ORCID Profile
0000-0002-9461-2790
Current Organisations
Te Whatu Ora Health New Zealand Waikato
,
Royal Australasian College of Physicians
,
University of Otago
,
The University of Auckland
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Publications
Surgical Excision Margins in Primary Care and Plastic Surgery for Keratinocytic Cancers Diagnosed via Teledermatology: Retrospective Observational Cross-Sectional Study
Publisher: JMIR Publications Inc.
Date: 17-08-2023
DOI: 10.2196/49466
Abstract: The incidence of keratinocytic cancers is increasing. In New Zealand, surgical treatment of skin cancers is often undertaken in primary care. In the Waikato district, general practitioners (GPs) are encouraged to confirm diagnoses via teledermatology. Histological examination should confirm clear surgical margins to reduce tumor recurrence. International guidelines recommend a lateral margin of ≥3 mm for basal cell carcinomas (BCCs) and ≥4 mm for squamous cell carcinomas (SCCs). This study aimed to determine lateral and deep margins in keratinocytic cancer excisions performed by GPs (in a private setting) and plastic surgeons (in a private or public setting) after a teledermatologist had confirmed that excision was necessary. Demographic, clinical, and histological features were recorded. A retrospective observational cross-sectional study was conducted. The s le in the electronic dermatology referral database included keratinocyte cancers recommended for excision from March to May 2022. Histological reports revealed that excision was complete in 186 of 201 confirmed cases of keratinocyte cancer. The lateral margins of resection were considered in 10 tumors and deep margins in 8 tumors. All incomplete excisions were carried out by GPs, 11 of which were on the head and neck. There were 133 BCCs, 100 of which were excised by a GP, 3 by a private plastic surgeon, and 30 by a public hospital surgeon. In total, 52 BCCs were present on the head and neck (25 excised by GPs, 25 by hospital plastic surgeons, and 2 by private plastic surgeons) and 81 were present on other sites (75 excised by GPs, 5 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 9 cases (of which 5 cases involved head and neck tumors). The minimum distance from the tumor to the lateral margin was mm in 80 tumors: 64 were excised by a GP, 2 by private plastic surgeons, and 14 by hospital plastic surgeons. This distance was ≥3 mm in 44 tumors (27 excised by GPs, 1 by a private plastic surgeon, and 16 by hospital plastic surgeons). These data show significant adherence to surgical margin recommendations among plastic surgeons compared to that among GPs (odds ratio 2.873, CI 1.274-6.477 P=.009). There were 68 SCCs: 57 were excised by a GP, 2 by a private plastic surgeon, and 9 by a public hospital surgeon. In total, 21 SCCs were on the head and neck (14 excised by GPs, 6 by hospital plastic surgeons, and 1 by a private plastic surgeon) and 47 were on other sites (43 excised by GPs, 3 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 1 head and neck SCC case and were not reported in others. The minimum distance from the tumor to the lateral margin was mm in 35 cases: 31 were excised by a GP, 1 by a private plastic surgeon, and 3 by a hospital plastic surgeon. This distance was ≥4 mm in 31 cases (24 excised by GPs, 1 by a private plastic surgeon, and 6 by hospital plastic surgeons). These data do not show significant difference in adherence to surgical margin recommendations between GPs and plastic surgeons (P .05). Complete resection reduces the risk of recurrence of keratinocytic tumors. GPs in our study were less likely than specialist surgeons to respect surgical margin recommendations established in international guidelines for managing keratinocytic cancer. None declared.
Teledermatology in the Waikato region of New Zealand
Publisher: SAGE Publications
Date: 12-2001
Abstract: Teledermatology consultations over a video-link began at Health Waikato in 1995. Clinical trials involving about 500 patients have demonstrated the diagnostic accuracy and economic gains of these teleconsultations, and patient satisfaction with them. Yet, six years on, out-of-date equipment remains under-used. There has been no expansion of the network and no additional clinical teleconsultation services. Possible reasons include the excessive capital cost of videoconferencing equipment, clinician overwork, inconvenience, lack of reimbursement, administrative and governmental inertia, and little demand from patients and their doctors. To widen our referral base without the inconvenience of videoconferencing, we decided to offer a secure browser-based dermatology tele-advice service to referring general practitioners who owned digital cameras. With the increase in online health information and electronic communication, we assumed it would be popular. But, despite up to six-month waits for patients to be seen in the dermatology outpatient clinic, few patients have been referred to the service. Explanations have included time constraints, unavailability of a camera, no Internet access at the time of consultation and lack of reimbursement. Can we look forward to a future in which all doctors have high-speed access to the Internet at their desktop through their practice management systems? Who will pay? Will they continue to prefer conventional referral?
Diagnostic criteria in 72 women with erosive vulvovaginal lichen planus
Publisher: Wiley
Date: 26-05-2015
DOI: 10.1111/AJD.12355
Abstract: Erosive vulvovaginal lichen planus (EVLP) is a chronic, painful dermatosis affecting mucocutaneous sites. Clinicopathological diagnostic criteria have been described on the basis of expert consensus. The aim of this study was to review the presentation of EVLP, particularly assessing the frequency of suggested diagnostic criteria. Clinical signs, symptoms and histological features of women with a clinical diagnosis of EVLP were identified from clinical records and photographs. In all, 72 women with an average age of 67 years were included. Pain or burning were documented in 66/72 cases (92%) and itch in 36 (50%). Clinical images showed well-demarcated red shiny areas or erosions at the vaginal introitus (96%), scarring with loss of normal architecture (88%) and hyperkeratotic border and Wickham striae (46%). A total of 27 women had mucosal disease at another site (38%) and 24 had vaginal involvement (33%). Vulval histology was available for 45/72 cases (63%). The most prevalent histological finding was a band of inflammation with predominant lymphocytes (35/72, 49%). Overall, 97% of cases had at least three of nine suggested diagnostic criteria. The most frequent findings in women with EVLP were symptoms of pain or burning, well-demarcated red shiny areas or erosions at the introitus and scarring with loss of architecture. Our findings support the recently described diagnostic criteria for EVLP.
Do pictures say a thousand words: Email referrals for dermatology advice at Waikato Hospital.
Publisher: Wiley
Date: 08-2017
DOI: 10.1111/AJD.12630
Palmoplantar keratoderma: An adverse reaction to influenza vaccination
Publisher: Wiley
Date: 30-09-2011
DOI: 10.1111/J.1440-0960.2011.00817.X
Abstract: Acquired palmoplantar keratoderma (PPK) is a rare group of conditions with a number of aetiologies, including adverse reactions to drugs. Herein, we report a case of acquired PPK in association with influenza vaccination, confirmed by rechallenge.
Better, sooner, more convenient: A successful teledermoscopy service
Publisher: Wiley
Date: 29-12-2012
DOI: 10.1111/J.1440-0960.2011.00836.X
Abstract: A virtual lesion clinic (VLC) using store-and-forward teledermoscopy was introduced to reduce waiting times and improve access for skin lesion assessment by dermatologists. We aimed to review the efficiency and patient acceptance of a new community-based teledermoscopy service by comparing it to hospital-based face-to-face (FTF) skin lesion clinics. A prospective study compared patient flow through a community-based VLC and a tertiary hospital FTF dermatology clinic. Surveys were sent to patients and their referring doctors after attendance. Waiting times, diagnosis, outcomes, financial costs, patient acceptability and convenience were compared. A total of 300 patients were assessed 200 were seen in the VLC and 100 in the conventional FTF clinic. Of the 200 patients seen in the VLC, 88% did not require a subsequent FTF clinic assessment to establish the diagnosis. Mean waiting times for first assessment were reduced by two thirds (from 114 days to 39 days) in those seen by the VLC compared to FTF. Financial analysis demonstrated cost savings of 14%. Surveyed patients were highly satisfied and confident in the VLC service. A community-based teledermoscopy service may allow improved management of outpatient referrals while providing a better, quicker and more convenient service. It may also provide cost savings, as teledermoscopy assessment can be cheaper than traditional assessment.
Vaginal stenosis after toxic epidermal necrolysis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
HAIR BUNDLES: A PRESENTATION OF FOLLICULITIS
Publisher: Wiley
Date: 12-1985
DOI: 10.1111/J.1440-0960.1985.TB01768.X
Abstract: The targeting of type III secretion (TTS) proteins at the injectisome is an important process in bacterial virulence. Nevertheless, how the injectisome specifically recognizes TTS substrates among all bacterial proteins is unknown. A TTS peripheral membrane ATPase protein located at the base of the injectisome has been implicated in the targeting process. We have investigated the targeting of the EspA filament protein and its cognate chaperone, CesAB, to the EscN ATPase of the enteropathogenic E. coli (EPEC). We show that EscN selectively engages the EspA-loaded CesAB but not the unliganded CesAB. Structure analysis revealed that the targeting signal is encoded in a disorder-order structural transition in CesAB that is elicited only upon the binding of its physiological substrate, EspA. Abrogation of the interaction between the CesAB-EspA complex and EscN resulted in severe secretion and infection defects. Additionally, we show that the targeting and secretion signals are distinct and that the two processes are likely regulated by different mechanisms.
