ORCID Profile
0000-0001-7935-9179
Current Organisations
American College of Mohs Surgery
,
Skintel
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 26-06-2019
DOI: 10.1111/AJD.12870
Publisher: Wiley
Date: 30-10-2023
DOI: 10.1111/AJD.14178
Publisher: Wiley
Date: 31-03-2015
DOI: 10.1111/AJD.12332
Abstract: A useful application of the flexible razor blade in Mohs micrographic surgery that can save time and result in a well-presented specimen is described.
Publisher: Oxford University Press (OUP)
Date: 10-09-2010
DOI: 10.1111/J.1365-2230.2010.03807.X
Abstract: We report a 44-year-old man who presented with recurrent unexplained encephalopathy and myositis despite extensive neurological and metabolic investigations. Eventually, he was noted to have multiple asymptomatic flesh-coloured papules suggestive of scleromyxoedema, which was confirmed by histology. Although primarily a cutaneous disease, extracutaneous features of scleromyxoedema may dominate the clinical picture of this rare mucin-deposition disorder.
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1440-0960.2009.00621.X
Abstract: Three women with known breast cancer presented with very similar annular erythemas of their chest walls. All women were in remission from their breast cancer for at least 6 months. Their breast cancers had initially responded well to multi-modality treatment with no clinical or radiologic evidence of recurrence, until the development of the annular erythema. In the first case, the annular erythema was treated unsuccessfully as a dermatitis and then as tinea corporis. In the second case, subacute cutaneous lupus was considered but lupus antibodies were negative. In the third case, the annular erythema was promptly recognized and biopsied. Histology in all three cases revealed identical findings of invasive ductal carcinoma involving the lymphatics of the skin. Immunohistochemical staining of the carcinoma was positive for human epidermal growth factor receptor 2 but negative for oestrogen and progesterone receptors. Annular erythema can pose a wide differential but rarely has it been described as a sign of locally recurrent cancer. These cases highlight the importance of recognizing this entity in the oncologic patient, where prompt skin biopsies can confirm the diagnosis and allow early initiation of therapy.
Publisher: Bentham Science Publishers Ltd.
Date: 07-2015
Publisher: Oxford University Press (OUP)
Date: 04-0003
DOI: 10.1111/BJD.13529
Publisher: Wiley
Date: 02-11-2016
DOI: 10.1111/JDV.14012
Abstract: Periocular basal cell carcinomas (pBCC) have unpredictable growth. The authors seek to derive a decision rule for predicting surgical complexity in pBCC. This study was conducted at two centres in New Zealand from September 2010 to November 2015. Baseline demographic information and an initial assessment of operative complexity (a four-point grading scale) were collected. Assessment of operative complexity was repeated at the time of reconstruction. Univariate analysis was applied to identify the associative factors and supervised machine learning was used to determine the best predictive models to construct a clinical decision rule. A total of 156 patients and 156 periocular BCC were analysed. Univariate analysis revealed that older age, recurrent skin cancer, large tumour size, being a public patient and high complexity at pre-operative assessment were associated with high actual operative complexity. Tumour histology was not associated with more complex surgery. Machine learning analyses revealed that Naive Bayesian classifier was able to distinguish surgical complexity with an average area under the receiver operating characteristic curve (AUC) of 0.854 (95% CI: 0.762-0.946) whereas a simpler, alternating decision tree (ADT) that used only three clinical variables achieved an AUC of 0.853 (95% CI: 0.739-0.931). The ADT model was 10.1 times more likely to correctly identify a high complexity case. The three predictive variables were pre-operative assessment of complexity (high vs. low), surgical delays [early (<75 days) or delayed (≥75 days)], and tumour size [small (<14 mm), or large (≥14 mm)]. For the subgroup with large tumours but low initial assessed complexity, late surgery was associated with a 6.7-fold increase in risk of high-risk surgery. A simple, three-variable risk stratification system was able to predict the operative complexity of pBCC.
