Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm that arises within the dermis of chronically sun-exposed skin. Although wide local excision is standard practice, patients are regularly elderly and highly com...Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm that arises within the dermis of chronically sun-exposed skin. Although wide local excision is standard practice, patients are regularly elderly and highly comorbid and therefore, curettage may offer a suitable alternative as a same day treatment with minimal aftercare. A retrospective case series was conducted analysing the files of all patients diagnosed with histopathological AFX at a single dermatology practice in Fremantle, Western Australia between the years 2016 and 2025. Kaplan-Meier analyses estimated recurrence rate with subgroup analyses comparing recurrence with gender, lesion location and lesion size. The study analysed 77 cases of AFX tumours treated with curettage and cautery. Patients had a mean age of 78.3 years with male predominance in the sample population. A total of nine tumours had documented recurrence, within a median time of 6.41 months, reflecting a crude recurrence rate of 11.69% and a Kaplan-Meier estimated 5-year recurrence rate of 16.99%. There were no disease-specific deaths, and no cases developed metastases. Given the high efficacy of curettage and cautery reflected in the study, and the lacking risk of disease-specific deaths and metastasis, a valuable treatment option is proposed. Employing curettage and cautery for AFX may reduce the personal and economic burden of cumbersome interventions, mitigating hospital admission and extensive wound care. Curettage and cautery may be of particular benefit in the nursing home population.
BACKGROUND: Surgical attire and personal protective equipment (PPE) represent significant financial and environmental costs in dermatologic surgery. Evidence suggests that lower-resource approaches can maintain low surgi...BACKGROUND: Surgical attire and personal protective equipment (PPE) represent significant financial and environmental costs in dermatologic surgery. Evidence suggests that lower-resource approaches can maintain low surgical site infection (SSI) rates. OBJECTIVES: To describe international PPE use and highlight opportunities to improve sustainability and reduce unnecessary expenditure while ensuring patient safety. METHODS: A 16-item online questionnaire was developed in Google Forms, refined through colleague feedback, circulated in March 2025 via the British Society for Dermatological Surgery, the New Zealand Dermatological Society Inc., and the European Society for Micrographic Surgery, with one reminder sent. It collected demographic data and tailored questions for Mohs surgeons and those performing flap/graft repairs. RESULTS: Responses were obtained from 205 clinicians across 25 countries, predominantly from the UK (59.5%), New Zealand (13.7%), and the Netherlands (6.8%). Most were consultant dermatologists (79.5%); 42.0% were Mohs surgeons. Considerable variation was reported in glove type, attire, and mask use. For diagnostic biopsies, 40.0% used clean gloves, 63.9% sterile gloves, and 40.0% wore clean scrubs alone, while 26.3% operated in normal work clothes. For excisions with direct closure, 92% used sterile gloves, though over half wore only clean scrubs. Among Mohs surgeons, 20.9% used clean gloves for tumour extirpation and most (75.6%) wore clean scrubs alone. Reusable attire was limited, mainly scrubs and personal eyewear, while disposable caps and masks predominated. CONCLUSION: This international survey demonstrates variability in dermatologic surgical PPE, with single-use items remaining widespread despite limited evidence of benefit. Evidence-based standardisation could improve sustainability, reduce costs, and maintain excellent patient outcomes.
Bullous pemphigoid (BP) is a common autoimmune blistering disease associated with medications, particularly dipeptidyl peptidase-4 inhibitors such as vildagliptin, funded in New Zealand since 2018. We conducted a retrosp...Bullous pemphigoid (BP) is a common autoimmune blistering disease associated with medications, particularly dipeptidyl peptidase-4 inhibitors such as vildagliptin, funded in New Zealand since 2018. We conducted a retrospective single-centre study of histologically confirmed BP cases between 2018 and 2023. Of 49 patients identified, 15 (30.6%) had vildagliptin-induced BP. Māori patients were over-represented in this subgroup. The mean time to BP onset after vildagliptin initiation was 388 days. Non-vildagliptin BP was more likely to require systemic immunosuppression. Vildagliptin-induced BP represents a common and under-recognised clinical entity in New Zealand.
Complications from intense pulsed light treatments are often attributed to the use of broad wavelength light and insufficient operator skill. This case series reviews four patients who experienced intense pulsed light (I...Complications from intense pulsed light treatments are often attributed to the use of broad wavelength light and insufficient operator skill. This case series reviews four patients who experienced intense pulsed light (IPL) treat-induced complications at cosmetic clinics across Melbourne, Australia. The findings aim to educate both clinicians and consumers about the common complications seen with IPL treatment, the potential severity of these complications and to offer recommendations to enhance the safety of IPL treatments for individuals with skin of colour.