Teledermatology in New Zealand
Publisher: SAGE Publications
Date: 03-2001
DOI: 10.1007/BF02737864
Quality of Life and Sexual Distress in Women With Erosive Vulvovaginal Lichen Planus
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Experience with quality assurance in two store-and-forward telemedicine networks
Publisher: Frontiers Media SA
Date: 26-11-2015
Surgical Excision Margins in Primary Care and Plastic Surgery for Keratinocytic Cancers Diagnosed via Teledermatology: Retrospective Observational Cross-Sectional Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 30-05-2023
Abstract: he incidence of keratinocytic cancers is increasing. In New Zealand, surgical treatment of skin cancers is often undertaken in primary care. In the Waikato district, general practitioners (GPs) are encouraged to confirm diagnoses via teledermatology. Histological examination should confirm clear surgical margins to reduce tumor recurrence. International guidelines recommend a lateral margin of ≥3 mm for basal cell carcinomas (BCCs) and ≥4 mm for squamous cell carcinomas (SCCs). his study aimed to determine lateral and deep margins in keratinocytic cancer excisions performed by GPs (in a private setting) and plastic surgeons (in a private or public setting) after a teledermatologist had confirmed that excision was necessary. Demographic, clinical, and histological features were recorded. retrospective observational cross-sectional study was conducted. The s le in the electronic dermatology referral database included keratinocyte cancers recommended for excision from March to May 2022. istological reports revealed that excision was complete in 186 of 201 confirmed cases of keratinocyte cancer. The lateral margins of resection were considered in 10 tumors and deep margins in 8 tumors. All incomplete excisions were carried out by GPs, 11 of which were on the head and neck. There were 133 BCCs, 100 of which were excised by a GP, 3 by a private plastic surgeon, and 30 by a public hospital surgeon. In total, 52 BCCs were present on the head and neck (25 excised by GPs, 25 by hospital plastic surgeons, and 2 by private plastic surgeons) and 81 were present on other sites (75 excised by GPs, 5 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 9 cases (of which 5 cases involved head and neck tumors). The minimum distance from the tumor to the lateral margin was & mm in 80 tumors: 64 were excised by a GP, 2 by private plastic surgeons, and 14 by hospital plastic surgeons. This distance was ≥3 mm in 44 tumors (27 excised by GPs, 1 by a private plastic surgeon, and 16 by hospital plastic surgeons). These data show significant adherence to surgical margin recommendations among plastic surgeons compared to that among GPs (odds ratio 2.873, CI 1.274-6.477 i P /i =.009). There were 68 SCCs: 57 were excised by a GP, 2 by a private plastic surgeon, and 9 by a public hospital surgeon. In total, 21 SCCs were on the head and neck (14 excised by GPs, 6 by hospital plastic surgeons, and 1 by a private plastic surgeon) and 47 were on other sites (43 excised by GPs, 3 by hospital plastic surgeons, and 1 by a private plastic surgeon). Lateral margins were considered in 1 head and neck SCC case and were not reported in others. The minimum distance from the tumor to the lateral margin was & mm in 35 cases: 31 were excised by a GP, 1 by a private plastic surgeon, and 3 by a hospital plastic surgeon. This distance was ≥4 mm in 31 cases (24 excised by GPs, 1 by a private plastic surgeon, and 6 by hospital plastic surgeons). These data do not show significant difference in adherence to surgical margin recommendations between GPs and plastic surgeons ( i P /i & .05). omplete resection reduces the risk of recurrence of keratinocytic tumors. GPs in our study were less likely than specialist surgeons to respect surgical margin recommendations established in international guidelines for managing keratinocytic cancer.
Retrospective review of teledermatology in the Waikato, 1997-2002
Publisher: Wiley
Date: 02-2004
DOI: 10.1111/J.1440-0960.2004.00047.X
Abstract: We reviewed scheduled interactive teledermatology consultations from 1997 to 2002 between the Department of Dermatology of Health Waikato in Hamilton and remote sites at Taumarunui Hospital, Taupo Health Centre and the Ranolf Medical Centre, Rotorua, in New Zealand. Eighty-five per cent of 384 appointments were attended and most non-attendances were unexplained. The reason for consulting a dermatologist was inflammatory skin disease in 74% of cases, cutaneous infection in 10%, a skin lesion in 12% and no diagnosis was made in 4%. Follow ups were arranged for 41%, mainly by telemedicine (74%). Despite the apparent success of 75% of consultations and positive feedback from patients attending them, the service has not proved sustainable long-term. This is because of other priorities for the delivery of health care, lack of support by clinicians and administrators, and ongoing financial costs.
A baseline patch test series for New Zealand.
Publisher: Wiley
Date: 22-07-2021
DOI: 10.1111/AJD.13673
Abstract: Patch testing is the gold standard diagnostic test for allergic contact dermatitis and needs to be relevant to the region and the population being tested. The aim of this study was to develop a specific New Zealand baseline series (NZBS). We performed a retrospective case note review of patients attending four regional patch test centres between 2008 and 2020. Demographic and diagnostic information was collected for each patient along with results of patch testing. Using the results of this review, a group of 11 dermatologists with an interest in contact dermatitis agreed on a core group of allergens for inclusion in an NZBS, based on the frequency of positive reactions and allergens of interest. The remaining potential allergens were ranked by each dermatologist using an online questionnaire, with inclusion in the final NZBS by consensus. Results from 2402 patients (67% female, mean age 44 years) from Auckland, Wellington, Palmerston North and Christchurch were collated. The 10 most frequent positive (relevant and non-relevant) allergens were nickel sulfate (22.0%), fragrance mix I (8.6%), cobalt chloride (7.3%), Myroxylon pereirae (5.6%), colophonium (5.1%), p-phenylenediamine (4.9%), methylisothiazolinone/methylchloroisothiazolinone (4.1%), fragrance mix II (3.9%), potassium dichromate (3.5%) and methylisothiazolinone (3.4%). Based on these results, a core series of 30 allergens was developed, with an additional 30 allergens added to form the extended series (total 60 allergens). The baseline series of patch test allergens for routine use in New Zealand (NZBS) is based on national patch test data and expert consensus.
An observational case series on dermatoscopic patterns of fading melanocytic naevi
Publisher: Wiley
Date: 03-2016
DOI: 10.1111/AJD.12464
Abstract: The prevalence of melanocytic naevi falls with age. It has been postulated that this could be due to spontaneous involution (fading). Our objective was to provide dermatoscopic evidence of fading naevi and to describe the patterns of fading observed. Serial dermatoscopic images of naevi demonstrating fading were collected from a set of 25 000 images. Any naevi that showed significant fading, as compared to previous imaging of the same lesion, were included in the analysis. A total of 47 naevi in 21 patients were found to have significantly faded over a span of 2-11 years. The dermatoscopic fading was observed to occur in two patterns. The most common pattern observed was generalised fading (n = 45), where fading was present over all the naevus. There were two cases of focal fading (n = 2) where fading was present only over one area of the naevus. Fading melanocytic naevi are uncommon. Melanocytic naevi fade in recognisable patterns, with generalised fading most commonly observed in our series.
Dermoscopic 'Chaos and Clues' in the diagnosis of melanoma in situ.
Publisher: Wiley
Date: 02-11-2018
DOI: 10.1111/AJD.12740
Abstract: To describe the dermoscopic features of melanoma in situ using the Chaos and Clues method. Histologically proven primary melanoma in situ (MIS) diagnosed through a specialist teledermoscopy clinic were reviewed by three dermatologists. By consensus they agreed on the global dermoscopic pattern, colours, presence of chaos (asymmetry of colour and structure and more than one pattern), and each of the nine clues described for malignancy. One hundred MIS in 92 patients of European ethnicity (45 males) were assessed. Mean age was 67.3 years (range 20-95). The mean dimensions of the lesions were 11.1 × 12.0 mm (range 2.5-31.3 × 2.3-32.3 mm). Using pattern analysis, 82% of the lesions had three or more patterns (multicomponent) and the rest had 2 patterns. Colours included light brown (100%), dark brown (98%) and grey (75%). All MIS demonstrated chaos. The most prevalent clues were thick lines (88%), eccentric structureless areas (88%), and grey or blue structures (75%). Dermoscopy can be very helpful in the early diagnosis of melanoma and MIS. The Chaos and Clues method is simple to use. Its unambiguous descriptors can be successfully used to describe MIS. The presence of chaos and clues to malignancy (including thick lines, eccentric structureless areas, and blue/grey structures) should raise a red flag and lead to referral or excision.
