical metadata from 53 601 skin lesions in 25 105 patients who attended private skin cancer diagnosis clinics in the UK between 2015 and 2022. For each lesion, we included the following meta-features: 7PCL (change of lesion size, shape, colour, lesion &amp;gt; 7 mm, inflamed, oozing, itching), weighted 7PCL, Williams score characteristics (patient age, patient sex, natural hair colour, arm mole count, sunburn history, prior nonmelanoma skin cancer), the overall Williams score, prior melanoma, lesion location, lesion age, and whether this was a predominantly nonpigmented pink lesion. All lesions were categorized as suspicious (10%) or nonsuspicious (90%) by skin cancer specialists during telemedicine triage (cancer detection rate = 5%). All meta-features were used as ML model inputs to classify whether each input was associated with suspicious or nonsuspicious classes. This study integrates five ML models (naive Bayes, logistics regression, support vector machine, random forest, and multilayer perceptron) to detect suspicious skin lesions based on patient metadata. Firstly, we compared the ML model performance between the original 7PCL and weighted 7PCL in correctly identifying suspicious skin lesions. We then added each meta-feature with 7PCL and tabulated the performance gain. We utilized balanced accuracy, sensitivity, specificity and area under the curve as evaluation metrics. There were no significant differences observed in model performance between the 7PCL and weighted 7PCL (sensitivity 68.1%). However, the performance of the ML model was improved significantly for each added meta-feature, with the best performance gain (sensitivity 85.2%) observed when 11 meta-features (lesion pink, Williams score, lesion age, sunburn, patient age, Williams group, patient sex, hair colour, site of the lesion on the body, freckling tendency, and mole count) were added to the 7PCL. This research has identified the optimal subset of meta-features that improve ML model performance for categorizing suspicious skin lesions during telemedicine triage, compared with 7PCL alone. Fusing these high-performing meta-features with image modalities is likely to further boost the ML model performance for skin cancer detection, and they could also be used to modify current skin cancer referral guidelines. The study is funded and supported by Innovate UK and the private teledermatology pathway provider.
DS10 Postoperative complications after two-stage interpolated flap repairs for nasal defects after Mohs surgery
Authors: Arif Aslam
Journal: British Journal of Dermatology (2024)

Abstract Dermatologists perform more flaps after skin cancer surgery than all other specialties. This study evaluated complications after interpolated flap repairs (forehead and cheek–nose) of the nose after Mohs surgery. This was a single-surgeon prospective study of 64 patients undergoing two-stage interpolated flap repairs over a 6-year period. Complications such as bleeding, infection, flap necrosis and hospitalization were reported. Seventeen patients experienced complications after flap placement, and six after the flap division and inset. The most common complication after the flap was created was bleeding, with infection being the most common after takedown. This study shows that two-stage flap repairs for the nose after Mohs surgery can be safely performed in a hospital outpatient setting under local anaesthesia.
P064 Prevention is better than cure: acitretin and chemoprevention
Authors: Fazleenah Ajmul Hussain, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2024)

Abstract Solid organ transplant recipients (SOTRs) have an increased incidence of cutaneous malignancy, especially nonmelanoma skin cancers (NMSC), where the risk is estimated to be up to 65 times higher than that of the general population. A 10-fold increase in mortality has been reported for NMSC in SOTRs. There are currently no guidelines on chemoprevention of recurrent keratinocyte tumours (KTs) in patients with or without transplants, leading to variation in clinical practice. We undertook an online survey analysing acitretin use for NMSC chemoprevention among British dermatologists. The questionnaire was distributed through email to dermatologists in the UK. We received 52 responses, of which 37 (71%) were from consultants. Most responses came from dermatologists practising in Scotland (34, 65%). The cohort was highly experienced, with 20 (38%) having &amp;gt; 20 years’ dermatology experience and 13 (25%) responders having 11–20 years’ experience. Overall, 24 (46%) saw fewer than five SOTRs in their clinic in a month and 20 (38%) saw hardly any. In nontransplant patients, 26 (50%) dermatologists prescribed acitretin for recurrent KTs, whereas 13 (25%) did not. The preferred dosing was 10 mg for the majority (29, 60% of those with data). Prescribers (n = 25, 53%) commenced patients on acitretin after they developed at least two to five KTs; one prescriber started acitretin after development of at least one KT. In the SOTR group, acitretin was prescribed after development of recurrent KT and not pre-emptively; 10 mg was the preferred dose for majority (22, 47%). For both SOTRs and nontransplant patients, acitretin was prescribed indefinitely by 31 (63%) responders. Interestingly, 17 (35%) dermatologists did not prescribe acitretin in SOTRs and 10 (20%) did not prescribe acitretin in either SOTRs or nontransplant patients. Thirteen (25%) did not prescribe acitretin in nontransplant patients with recurrent KT. Side-effects of acitretin were not severe enough to lead to discontinuation according to 16 (35%) responders. Some commented that adverse events were patient and dose dependent, and by minimizing the dose of acitretin, they reduced side-effects. In total, 47 (92%) provided regular photoprotective advise to patients with recurrent KTs. Overall, 49 (94%) did not encounter patients with skin of colour with recurrent KTs in their practice. To our knowledge, this is the first survey assessing the practice of acitretin use in chemoprevention in both transplant and nontransplant patients. Our survey suggests discrepancies in practice among dermatologists prescribing acitretin in SOTRs and nontransplant patients. More than one-third did not prescribe acitretin in SOTRs with recurrent KTs. There is good evidence that acitretin reduces the incidence of KT in SOTRs, and hence its use should be encouraged in this cohort.