Publisher: Oxford University Press (OUP)
Date: 21-09-0002
DOI: 10.1111/BJD.13470
Abstract: Basal cell carcinomas (BCCs) are generally regarded as slow-growing tumours. There is a paucity of data on the rate of BCC growth and the impact of delayed excision. To measure the growth rate and assess the impact of delayed excision on the growth of periocular BCC (pBCC). Patients referred to an oculoplastic service for excision of pBCC were recruited. The tumour dimensions and patient demographic data were recorded at the first specialist appointment (FSA). Measurement of the pBCC was repeated when the patient attended for tumour excision by Mohs micrographic surgery (MMS). Correlation analyses were performed to determine whether the histological subtype and patient factors affected the pBCC growth rates. The study included 112 patients and 115 pBCCs. The primary ethnicity was European with Fitzpatrick type I and II skin. The mean size of the pBCC at FSA was 8 × 6 mm (range 6-12 × 4-8 mm) with a mean area of 68·5 mm(2). The average waiting time for MMS was 157 ± 87 days. The pBCCs grew at a mean rate of 11·2 mm(2) every 30 days. From the FSA to the MMS, a mean increase of 41·9 mm(2) was observed. Recurrent tumours, larger tumours at presentation and male sex were associated with a faster growth rate. Periocular basal cell carcinomas can grow rapidly, and many have aggressive histological subtypes. Rapid growth is more likely in recurrent tumours, larger tumours and in men.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Publisher: Oxford University Press (OUP)
Date: 23-09-2023
DOI: 10.1093/BJD/LJAD363
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1440-0960.2009.00617.X
Abstract: Dermatomyositis has a known association with malignancy. We report a case of dermatomyositis occurring in early-stage testicular cancer where the patient was in remission. It stresses the importance of considering testicular cancer as an association with dermatomyositis, as it is a potentially curable malignancy.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Oxford University Press (OUP)
Date: 08-2013
DOI: 10.1111/BJD.12342
Publisher: Wiley
Date: 25-10-2013
DOI: 10.1111/AJD.12044
Abstract: To compare the effect of anti-tumour necrosis factor (TNF)-α therapies with agents that do not target TNF-α on bodyweight and body mass index (BMI) in patients with psoriasis. A retrospective analysis of patients from the Skin and Cancer Foundation and St Vincent's Hospital Melbourne. Bodyweight and BMI were compared at baseline and weeks 12, 24 and 48. A total of 143 patients were studied, equating 286 treatment courses in all. Of these, 178 courses were with an anti-TNFα agent (54 on adalimumab, 61 on etanercept and 63 on infliximab) and 108 courses were on non-anti-TNFα agents (73 on efalizumab and 35 on ustekinumab). Anti-TNFα therapy with adalimumab and infliximab resulted in weight gain from week 12 until week 48. At week 12 the infliximab group gained 1.7 ± 4.7 kg and adalimumab group gained 1.5k ± 4.5 kg. This effect persisted at week 24 (infliximab: 3.4 ± 5.7 kg adalimumab: 2.2 ± 4.4 kg) until the end of the study (infliximab: 1.3 ± 2.9 kg adalimumab: 2.4 ± 6.4 kg). There was a trend for weight gain in the etanercept group that did not reach statistical significance. Therapy with ustekinumab and efalizumab did not result in weight gain. Therapy with adalimumab and infliximab is associated with a significant increase in bodyweight and BMI.
Publisher: AIP Publishing
Date: 07-2011
DOI: 10.1063/1.3608111
Abstract: We introduce a highly compact fiber-optic Fabry-Pérot refractive index sensor integrated with a fluid channel that is fabricated directly near the tip of a 32 μm in diameter single-mode fiber taper. The focused ion beam technique is used to efficiently mill the microcavity from the fiber side and finely polish the end facets of the cavity with a high spatial resolution. It is found that a fringe visibility of over 15 dB can be achieved and that the sensor has a sensitivity of ∼1731 nm/RIU (refractive index units) and a detection limit of ∼5.78 × 10−6 RIU. This miniature integrated all-in-fiber optofludic sensor may find use in minimal-invasive biomedical applications.
Publisher: Wiley
Date: 11-10-2023
DOI: 10.1111/AJD.14169
Publisher: Oxford University Press (OUP)
Date: 20-03-2010
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.