Teledermatology for Enhancing Skin Cancer Diagnosis and Management: Retrospective Chart Review
Publisher: JMIR Publications Inc.
Date: 29-05-2023
DOI: 10.2196/45430
Abstract: Skin cancer rates are at all-time highs, but the shortage of dermatologists compels patients to seek medical advice from general practitioners. A new referral pathway called the Suspected Skin Cancer (SSC) service was established to provide general practitioners in Waikato, New Zealand, with rapid diagnosis and treatment advice for lesions suspicious for skin cancer. The aim of this study was to assess the quantity, quality, and characteristics of referrals to the SSC teledermatology service during its first 6 months. A retrospective chart review of all referrals sent to the SSC teledermatology service during the first 6 months of its operation was conducted. Time to advice, diagnoses, diagnostic discordance, adherence to advice, and time to treatment were recorded. Diagnostic discordance between general practitioners, dermatologists, and pathologists was calculated. The SSC service received 340 referrals for 402 lesions. Dermatologists diagnosed 256 (63.7%) of these lesions as benign 56 (13.9%) were histologically confirmed as malignant, including 19 (4.7%) melanomas. The overall discordance between referrer and dermatologist on specific and broad (ie, benign or malignant) diagnoses for 402 lesions was 47% and 26% (κ=0.58, SD 0.07), respectively 44% and 26% (κ=0.61, SD 0.15) between referrer and pathologist and 18% and 12% (κ=0.82, SD 0.12) between dermatologist and pathologist. The mean time between referral submission and receiving advice was 1.02 days. The average time to action (eg, excision) was 64.8 days. An electronic referral system can be an effective form of teledermatology for providing prompt diagnosis and management advice for benign and malignant skin lesions.
E‐referrals and teledermatoscopy grading for melanoma: a successful model of care
Publisher: Wiley
Date: 16-02-2020
DOI: 10.1111/AJD.13230
Growth rate of clinically diagnosed superficial basal cell carcinoma and changes in dermoscopic features over time
Publisher: Wiley
Date: 23-06-2020
DOI: 10.1111/AJD.13352
Interobserver variability of teledermoscopy: an international study
Publisher: Oxford University Press (OUP)
Date: 04-11-2010
DOI: 10.1111/J.1365-2133.2010.10010.X
Abstract: Teledermoscopy is a rapidly developing field of dermatology with studies demonstrating excellent agreement with face-to-face diagnosis. However, we are unaware of studies evaluating interobserver variability in diagnosis between dermatologists from different continents. This evaluation is important to determine the robustness of teledermoscopy and allow comparisons to be made between different studies. To assess the interobserver diagnostic variability between five independent experienced dermatologists (A-E) in New Zealand, Australia and the U.S.A. Images from 979 lesions from 206 patients were distributed to five dermatologists. The lesions were viewed and diagnoses recorded using MoleMap Diagnose (MoleMap, Auckland, New Zealand) software. The diagnoses were analysed for interobserver variability. There was excellent agreement between four of five dermatologists (A-D) for lesions that were agreed upon as melanoma (κ = 0·81-0·97) and benign naevus (κ = 0·77-0·82).The fifth dermatologist (E) made a more frequent diagnosis of atypical naevus and melanoma than the others. For nonmelanocytic lesions, there was moderate to very good agreement for seborrhoeic keratosis (κ = 0·64-0·80) and basal cell carcinoma (κ = 0·55-0·67), but poor agreement for invasive squamous cell carcinoma (SCC) (κ = 0·05-0·15). Agreement for actinic keratosis (κ = 0·32-0·67) and SCC in situ (κ = 0·15-0·32) was only moderate. When atypical and benign naevi were grouped together and actinic keratosis and SCC in situ grouped together, there was better agreement among all dermatologists. There was good ability to distinguish malignant from benign lesions (κ = 0·57-0·93). There was good agreement among dermatologists A-D but dermatologist E varied from the group with more frequent diagnosis of melanoma and atypical naevus. This difference could be due to different definition of terms with lack of consensus guidelines in definition of atypical naevus, lack of familiarity with the specific patient population and/or diagnostic drift.
Modelling Mitochondrial Disease in Human Pluripotent Stem Cells: What Have We Learned?
Publisher: MDPI AG
Date: 20-07-2021
DOI: 10.3390/IJMS22147730
Abstract: Mitochondrial diseases disrupt cellular energy production and are among the most complex group of inherited genetic disorders. Affecting approximately 1 in 5000 live births, they are both clinically and genetically heterogeneous, and can be highly tissue specific, but most often affect cell types with high energy demands in the brain, heart, and kidneys. There are currently no clinically validated treatment options available, despite several agents showing therapeutic promise. However, modelling these disorders is challenging as many non-human models of mitochondrial disease do not completely recapitulate human phenotypes for known disease genes. Additionally, access to disease-relevant cell or tissue types from patients is often limited. To overcome these difficulties, many groups have turned to human pluripotent stem cells (hPSCs) to model mitochondrial disease for both nuclear-DNA (nDNA) and mitochondrial-DNA (mtDNA) contexts. Leveraging the capacity of hPSCs to differentiate into clinically relevant cell types, these models permit both detailed investigation of cellular pathomechanisms and validation of promising treatment options. Here we catalogue hPSC models of mitochondrial disease that have been generated to date, summarise approaches and key outcomes of phenotypic profiling using these models, and discuss key criteria to guide future investigations using hPSC models of mitochondrial disease.
Are We Missing Something? The Skin Lesions Not Seen in Teledermatology (Preprint)
Publisher: JMIR Publications Inc.
Date: 02-12-2021
Abstract: he suspected skin cancer electronic referral pathway was introduced in 2017. It requires general practitioners to add regional, close-up, and dermoscopic images to a lesion-specific referral template for a teledermatologist to review and advise on management. The virtual lesion clinic is a nurse-led clinic used since 2010 to obtain high-quality images for teledermoscopy assessment. A limitation of both services is the absence of a full-body examination. his study aims to evaluate the number of skin cancers missed during teledermatology assessment. his is a retrospective review of skin lesion referrals to dermatology. Suspected skin cancer referrals made in the latter half of 2020 were compared with referrals to the virtual lesion clinic during a similar time period in 2016. he study included 481 patients with 548 lesions in the 2020 suspected skin cancer cohort that were matched for age, sex, and ethnicity to 400 patients with 682 lesions in the 2016 virtual lesion clinic cohort. A total of 41 patients underwent subsequent specialist review in the suspected skin cancer cohort compared to 91 in the virtual lesion clinic cohort. A total of 20% of the suspected skin cancer cohort and 24% of the virtual lesion clinic cohort were found to have at least one additional lesion of concern. The majority of these were keratinocytic skin cancers there were 2 and 0 additional melanomas or melanoma-in-situ, respectively. The virtual lesion clinic nurses identified additional lesions for imaging in 78 of 400 (20%) patients assessed in the virtual lesion clinic. The teledermatologist determined (author AO) that 73% of these additional lesions were malignant. Of the 548 lesions, 10 (2%) in the suspected skin cancer group were rereferred, none of which had a change in diagnosis. Out of 682 lesions, 16 (2%) in the virtual lesion clinic cohort were rereferred, 6 (1%) of which had a change in diagnosis. atients diagnosed with skin cancer often have multiple lesions of concern. Single-lesion teledermoscopy diagnoses have high concordance with in-person evaluation and histology however, we have shown that in-person examination may reveal other suspicious lesions. The importance of a full-body skin examination should be emphasized to the referrer.
Bullous systemic lupus erythematosus
Publisher: Wiley
Date: 08-11-2000
DOI: 10.1046/J.1440-0960.2000.00426.X
Abstract: A 19-year-old woman with a 6 month history of systemic lupus erythematosus (SLE) developed a widespread urticated, erythematous eruption associated with tense, fluid-filled blisters, erosions and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence showed markedly positive granular IgG deposition with weak IgM, IgA and C3 at the dermoepidermal junction. No circulating antibodies were detected on indirect immunofluorescence. A diagnosis of bullous systemic erythematosus was made. Treatment with prednisone was ineffective. Subsequent treatment with dapsone led to rapid sustained remission of skin symptoms. Bullous SLE is a rare manifestation of SLE. We review the recent literature and discuss the distinctive features of this condition and contrast them with cutaneous SLE with blisters and the subepidermal blistering disorders.
Artificial Intelligence Support for Skin Lesion Triage in Primary Care and Dermatology (Preprint)
Publisher: JMIR Publications Inc.
