Trends in dermoscopy use in the UK: results from surveys in 2003 and 2012.

BACKGROUND: Dermoscopy is a useful tool to aid diagnosis of pigmented and non-pigmented skin lesions, as well as many other dermatological conditions. Use of dermoscopy is increasing worldwide, but to date, there are no reported data on attitudes of dermatologists in the United Kingdom (UK) towards dermoscopy. OBJECTIVE: To determine current attitudes of UK dermatologists towards dermoscopy and assess how these attitudes have changed over the last decade. METHODS: In October 2012, an online survey was sent to members of British Association of Dermatologists over a 12-week period. Data were subsequently compared with data from a similar UK nationwide paper questionnaire distributed to members in 2003. RESULTS: The 2003 survey collected 292 responses (uptake 42%), and in 2012 there were 209 responses (22%), predominantly from consultants and registrars. In 2012, 86% respondents reported increased use of dermoscopy over the previous decade with 98.5% of respondents reporting regular clinical use of dermoscopy, compared with 54% in 2003. Overall, 81% respondents in 2012 had received dermoscopy training, mainly from UK-based courses (62% of respondents) but increasingly via Internet-based resources (30% vs. 7% in 2003). However, 39% respondents lacked confidence when making a diagnosis based on their interpretation of dermoscopy findings. CONCLUSIONS: Over the last decade, use of dermoscopy has increased amongst UK dermatologists and the majority of respondents now employ dermoscopy in daily clinical practice. However, the use of dermoscopy in the dermatology community overall is not known and for those individuals there is a continued need for education.

Treatment of actinic cheilitis with imiquimod 5% and a retractor on the lower lip: clinical and histological outcomes in 5 patients.

Imiquimod 5% (Aldara, 3M Healthcare Ltd.) is a topically applied immune response modifier used in the treatment of superficial basal cell carcinoma, actinic keratosis, and genital warts. We reviewed the casenotes of 5 patients with histologically confirmed dysplastic lower lips who had been treated with topical imiquimod. Each patient was provided with a specially designed lower lip retractor to prevent spread of the cream. Treatment was stopped after 6 weeks or if an acute inflammatory reaction developed. The lower lip was biopsied 4 weeks later, and histologically the dysplastic changes had been reversed in all 5 patients. The lip retractor was well-tolerated, and prevented spread of the cream. Imiquimod 5% cream offers an alternative method to manage dysplastic lips. Our lip retractor is a simple and cost-effective method of isolating the lower lip and allowing application of topical agents. The method could equally well be used for agents other than imiquimod.

Randomized comparison of Mohs micrographic surgery and surgical excision for small nodular basal cell carcinoma: tissue-sparing outcome.

BACKGROUND: Mohs micrographic surgery (MMS) is recognized globally as the criterion standard for high-risk basal cell carcinoma (BCC). The main advantage of MMS over conventional surgery is the chance of complete tumor removal, but it is also thought, based on experience, to be tissue sparing. OBJECTIVE: To determine whether MMS leaves smaller surgical defects than standard surgery. METHODS AND MATERIALS: This was a randomized trial involving 30 patients with a clinical diagnosis of BCC. Patients were randomly assigned to MMS or standard surgery. In the standard surgery group the BCCs were excised with 4-mm margins. In the MMS group, tumors were excised with 2-mm margins and subsequent stages of MMS until the tumor was completely removed. An observer unaware of the treatment allocation calculated the defect size. The main outcome measure was defect size in mm(2). RESULTS: The median area of the surgical defects in the MMS group was 116.6 mm(2), versus 187.7 mm(2) in the standard surgery group (95% confidence interval for difference=61-126, p<.001). CONCLUSIONS: This is the first randomized trial demonstrating that MMS is a tissue-sparing treatment. TRIAL REGISTRATION: http://www.clinicaltrials.gov Identifier: NCT00571363. The authors have indicated no significant interest with commercial supporters.