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
DOI: 10.1111/J.1524-4725.2010.01680.X
Abstract: Skin cancers of the nasal tip present a challenge for the dermatologic surgeon. The bilobed flap has been widely used as the "workhorse" flap for such defects but requires meticulous design and may be complicated by a tendency toward pin-cushioning. To describe the use of the nasal sidewall rotation (NSR) flap for reconstructing defects on the nasal tip. A retrospective analysis of the Mohs micrographic surgery database over a 4-year period was performed. All cases in which the NSR flap was used were identified. Defect location and size and any postoperative complications were noted. All patients were reviewed at the time of suture removal and at 6 weeks. There were 65 cases (19 men and 46 women). Age ranged from 39 to 86 (mean 60.5, median 59). Defect size varied from 0.4 to 2.0 cm in diameter, with 63% measuring 1.0 to 1.4 cm. Good to excellent results were seen in all patients, and postoperative complications were uncommon and minor. CONCLUSION The NSR flap is a versatile and useful alternative for reconstructing surgical defects of the nasal tip. The authors have indicated no significant interest with commercial supporters.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
Publisher: Wiley
Date: 13-10-2010
DOI: 10.1111/J.1440-0960.2010.00701.X
Abstract: Phototherapy is effective for many dermatoses in adults, but there is a paucity of data for its use in children. To review the efficacy and tolerability of narrowband UVB phototherapy in children at a tertiary centre in New Zealand, and determine if there were any factors that differentiated responders from non-responders. A prospective analysis of children (<16 years old) who had undergone phototherapy over a 15-year period. 116 children received phototherapy with a total of 144 courses. Mean age was 11.0 years with the majority being European and having skin phototype II. Atopic dermatitis was the most common indication for treatment followed by psoriasis, pityriasis lichenoides, nodular prurigo, morphea, vitiligo, urticaria pigmentosa and erythropoietic porphyria. Treatment was effective in the majority of children (72%). Most received only one course. For responders, the mean number of treatments was 32.4. The mean dose per treatment to achieve clearance was 886 mJ/cm(2) and the mean maximum treatment dose per treatment was 1328 mJ/cm(2) . All children tolerated treatment well with 36% developing brief, minimally symptomatic, erythema. Only two children experienced exacerbations of their underlying dermatoses. This study shows that phototherapy is an effective and well-tolerated treatment modality in children.
Publisher: Oxford University Press (OUP)
Date: 21-03-2013
DOI: 10.1111/BJD.12153
Publisher: Wiley
Date: 05-12-2021
DOI: 10.1111/AJD.13522
Abstract: Healthcare is a potent emitter of greenhouse gases amounting up to 7% of total estimated greenhouse gas emissions (CO 2 e) for Australia. Australia has one of the highest incidences of skin cancer in the world but there is a paucity of data on the ecological impact of skin cancer excision/dermatologic surgery. The authors reviewed the various impact inventories in order to perform a life cycle assessment of skin cancer excision. A total of 8641 tonnes of estimated CO 2 e are produced from dermatologic surgery annually in Australia (6751 tonnes from private clinical rooms and 1890 tonnes from hospitals) and the waste generated contributes significantly to terrestrial ecotoxicity and acidification of land and water. Various means can be carried out to reduce this impact, ranging from simple behavioural changes to larger, policy changes.
Publisher: Oxford University Press (OUP)
Date: 05-2014
DOI: 10.1111/BJD.12792
Abstract: Skin cancers of the nasal ala are commonly encountered in dermatological surgery. Various techniques have been described to reconstruct surgical defects of the ala, including melolabial transposition flaps, interpolated melolabial flaps, bilobed and trilobed transposition flaps, island pedicle flaps and spiral flaps. Full-thickness skin grafts have received little attention in the reconstructive literature. We present our experience with full-thickness skin grafts for the reconstruction of partial thickness defects of the nasal ala in the largest series to date. A retrospective analysis of the Mohs micrographic surgery database over a 9-year period was performed. All cases of full-thickness skin grafts for reconstruction of the nasal ala were identified. Defect location, size and any postoperative complications were noted. All patients were reviewed at the time of suture removal, at 3 and 6 weeks postoperatively and at 1 year. There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88 years with a mean of 65 years (median 66). Defect size varied from 0·3 × 0·4 cm to 2·0 × 2·7 cm, with the average defect size measuring 1·0-1·2 cm in diameter. Thirty-six per cent (67 of 186) of cases underwent postoperative dermabrasion, and 8% (14 of 186) received postoperative intralesional triamcinolone. The incidence of graft failure and infection was low. Good-to-excellent cosmetic results were seen in all patients and postoperative complications were uncommon and minor. The use of full-thickness skin grafts for defects of the nasal ala is a simple and versatile reconstructive option with excellent functional and aesthetic outcomes.
No related grants have been discovered for Eugene Tan.