Date: 02-12-2021
Abstract: rimary care providers, dermatology specialists, and health care access are key components of primary prevention, early diagnosis, and treatment of skin cancer. Artificial intelligence (AI) offers the promise of diagnostic support for nonspecialists, but real-world clinical validation of AI in primary care is lacking. e aimed to (1) assess the reliability of an AI-based clinical triage algorithm in classifying benign and malignant skin lesions and (2) evaluate the quality of images obtained in primary care using the study camera (3Gen DermLite Cam v4 or similar). his was a single-center, prospective, double-blinded observational study with a predetermined study design. We recruited participants with suspected skin cancer in 20 primary care practices who were referred for assessment via teledermatology. A second set of photographs taken using a standardized camera was processed by the AI algorithm. We evaluated the image quality and compared two teledermatologists’ diagnoses by consensus (the “gold standard”) with AI and histology where applicable. ur primary outcome assessment stratified 391 skin lesions by management as benign, uncertain, or malignant. Uncertain lesions were not included in the sensitivity and specificity analyses. Uncertain lesions included lesions that had either diagnostic or management uncertainties. For the remaining 242 lesions, the sensitivity was 97.26% (95% CI 93.13%-99.25%) and the specificity was 97.92% (95% CI 92.68%-99.75%). The AI algorithm was compared with the histological diagnoses for 123 lesions. The sensitivity was 100% (95% CI 95.85%-100%) and the specificity was 72.22% (95% CI 54.81%-85.80%). he AI algorithm demonstrates encouraging results, with high sensitivity and specificity, concordant with previous AI studies. It shows potential as a triage tool in conjunction with teledermatology to augment health care and improve access to dermatology. Further real-life studies need to be conducted on a larger scale to assess the reliability, usability, and cost-effectiveness of the algorithm in primary care.
Pellagra, azathioprine and inflammatory bowel disease.
Publisher: Oxford University Press (OUP)
Date: 1997
DOI: 10.1046/J.1365-2230.1997.1930606.X
Abstract: Studies and tests to assess the tactical domain of young soccer players are recent, and few instruments meet the majority of quality criteria. To adapt and validate the The article consists of two studies. Study 1 ( In the cross-cultural evaluation, the Coefficient of content validity total (CCV The TCTOF-BRA presented satisfactory evidence, demonstrating it to be an instrument with valid and reliable measures for the evaluation of tactical knowledge (declarative and theoretical procedural), based on specific knowledge and decision making (cognitive domain), of Brazilian young soccer players from 12 to 17.9 years old.
Melanoma-diagnosis by telemedicine
Publisher: SAGE Publications
Date: 09-1996
Abstract: To test whether systemic cytokine release is associated with central nervous system inflammatory responses and glial injury in immune effector cell-associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor (CAR)-T cell therapy in children and young adults. We performed a prospective cohort study of clinical manifestations as well as imaging, pathology, CSF, and blood biomarkers on 43 subjects ages 1 to 25 who received CD19-directed CAR/T cells for acute lymphoblastic leukemia (ALL). Neurotoxicity occurred in 19 of 43 (44%) subjects. Nine subjects (21%) had CTCAE grade 3 or 4 neurological symptoms, with no neurotoxicity-related deaths. Reversible delirium, headache, decreased level of consciousness, tremor, and seizures were most commonly observed. Cornell Assessment of Pediatric Delirium (CAPD) scores ≥9 had 94% sensitivity and 33% specificity for grade ≥3 neurotoxicity, and 91% sensitivity and 72% specificity for grade ≥2 neurotoxicity. Neurotoxicity correlated with severity of cytokine release syndrome, abnormal past brain magnetic resonance imaging (MRI), and higher peak CAR-T cell numbers in blood, but not cerebrospinal fluid (CSF). CSF levels of S100 calcium-binding protein B and glial fibrillary acidic protein increased during neurotoxicity, indicating astrocyte injury. There were concomitant increases in CSF white blood cells, protein, interferon-γ (IFNγ), interleukin (IL)-6, IL-10, and granzyme B (GzB), with concurrent elevation of serum IFNγ IL-10, GzB, granulocyte macrophage colony-stimulating factor, macrophage inflammatory protein 1 alpha, and tumor necrosis factor alpha, but not IL-6. We did not find direct evidence of endothelial activation. Our data are most consistent with ICANS as a syndrome of systemic inflammation, which affects the brain through compromise of the neurovascular unit and astrocyte injury. ANN NEUROL 2019.
Teledermatology for Enhancing Skin Cancer Diagnosis and Management: Retrospective Chart Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 30-12-2022
Abstract: kin cancer rates are at all-time highs, but the shortage of dermatologists compels patients to seek medical advice from general practitioners. A new referral pathway called the Suspected Skin Cancer (SSC) service was established to provide general practitioners in Waikato, New Zealand, with rapid diagnosis and treatment advice for lesions suspicious for skin cancer. he aim of this study was to assess the quantity, quality, and characteristics of referrals to the SSC teledermatology service during its first 6 months. retrospective chart review of all referrals sent to the SSC teledermatology service during the first 6 months of its operation was conducted. Time to advice, diagnoses, diagnostic discordance, adherence to advice, and time to treatment were recorded. Diagnostic discordance between general practitioners, dermatologists, and pathologists was calculated. he SSC service received 340 referrals for 402 lesions. Dermatologists diagnosed 256 (63.7%) of these lesions as benign 56 (13.9%) were histologically confirmed as malignant, including 19 (4.7%) melanomas. The overall discordance between referrer and dermatologist on specific and broad (ie, benign or malignant) diagnoses for 402 lesions was 47% and 26% (κ=0.58, SD 0.07), respectively 44% and 26% (κ=0.61, SD 0.15) between referrer and pathologist and 18% and 12% (κ=0.82, SD 0.12) between dermatologist and pathologist. The mean time between referral submission and receiving advice was 1.02 days. The average time to action (eg, excision) was 64.8 days. n electronic referral system can be an effective form of teledermatology for providing prompt diagnosis and management advice for benign and malignant skin lesions.
Rapid repigmentation after depigmentation therapy: vitiligo treated with monobenzyl ether of hydroquinone.
Publisher: Wiley
Date: 05-1996
DOI: 10.1111/J.1440-0960.1996.TB01014.X
Abstract: Repigmentation occurred within a few weeks of discontinuing successful depigmentation therapy with monobenzyl ether of hydroquinone, in a patient with extensive vitiligo. Patients undertaking depigmentation therapy should be warned that this may occur. The mechanism is unknown.
A 9-Year Teledermoscopy Service: Retrospective Service Review
Publisher: No publisher found
Date: 2021
DOI: 10.2196/35401
Online patient information
Publisher: Frontline Medical Communications, Inc.
Date: 09-2002
Abstract: Information appropriate for patients with skin diseases is readily available on the Internet. Patients primarily seek disease-related information, but may also search for a dermatologist, shop for skin care products, or look to a consumer organization for support. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Interactive opportunities include bulletin boards, ask-an-expert forums, and live chat. Although it is easy to find excellent dermatological information, the Internet is dynamic and unmoderated and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers in evaluating the quality of health-related information.
Waikato Teledermatology: a pilot project for improving access in New Zealand.
Publisher: SAGE Publications
Date: 06-2015
Abstract: Teledermatology can improve access to specialist dermatological advice. We describe a retrospective review of the first 12 months of Waikato Teledermatology (WT), a low-cost, secure, website-based, store-and-forward teledermatology network using the Collegium Telemedicus platform. We determined specialist response time, referral metrics, patient diagnosis and progress reports from the network’s database. The programme’s value was evaluated by post-pilot online surveys of referrers and specialist dermatologists. WT was used by 31 referring doctors for 309 consultations with four dermatologists between July 2013 and June 2014. Mean and median specialist response time was 2.07 hours (range: 0.13–5.64 hours). The researchers categorized the referrals as tumours (56.8%) and rashes (43.2%), including inflammatory dermatoses (51.9%), infection (18.1%), uncertain (16.5%), miscellaneous (7.5%), and of environmental origin (6%). Thirty tumours were biopsied, including nine melanomas and three basal cell carcinomas. A total of 158 progress reports and 35 survey responses were received. Reported advantages included decreased delay, improved accuracy of diagnosis and treatment compared to that made without specialist input, decreased unnecessary procedures such as biopsies of undiagnosed conditions, and increased appropriate referrals for face-to-face assessment, thus leading to cost savings for the patient and the health care system. The major disadvantages were the time burden for clinicians to complete consultations, the lack of integration with the patients’ usual electronic medical record and absence of funding. WT proved an effective and acceptable approach to improving patient access to dermatologic services.