Confirmation of histological clearance of superficial basal cell carcinoma with multiple serial sectioning and Mohs' micrographic surgery following treatment with imiquimod 5% cream.

BACKGROUND: Although the effectiveness of daily dosing regimens of 5% imiquimod cream for the treatment of superficial basal cell carcinomas (sBCC) has been documented by recent studies, concerns about long-term outcome remain. The majority of efficacy data is based on clinical clearance and limited histological examination which may not identify tumour presence at the periphery. OBJECTIVE: To assess the efficacy of 5% imiquimod cream for sBCC using detailed histological assessment 1 year after completion of treatment. METHODS: Nine individuals with biopsy-proven sBCC treated with 5% imiquimod cream 1 year previously and who remained clinically clear were recruited. Paraffin-embedded excision specimens from the original tumour site were extensively examined by a dermatopathologist. Examination and analysis of frozen sections of the original tumour perimeter using Mohs' micrographic surgery (MMS) were then performed. RESULTS: Eight of nine individuals, 89% (95% CI 56% to 97%) were histologically clear of sBCC at 52 weeks. One individual had a single focus of sBCC at one lateral margin. CONCLUSION: The results show agreement between the clinical and histological assessment of tumour clearance. However, the persistence of disease in one patient, although limited, indicates the need for cautious long-term follow-up studies on the use of 5% imiquimod cream for sBCC.

A randomized parallel study to assess the safety and efficacy of two different dosing regimens of 5% imiquimod in the treatment of superficial basal cell carcinoma.

OBJECTIVES: This study was designed to compare the safety and efficacy of two cycled dosing regimens of imiquimod 5% cream for treatment of superficial basal cell carcinoma (sBCC). METHODS: Patients (n = 32) were randomized to receive one of two treatment regimens: 8 weeks of treatment with once-daily dosing for alternate weeks (R1) and 5 weeks of once-daily dosing with a 1-week interval in the middle of the course (R2). Efficacy measures were tumour clearance at weeks 19 and 52 and measures of patients' acceptability. RESULTS: Data from 30 patients (13 females), 14 on R1 and 16 on R2, were analysed. The results revealed an initial clearance rate of 64% at week 19 for R1 and 81% for R2 (95% CI for difference: -14% to 45%, p = 0.21). However, clearance rates at week 52 were significantly different: 43% for R1 and 88% for R2 (95% CI for difference: 11% to 68%, p = 0.02). There was no difference in acceptability of treatment as measured by composite median visual analogue scores at week 8. CONCLUSION: Five weeks of 5% imiquimod cream once daily with a 1-week interval was more effective but as well tolerated as the 8-week alternate week regimen for sBCC.

A randomized, investigator-masked clinical evaluation of the efficacy and safety of clobetasol propionate 0.05% shampoo and tar blend 1% shampoo in the treatment of moderate to severe scalp psoriasis.

The clinical benefit of currently available tar blend shampoos for the treatment of scalp psoriasis is restricted due to their limited efficacy, low cosmetic appeal and potential for carcinogenicity. This 4-week multicentre, randomized, parallel-group, investigator-masked study included 162 subjects and aimed to compare the efficacy, safety and cosmetic acceptability of clobetasol propionate 0.05% shampoo versus a currently marketed tar blend 1% shampoo in subjects with moderate to severe scalp psoriasis. Clobetasol propionate shampoo was superior to tar blend shampoo with respect to all efficacy variables tested (p<0.001): Total and Global Severity Score; erythema; plaque thickening; desquamation; pruritus; total scalp area involved; and the subject's global assessment of clinical improvement. Both treatments were safe and well-tolerated. Furthermore, more subjects indicated that clobetasol propionate shampoo was more cosmetically acceptable than tar blend shampoo. Clobetasol propionate 0.05% shampoo is a good alternative to tar blend shampoo in the treatment of moderate to severe scalp psoriasis.