A cost-minimization analysis of the societal costs of realtime teledermatology compared with conventional care: results from a randomized controlled trial in New Zealand
Publisher: SAGE Publications
Date: 08-2001
Abstract: A randomized controlled trial was carried out to measure the societal costs of realtime teledermatology compared with those of conventional hospital care in New Zealand. Two rural health centres were linked to a specialist hospital via ISDN at 128 kbit/s. Over 10 months, 203 patients were referred for a specialist dermatological consultation and 26 were followed up, giving a total of 229 consultations. Fifty-four per cent were randomized to the teledermatology consultation and 46% to the conventional hospital consultation. A cost-minimization analysis was used to calculate the total costs of both types of dermatological consultation. The total cost of the 123 teledermatology consultations was NZ$34,346 and the total cost of the 106 conventional hospital consultations was NZ$30,081. The average societal cost of the teledermatology consultation was therefore NZ$279.23 compared with NZ$283.79 for the conventional hospital consultation. The marginal cost of seeing an additional patient was NZ$135 via teledermatology and NZ$284 via conventional hospital appointment. From a societal viewpoint, and assuming an equal outcome, teledermatology was a more cost-efficient use of resources than conventional hospital care.
Preventing long term relapsing tinea unguium with topical anti-fungal cream: a case report.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2009
Clinical review of 202 patients with vulval lichen sclerosus: A possible association with psoriasis
Publisher: Wiley
Date: 11-01-2007
DOI: 10.1111/J.1440-0960.2007.00322.X
Abstract: Two hundred and two patients with clinically typical or biopsy-confirmed vulval lichen sclerosus were reviewed either at consultation (75%) or by retrospectively examining their chart. At diagnosis, 79% were 50 years or older. Ninety-six per cent complained of itching, pain and/or dyspareunia. Lichen sclerosus most often affected the labia minora and perineum but 50% had perianal and 13% had extragenital disease. Thirty-five patients gave a history of psoriasis (17%), which affected the vulval area in 10. Thyroid disease was reported in 39 patients (19%), and 33 gave a family history of thyroid disease. Of those tested (142), 20% had elevated thyroid antibodies. Topical clobetasol propionate was very effective but at least intermittent treatment was required long term in 85%. At follow up, 101 of 185 patients (56%) were asymptomatic but 22 (12%) continued to have moderate-to-severe symptoms. Thyroid disease and psoriasis are common associated conditions.
Diagnostic value of written referral and/or images for skin lesions
Publisher: SAGE Publications
Date: 04-2006
DOI: 10.1258/135763306776738620
Abstract: We examined whether it is possible for a dermatologist to diagnose benign and malignant skin lesions by telemedicine, given a comprehensive history and/or clinical images. A medical student recorded a standardized history and description of 109 skin lesions and took digital photographs of the presenting lesion(s) immediately prior to a normal outpatient dermatology consultation. About 52 dermatologists were invited to participate in online diagnosis. In all, 38 took part and they were provided with the text and/or the image(s) online on a secure Website. When the images and text were provided, 53% of teledermatology diagnoses were the same as the face-to-face diagnosis. When images alone were provided, 57% of diagnoses were the same. When text alone was provided, 41% of diagnoses were the same. The relatively low diagnostic concordance may have been due to the inexperience of many teledermatologists and poor quality image display systems. The teledermatologists were less confident in their diagnoses than face-to-face specialists, especially in the absence of images. The teledermatology management plan was more likely to include biopsy, excision or review than was the case at the face-to-face consultation. Teledermatology may result in an increase in follow-up appointments and surgical procedures.
Erythema multiforme triggered by imiquimod 5% cream.
Publisher: Wiley
Date: 11-07-2017
DOI: 10.1111/AJD.12578
Dermatoscopic features of vulval lesions in 97 women
Publisher: Wiley
Date: 05-03-2016
DOI: 10.1111/AJD.12298
Mobile teledermatology is here to stay
Publisher: Oxford University Press (OUP)
Date: 04-2015
DOI: 10.1111/BJD.13722
Multiple eruptive squamous cell carcinoma in a patient with chronic plaque psoriasis on adalimumab.
Publisher: Wiley
Date: 03-07-2013
DOI: 10.1111/J.1440-0960.2012.00920.X
Abstract: A 67-year-old man with chronic plaque psoriasis previously treated with psoralen plus PUVA, ciclosporin, methotrexate and acitretin developed eruptive squamous cell carcinoma after seven doses of adalimumab. We review the association of squamous cell carcinoma with immunosuppressive agents used for the treatment of chronic plaque psoriasis. Initiation of tumour necrosis factor (TNF)-α inhibitors in a patient at high risk of non-melanoma skin cancer may warrant chemoprophylaxis with acitretin.
A 9-Year Teledermoscopy Service: Retrospective Service Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 02-12-2021
Abstract: teledermoscopy service was established in January 2010, where patients attended nurse-led clinics for imaging of lesions of concern and remote diagnosis by a dermatologist. he study aimed to review the number of visits, patient characteristics, the efficiency of the service, and the diagnoses made. e evaluated the waiting time and diagnosis of skin lesions for all patient visits from January 1, 2010, to May 31, 2019. The relationships between patient characteristics and the diagnosis of melanoma were specifically analyzed. he teledermoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma/melanoma in situ were male sex, European ethnicity, and Fitzpatrick skin type 2. Attendance was maximal during 2015 and 2016. The seasonal variation in visits 2011-2018 revealed a consistent peak at the end of summer and a dip at the end of winter. In the year 2010, 306 patients attended 76% (233/306) of these were discharged to primary care and 24% (73/306) were referred to hospital for specialist assessment. For patients diagnosed by the dermatologist with suspected melanoma from January 1, 2010, to May 31, 2019, the median waiting time for an imaging appointment was 44.5 days (average 57.9 days, range 8-218 days). The most common lesions diagnosed were benign naevus (2933/11,005, 27%), benign keratosis (2576/11,005, 23%), and keratinocytic cancer (1707/11,005, 15%) melanoma was suspected in 5% (507/11,005) of referred lesions ( xref ref-type="supplementary-material" rid="app1" Multimedia Appendix 1 /xref ). The positive predictive value of melanoma/melanoma in situ was 61.1% (320 true positives and 203 false positives). The number needed to treat (ie, the ratio of the total number of excisions to the number with a histological diagnosis of melanoma/melanoma in situ) was 2.02. iagnoses were comparable to the experience of other teledermoscopy services. Teledermoscopy using a nurse-led imaging clinic can provide efficient and convenient access to dermatology by streamlining referrals to secondary care and prioritizing patients with skin cancer for treatment.
CUTANEOUS VASCULITIS FROM MAPROTILINE
Publisher: Wiley
Date: 04-1985
DOI: 10.1111/J.1445-5994.1985.TB04019.X
Abstract: An 83 year old woman with depression, while receiving maprotiline, developed a vasculitic skin eruption which resolved on discontinuing the drug. Vasculitis has not previously been reported with this drug.
Timeliness of diagnosis and treatment of cutaneous melanoma with dermatology, general practice, plastics surgery collaboration – are we meeting standards?
Publisher: CSIRO Publishing
Date: 26-04-2023
DOI: 10.1071/HC23013
(19) Ulcerative lichen planus of the mouth and feet
Publisher: Oxford University Press (OUP)
Date: 07-1985
Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic
Publisher: MDPI AG
Date: 20-11-2021
Abstract: We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively (p 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.
The onset of ultraviolet erythema.
Publisher: Oxford University Press (OUP)
Date: 02-1987
DOI: 10.1111/J.1365-2133.1987.TB05810.X
Abstract: The onset of erythema induced by UVB and by UVC radiation was monitored in two subjects using a reflectance instrument. It was shown that vasodilation occurred some time before erythema became visible, even with small exposure doses of UVB or UVC, after which visible erythema was not apparent for several hours. In one subject, vasodilation was detected very shortly after irradiation and may have even begun during irradiation. In the other subject vasodilation was detected later at most exposure doses, but still some time before erythema became visible. We conclude that the so-called 'latent period' between irradiation and appearance of erythema is an artificial concept arising from the insensitivity of the eye.
Artificial Intelligence Support for Skin Lesion Triage in Primary Care and Dermatology
Publisher: JMIR Publications Inc.
Date: 10-12-2021
DOI: 10.2196/35395
Abstract: Primary care providers, dermatology specialists, and health care access are key components of primary prevention, early diagnosis, and treatment of skin cancer. Artificial intelligence (AI) offers the promise of diagnostic support for nonspecialists, but real-world clinical validation of AI in primary care is lacking. We aimed to (1) assess the reliability of an AI-based clinical triage algorithm in classifying benign and malignant skin lesions and (2) evaluate the quality of images obtained in primary care using the study camera (3Gen DermLite Cam v4 or similar). This was a single-center, prospective, double-blinded observational study with a predetermined study design. We recruited participants with suspected skin cancer in 20 primary care practices who were referred for assessment via teledermatology. A second set of photographs taken using a standardized camera was processed by the AI algorithm. We evaluated the image quality and compared two teledermatologists’ diagnoses by consensus (the “gold standard”) with AI and histology where applicable. Our primary outcome assessment stratified 391 skin lesions by management as benign, uncertain, or malignant. Uncertain lesions were not included in the sensitivity and specificity analyses. Uncertain lesions included lesions that had either diagnostic or management uncertainties. For the remaining 242 lesions, the sensitivity was 97.26% (95% CI 93.13%-99.25%) and the specificity was 97.92% (95% CI 92.68%-99.75%). The AI algorithm was compared with the histological diagnoses for 123 lesions. The sensitivity was 100% (95% CI 95.85%-100%) and the specificity was 72.22% (95% CI 54.81%-85.80%). The AI algorithm demonstrates encouraging results, with high sensitivity and specificity, concordant with previous AI studies. It shows potential as a triage tool in conjunction with teledermatology to augment health care and improve access to dermatology. Further real-life studies need to be conducted on a larger scale to assess the reliability, usability, and cost-effectiveness of the algorithm in primary care. MoleMap NZ, who developed the AI algorithm, provided some funding for this study. HT's salary was partially sponsored by MoleMap NZ, who developed the AI algorithm. AB is a shareholder and consultant to Molemap Ltd provider of the AI algorithm. None declared.
Body site locations of basal cell carcinoma, squamous cell carcinoma and actinic keratosis in patients referred to the Waikato District Health Board teledermoscopy clinic
Publisher: CSIRO Publishing
Date: 13-04-2022
DOI: 10.1071/HC21115
Abstract: Introduction Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratosis (AK) are usually located on sun-exposed areas of the body. Aims Our main aims were to identify the common body site locations of BCC, SCC and AK in patients attending the Waikato District Health Board teledermoscopy clinic, also known as the Waikato Virtual Lesion Clinic, as well as to analyse whether the distribution of location changes with age and sex. Methods This is a retrospective study where the body site location of 3272 keratinocytic lesions was determined and analysed in 1864 patients attending the Waikato District Health Board teledermoscopy clinics between 2010 and 2021. Results All three types of lesion were most commonly located in the head and neck region (40.9% of BCCs, 38% of SCCs, 83.2% of AKs), followed by 26.8% on the trunk for BCC, 32.3% on the lower extremities for SCC, and 11.6% on the upper extremities for AK. Discussion Our findings of body site locations for keratinocytic lesions were consistent with other studies. Patients were commonly diagnosed with multiple keratinocytic lesions.
Retrospective review of primary melanomas excised at Waikato Hospital, New Zealand, 2002-2003
Publisher: Wiley
Date: 11-01-2007
DOI: 10.1111/J.1440-0960.2007.00319.X
Abstract: The aim of this study was to review and compare melanomas referred by general practitioners and melanomas identified at specialist clinics. The medical records relating to 113 primary melanomas excised at Waikato Hospital (a specialist regional base hospital) during 2002 and 2003 were reviewed retrospectively. Forty-seven melanomas (41%) were detected when patients attended specialist clinics (mainly plastic surgery and dermatology), and 66 melanomas (59%) were specifically referred by general practitioners. The melanomas detected at specialist clinics had a lower mean Breslow thickness than those referred by general practitioners (0.57 mm compared with 1.45 mm). Patients referred by general practitioners waited a mean of 26.5 days (range 0-94 days) for first specialist assessment. Following specialist assessment, patients waited a mean of 24.2 days (0-81 days) before excision biopsy.
Patient cost-benefits of realtime teledermatology - A comparison of data from Northern Ireland and New Zealand
Publisher: SAGE Publications
Date: 04-2000
Abstract: As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology 24 as after a hospital appointment 26 and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.
Cutaneous adverse reactions following the Pfizer/BioNTech COVID ‐19 vaccine
Publisher: Wiley
Date: 23-05-2022
DOI: 10.1111/AJD.13859
Abstract: A growing number of cutaneous adverse reactions have been reported following the administration of a COVID‐19 vaccine. We describe a series of twenty patients who developed a variety of cutaneous conditions within two weeks of receiving the Pfizer/ BioNTech BNT162b2 vaccine.
PASI vs PO‐PASI: Patient‐Oriented PASI (PO‐PASI) is comparable to clinician score PASI
Publisher: Wiley
Date: 10-11-2021
DOI: 10.1111/AJD.13738
Abstract: This comparative observational study aimed to validate an online Patient‐oriented Psoriasis Area and Severity Index (PO‐PASI) by comparing it against the Psoriasis Area and Severity Index (PASI), of 97 adult participants with chronic plaque psoriasis. Pearson's correlation coefficient of 0.866 ( P ‐value = 0.0001) showed a strong positive linear correlation, and interclass correlation coefficients [ICC scores = 0.864 [95% confidence intervals (CIs) (0.803 ICC 0.907)]] suggest an interrater reliability of ‘good’ to ‘excellent’ when comparing PO‐PASI to the PASI score. Additionally, we compared PO‐PASI and PASI with DLQI and demonstrated an overall stronger positive correlation between PO‐PASI and DLQI when compared to PASI.
Online Consumer Health Education in Dermatology
Publisher: Mary Ann Liebert Inc
Date: 06-2003
DOI: 10.1089/153056203766437543
Abstract: Comprehensive and accurate health information for the consumer has the potential to improve patient care and health outcomes. NZDermNet, the web site of the New Zealand Dermatological Society, was established in 1996. Its consumer health information section includes more than 250 pages of information about skin diseases and their treatment. It has proven popular with health professionals and patients. In 2002 an average of more than 5000 visitors used the site daily.
Are We Missing Something? The Skin Lesions Not Seen in Teledermatology
Publisher: JMIR Publications Inc.
Date: 10-12-2021
DOI: 10.2196/35393
Abstract: The suspected skin cancer electronic referral pathway was introduced in 2017. It requires general practitioners to add regional, close-up, and dermoscopic images to a lesion-specific referral template for a teledermatologist to review and advise on management. The virtual lesion clinic is a nurse-led clinic used since 2010 to obtain high-quality images for teledermoscopy assessment. A limitation of both services is the absence of a full-body examination. This study aims to evaluate the number of skin cancers missed during teledermatology assessment. This is a retrospective review of skin lesion referrals to dermatology. Suspected skin cancer referrals made in the latter half of 2020 were compared with referrals to the virtual lesion clinic during a similar time period in 2016. The study included 481 patients with 548 lesions in the 2020 suspected skin cancer cohort that were matched for age, sex, and ethnicity to 400 patients with 682 lesions in the 2016 virtual lesion clinic cohort. A total of 41 patients underwent subsequent specialist review in the suspected skin cancer cohort compared to 91 in the virtual lesion clinic cohort. A total of 20% of the suspected skin cancer cohort and 24% of the virtual lesion clinic cohort were found to have at least one additional lesion of concern. The majority of these were keratinocytic skin cancers there were 2 and 0 additional melanomas or melanoma-in-situ, respectively. The virtual lesion clinic nurses identified additional lesions for imaging in 78 of 400 (20%) patients assessed in the virtual lesion clinic. The teledermatologist determined (author AO) that 73% of these additional lesions were malignant. Of the 548 lesions, 10 (2%) in the suspected skin cancer group were rereferred, none of which had a change in diagnosis. Out of 682 lesions, 16 (2%) in the virtual lesion clinic cohort were rereferred, 6 (1%) of which had a change in diagnosis. Patients diagnosed with skin cancer often have multiple lesions of concern. Single-lesion teledermoscopy diagnoses have high concordance with in-person evaluation and histology however, we have shown that in-person examination may reveal other suspicious lesions. The importance of a full-body skin examination should be emphasized to the referrer. The Waikato Medical Research Foundation provided financial support for the study. None declared.
Morphological evolution in melanoma in situ using revised pattern analysis
Publisher: Wiley
Date: 14-09-2020
DOI: 10.1111/PCMR.12923
Abstract: Sequential digital dermoscopic imaging (SDDI) compares surface microscopy images of skin lesions over multiple time points. We utilized a retrospective SDDI cohort to investigate the development of dermoscopic features associated with malignancy in melanoma in situ (MIS). A total of 124 in situ melanomas were assessed from 110 Caucasian patients aged ≥18 years, with ≥2 serial images obtained between 1999 and 2017 and followed for a mean 41 months (3-142). As a positive control group, 58 invasive melanomas from 53 patients were also reviewed. Change in MIS size or number of colours correlated to time (both p < .001). The odds of MIS displaying ≥3 clues to malignancy also correlated to time (OR 5.6-52.1) (p < .05). 75% of in situ melanomas matched a dermoscopic subtype on final imaging. While a clinically significant minority of in situ melanomas were unchanged or lost dermoscopic features, lesions predominantly increased in morphological complexity over time. Longer follow-up periods allow dermoscopic features associated with malignancy and histopathological progression to develop.
Web Analytics: What dermatologists need to know
Publisher: Wiley
Date: 30-08-2021
DOI: 10.1111/AJD.13413
Virtual lesion clinic – Evaluation of a teledermatology triage system for referrals for suspected melanoma
Publisher: Wiley
Date: 27-12-2021
DOI: 10.1111/AJD.13777
Abstract: The Virtual Lesion Clinic (VLC) of Waitematā District Health Board (WDHB) improves melanoma assessment and treatment using teledermatology. The VLC is reserved for pigmented lesions referred as suspected melanoma from primary care but indeterminate at the initial triage. To assess the efficacy of the VLC diagnosis of melanoma. A retrospective audit of suspected melanoma referrals (1 January 2012 to 31 December 2016) was conducted. Lesions were referred to the VLC if diagnostic uncertainty remained at the initial triage. VLC patients attended MoleMap imaging centres, a dermatologist reviewed history and images remotely and suggested a diagnosis and management plan. Post VLC provisional diagnosis of melanoma, all lesions subsequently excised were reviewed. A positive predictive value (PPV) was calculated using concordance between VLC diagnosis of melanoma and histopathological diagnosis of melanoma. Number needed to excise (NNE) for melanoma was derived, as well as an invasive to in‐situ melanoma ratio (IM:MIS) and false negative rate (FNR). The VLC received 1874 referrals for 3546 lesions during the 5‐year study period. Six hundred and seventy‐nine lesions were recommended excision/biopsy or specialist face‐to‐face assessment, and 504 lesions were subsequently excised. The PPV was 62%, NNE 1.62 and IM:MIS 0.76 for lesions suspected to be melanoma at VLC assessment. The VLC had a melanoma‐specific FNR of 7%. The VLC is effective in early diagnosis of melanoma with a high positive predictive value, low number needed to excise and low false negative rate amongst lesions referred as suspected melanoma.
Effect of narrowband ultraviolet B phototherapy on melanocytic naevi.
Publisher: Oxford University Press (OUP)
Date: 27-02-2013
DOI: 10.1111/BJD.12168
Abstract: Melanocytic naevi have been observed to undergo morphological changes following exposure to narrowband ultraviolet (NB-UV)B radiation. To analyse changes in naevi exposed to NB-UVB in a large cohort of patients. Subjects referred for phototherapy had macroscopic and dermoscopic images taken of prominent melanocytic naevi at the following time points: immediately prior to NB-UVB treatment, after 10 exposures, after 30 exposures or at the end of treatment if earlier, and 3 months after discontinuing treatment. Four dermatologists, by consensus, examined each naevus for specific clinical and dermoscopic features at each time point. The size (area) of each naevus was determined by plenimetry. Complete sets of images were taken for 36 out of 51 patients. The most common global dermoscopic patterns in the 440 naevi examined were reticular (50%) and globular (32%). Following NB-UVB exposure, blurring or merging of lines was observed in 45% of reticular naevi. An increase in colour intensity and in the number of dots or globules was observed in 63% of globular naevi, and 167 naevi (40%) underwent a change in size. Of these, 91/167 (54%) decreased in size, with a median area reduction of 8% (0·9-42%) while 76/167 (46%) increased in size, with a median area increase of 9% (1-76%). Around half of naevi exposed to a course of NB-UVB treatment undergo size or morphological changes. Naevi that enlarged tended to revert to pretreatment size 3 months after discontinuation of phototherapy.
Hartnup disease presenting in an adult.
Publisher: Oxford University Press (OUP)
Date: 09-1994
DOI: 10.1111/J.1365-2230.1994.TB02694.X
Abstract: A young woman presented with pellagra. Her symptoms were precipitated by prolonged lactation and increased activity. Dietary intake of niacin was within recommended guidelines. Chromatography of urinary amino acids was diagnostic of Hartnup disease, an inherited disorder usually presenting in childhood. Her symptoms resolved with oral nicotinamide.
Skin Lesion Segmentation in Dermoscopic Images With Ensemble Deep Learning Methods
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2020
The Acne Disability Index: usefulness confirmed.
Publisher: Wiley
Date: 02-1996
DOI: 10.1111/J.1440-0960.1996.TB00992.X
Abstract: One hundred and four patients with acne completed a questionnaire derived from the Cardiff Acne Disability Index Questionnaire. In addition, 59% of patients returned an identical follow-up questionnaire 6 months later. Significant disability from acne was identified in many patients, with the median initial Acne Disability Index (ADI) being 6 (maximum possible 15), improving to 3 after treatment. Scores correlated poorly with the clinical severity of acne. The questionnaire proved useful for identifying patients with poor self-image who might benefit from more potent treatment for their acne, and to evaluate the effect of treatment.
Store-and-Forward Teledermatology for Assessing Skin Cancer in 2023: Literature Review
Publisher: JMIR Publications Inc.
Date: 17-05-2023
DOI: 10.2196/43395
Abstract: The role of teledermatology for skin lesion assessment has been a recent development, particularly, since the COVID-19 pandemic has impacted the ability to assess patients in person. The growing number of studies relating to this area reflects the evolving interest. This literature review aims to analyze the available research on store-and-forward teledermatology for skin lesion assessment. MEDLINE was searched for papers from January 2010 to November 2021. Papers were searched for assessment of time management, effectiveness, and image quality. The reported effectiveness of store-and-forward teledermatology for skin lesion assessment produces heterogeneous results likely due to significant procedure variations. Most studies show high accuracy and diagnostic concordance of teledermatology compared to in-person dermatologist assessment and histopathology. This is improved through the use of teledermoscopy. Most literature shows that teledermatology reduces time to advice and definitive treatment compared to outpatient clinic assessment. Overall, teledermatology offers a comparable standard of effectiveness to in-person assessment. It can save significant time in expediting advice and management. Image quality and inclusion of dermoscopy have a considerable bearing on the overall effectiveness.
Successful melanoma triage by a virtual lesion clinic (teledermatoscopy)
Publisher: Wiley
Date: 15-09-2015
DOI: 10.1111/JDV.13309
Abstract: A Virtual Lesion Clinic (VLC) using teledermatoscopy was established to improve efficiency of the melanoma referral pathway. To assess diagnostic accuracy and to compare wait-times and costs of VLC and conventional clinics. Patients with suspected melanoma referred from primary care into a publicly funded health system attended local skin imaging centres, rather than hospital outpatient clinics. A teledermatologist assessed each lesion choosing specialist assessment/excision, General Practitioner (GP) follow-up, to re-image in 3 months, or self-monitoring/no concern. 613 skin lesions in 310 patients were evaluated over 12 months. Median time between receipt of referral and attendance at the VLC was 9 days compared to 26.5 days for standard outpatient assessment. Sixty-six percent (404/613) of lesions were considered benign, and 12% (73/613) were suspicious for melanoma. Of 129 lesions excised, 98 were skin cancers including 48 histologically confirmed melanomas with one spitzoid tumour of unknown malignant potential (STUMP), i.e. one melanoma per 1.59 suspected lesions biopsied and one melanoma in every 12.8 referred to the service. There were 49 non-melanoma skin cancers (NMSC). Teledermatoscopic diagnosis of melanomas was found to have a positive predictive value (PPV) of 63%. Compared to the conventional clinic, cost reductions from running the VLC for 1 year were in excess of NZ$364,000 (or NZ$1174 atient seen). The VLC offered an efficient, accurate and cost effective way of processing suspected melanoma referrals to the public health system.
Improving Skin cancer Management with ARTificial Intelligence (SMARTI): a pre-post intervention trial of an Artificial Intelligence system used as a diagnostic aid for skin cancer management in a real-world specialist dermatology setting
Publisher: Elsevier BV
Date: 05-2022
Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)
Publisher: Oxford University Press (OUP)
Date: 05-03-2010
DOI: 10.1111/J.1365-2133.2010.09673.X
Abstract: Teledermatology is a rapidly growing field with studies showing high diagnostic accuracy when compared with face-to-face diagnosis. Teledermoscopy involves the use of epiluminescence microscopy to increase diagnostic accuracy. The utility of teledermoscopy as a triage tool has not been established. To assess teledermoscopy as a triage tool for a hospital skin lesion clinic. Patients referred to a dermatology skin lesion clinic were recruited. Digital and dermoscopic photographs were taken of skin lesions of concern and the patients were then seen independently face-to-face by two out of three dermatologists. The digital images were evaluated 4 weeks later, as a teledermoscopy consultation, by two of these dermatologists. The diagnosis and management from both types of consultation were compared. Two hundred patients with a total of 491 lesions were seen. There was excellent agreement between teledermoscopy and face-to-face diagnosis with only 12.3% of lesions having disparate diagnoses of clinical significance. Twelve of 491 (2.4%) lesions appeared to have been under-reported by teledermoscopy when compared with face-to-face diagnosis. However, when histopathology became available, only one malignant lesion had been missed (a basal cell carcinoma diagnosed as solar keratosis) by teledermoscopy. Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers. Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist. This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.
Hepatitis C virus infection and porphyria cutanea tarda in Australasia.
Publisher: American Medical Association (AMA)
Date: 1996
DOI: 10.1001/ARCHDERM.1996.03890250105021
Abstract: In this issue of Neuron, Shi et al. (2021) show a protective role for the low-density lipoprotein receptor (LDLR) in tau pathology. Brain overexpression of LDLR lowers apolipoprotein E (apoE), suppresses microglial activation, preserves myelin, and ameliorates neurodegeneration, pointing the way toward potential new therapies.
Store-and-Forward Teledermatology for Assessing Skin Cancer in 2023: Literature Review (Preprint)
Publisher: JMIR Publications Inc.
Date: 14-10-2022
Abstract: he role of teledermatology for skin lesion assessment has been a recent development, particularly, since the COVID-19 pandemic has impacted the ability to assess patients in person. The growing number of studies relating to this area reflects the evolving interest. his literature review aims to analyze the available research on store-and-forward teledermatology for skin lesion assessment. EDLINE was searched for papers from January 2010 to November 2021. Papers were searched for assessment of time management, effectiveness, and image quality. he reported effectiveness of store-and-forward teledermatology for skin lesion assessment produces heterogeneous results likely due to significant procedure variations. Most studies show high accuracy and diagnostic concordance of teledermatology compared to in-person dermatologist assessment and histopathology. This is improved through the use of teledermoscopy. Most literature shows that teledermatology reduces time to advice and definitive treatment compared to outpatient clinic assessment. verall, teledermatology offers a comparable standard of effectiveness to in-person assessment. It can save significant time in expediting advice and management. Image quality and inclusion of dermoscopy have a considerable bearing on the overall effectiveness. >
A 9-Year Teledermoscopy Service in New Zealand: Retrospective Service Review
Publisher: JMIR Publications Inc.
Date: 06-10-2022
DOI: 10.2196/36351
Abstract: A teledermoscopy service was established in January 2010 wherein patients attended nurse-led clinics for the imaging of lesions of concern and remote diagnosis by a dermatologist. This study aims to review the number of visits, patient characteristics, the efficiency of the service, and the diagnoses made. We evaluated the waiting times and diagnoses of skin lesions for all patient visits from January 1, 2010, to May 31, 2019. The relationships between patient characteristics and the diagnosis of melanoma were specifically analyzed. The teledermoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma and melanoma in situ were male sex (P .001), European ethnicity (P=.001), an age of 65 to 74 years (P=.001), and Fitzpatrick skin type 2 (P=.001). Attendance was maximal during 2015 and 2016. The seasonal variations in visits from 2011 to 2018 revealed a consistent peak at the end of summer and a dip at the end of winter. In the year 2010, a total of 306 patients attended the clinic 76.1% (233/306) of these patients were discharged to primary care, and 23.9% (73/306) were referred to a hospital for a specialist assessment. For patients who were diagnosed with suspected melanoma by a dermatologist from January 1, 2010, to May 31, 2019, the median waiting time for an imaging appointment was 44.5 (mean 57.9 range 8-218) days. The most common lesions diagnosed were benign naevus (2933/11,005, 26.7%), benign keratosis (2576/11,005, 23.4%), and keratinocytic cancer (1707/11,005, 15.5%) melanoma was suspected in 4.6% (507/11,005) of referred lesions. The positive predictive value of melanoma and melanoma in situ was 61.1% (320 true positives and 203 false positives). The number needed to treat (ie, the ratio of the total number of excisions to the number with a histological diagnosis of melanoma or melanoma in situ) was 2.02. A teledermoscopy service offered by nurse-led imaging clinics can provide efficient and convenient access to dermatology services by streamlining referrals to secondary care and prioritizing patients with skin cancer for treatment.
Hepatitis C virus infection and porphyria cutanea tarda in Australasia [2]
Publisher: American Medical Association (AMA)
Date: 1996
A review of ultraviolet treatment for psoriasis at Waikato Hospital
Publisher: Wiley
Date: 08-1996
DOI: 10.1111/J.1440-0960.1996.TB01030.X
Abstract: Details of 79 courses of UVB and 40 courses of PUVA for patients with chronic plaque psoriasis at Waikato Hospital were prospectively collected when a new Phototherapy Unit opened. Efficacy was assessed by clearance rates (73% for UVB, 87.5% for PUVA). There was significant improvement in Psoriasis Disability Index, which was derived from a questionnaire assessing functional disability and completed by the patients before and after treatment. It took a median number of 24 treatments for psoriasis in the patients receiving UVB to clear, and for the PUVA patients the median was 19 treatments. The efficacy could not be correlated with skin type. Fifty per cent of UVB patients and 25% of PUVA patients received symptomatic burns, all localized and minor in nature. LIfetime PUVA dose was calculated, 90% of patients having received less than 400 J/cm2.
Grzybowski's generalized eruptive keratoacanthoma: Remission with cyclophosphamide
Publisher: Wiley
Date: 13-04-2005
DOI: 10.1111/J.1440-0960.2005.00157.X
Abstract: A 57-year-old woman presented with intensely pruritic generalized eruptive keratoacanthomas affecting cutaneous and mucosal surfaces (Grzybowski syndrome). She derived marginal benefit from anti-pruritic agents, acitretin and methotrexate. However, cyclophosphamide 100 mg daily for 1 month followed by 3 months at 200 mg daily resulted in remarkable improvement and eventual remission without further treatment. The disease resulted in severe ectropion of upper and lower eyelids bilaterally. Two years after the onset of her disease, the lower lid ectropions were repaired using skin grafting. There was no evidence for papillomavirus infection.
Phytophotodermatitis: Case reports of children presenting with blistering after preparing lime juice
Publisher: Elsevier BV
Date: 08-2008
Quantitative studies on UVA-induced erythema in human skin.
Publisher: Oxford University Press (OUP)
Date: 07-1987
DOI: 10.1111/J.1365-2133.1987.TB04091.X
Abstract: The erythemal response of normal human skin to UVA and UVB radiation was measured objectively using a reflectance instrument in seven subjects, and a laser Doppler velocimeter in two subjects. UVA radiation was produced using a newly-developed high-intensity UVA l . The slope of the log dose-erythemal response curve for UVA at 24 h after irradiation was found not to differ significantly from that for UVB. The time course of UVA erythema was biphasic erythema was present immediately after irradiation, fell to a minimum at about 4 h and then rose to a broad plateau between 6 and 24 h. The intensity of the early phase was dose-rate dependent, whereas that in the later phase depended on dose only.
Pellagra in a woman using alternative remedies.
Publisher: Wiley
Date: 02-1998
DOI: 10.1111/J.1440-0960.1998.TB01241.X
Abstract: A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.
The role of inosine pranobex in the treatment of herpes zoster and postherpetic neuralgia
Publisher: Oxford University Press (OUP)
Date: 07-1985
Teledermoscopy in high-risk melanoma patients: A comparative study of face-to-face and teledermatology visits
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: Teledermoscopy is considered a reliable tool for the evaluation of pigmented skin lesions. We compared the management decision in face-to-face visits vs. teledermatology in a high-risk melanoma cohort using total-body photography, macroscopic and dermoscopic images of single lesions. Patients were assessed both face-to face and by 4 remote teledermatologists. Lesions identified as suspicious for skin cancer by face-to-face evaluation underwent surgical excision. The teledermatologists recommended "self-monitoring", "short-term monitoring", or "excision". A 4-year monitoring was completed in a cohort of participating subjects. The general agreement, calculated by prevalence and bias-adjusted κ (PABAK), showed almost perfect agreement (PABAK 0.9-0.982). A total of 23 lesions were excised all teledermatologists identified the 9 melanomas. The greatest discrepancy was detected in "short-term monitoring". During 4-year monitoring one melanoma was excised that had been considered benign. In conclusion, melanoma identification by experts in pigmented lesions appears to be equivalent between face-to-face and teledermatological consultation.
Related Organisations
University Of Bristol
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Amanda Oakley.