This case series outlines a proposed simplified and cost-effective alternative to expensive laboratory-based autologous non-cultured epidermal suspension (NCES). In all five adult participants, 75%-100% repigmentation wa...This case series outlines a proposed simplified and cost-effective alternative to expensive laboratory-based autologous non-cultured epidermal suspension (NCES). In all five adult participants, 75%-100% repigmentation was observed at 6 months, with one participant experiencing unsatisfactory colour mismatch and one participant experiencing hypertrophic scarring. Larger, randomised controlled trials with extended follow-up are needed to determine the long-term efficacy and safety profile of our clinical NCES protocol.
The gold standard for medical data extraction has traditionally been manual; however, this approach is very time consuming, labour intensive, expensive and prone to error. Many approaches to automated data extraction hav...The gold standard for medical data extraction has traditionally been manual; however, this approach is very time consuming, labour intensive, expensive and prone to error. Many approaches to automated data extraction have been explored over the years; however, they have required significant technical knowledge and have not been reliably accurate. Large Language Models (LLMs) have been developed at an astronomical pace and have demonstrated incredible accuracy, and they are continuing to evolve and improve. The significant time and cost savings achieved with LLMs will allow for more efficient research and real-time monitoring of patient outcomes. This review explores how LLMs can be used in medical data collection, including the types of data collected and output given, types of LLMs used, amount of training required, the accuracy, speed, and cost of data extraction, types of errors commonly made, and any security concerns. There are still many challenges to overcome, particularly with reducing hallucinations/fictitious content and other common errors, ensuring patient privacy, handling complex tasks and producing output in clean and usable formats. Health professionals and researchers in the field of dermatology must be well trained and upskilled in the use of these new technologies and should continue to explore and build on what has already been achieved to optimise the use of LLMs in the automated data extraction process.
BACKGROUND/OBJECTIVES: Studies on factors that predict the number of stages in Mohs micrographic surgery (MMS) have been published previously. To date, no studies have analysed the predictors for the number of sections d...BACKGROUND/OBJECTIVES: Studies on factors that predict the number of stages in Mohs micrographic surgery (MMS) have been published previously. To date, no studies have analysed the predictors for the number of sections during MMS. METHODS: A retrospective case-control study of patients treated for keratinocyte cancer (KC) between 2013 and 2017 was conducted to identify predictive factors for 13 or more MMS sections. Patient, tumour, management and practitioner-related factors were analysed with univariate logistic regression and a multivariate predictive model. Surface area for tumours and defects was studied in cases and controls as a secondary outcome. RESULTS: Out of 10,132 tumours, a total of 195 cases representing 1.9% of all MMS procedures for the study period required more than 13 MMS sections. A control group with 213 tumours was also randomly selected. Largest preoperative tumour diameter, mixed histology, tumour recurrence and age were significant predictors for 13 or more MMS sections in a multivariate model (AUC 88.4%, sensitivity 77.2% and specificity 87.0%). Significantly larger defects were also found in our cases compared to the control group (median tumour to defect ratio 3.94 vs. 2.43; p < 0.0001). CONCLUSION: Identifying factors that predict 13 or more sections prior to surgery could assist the Mohs practitioner in informing patients and allocating time and resources accordingly.
BACKGROUND: Direct comparison of the adverse effect (AE) profiles of the hedgehog inhibitor (HIs) medications is limited to post hoc analyses of phase III clinical trials. OBJECTIVE: Compare the AE profiles between vismo...BACKGROUND: Direct comparison of the adverse effect (AE) profiles of the hedgehog inhibitor (HIs) medications is limited to post hoc analyses of phase III clinical trials. OBJECTIVE: Compare the AE profiles between vismodegib and sonidegib in the FDA Adverse Event Reporting System (FAERS). METHODS: Case/non-case analyses were performed in FAERS and reporting odds ratios (ROR) were compared to determine unique and disproportionate AEs between HIs. RESULTS: Vismodegib had significantly higher ROR for taste symptoms and alopecia. Sonidegib was associated with neutropenia and elevated blood creatinine phosphokinase. Both vismodegib and sonidegib were associated with an increased ROR for cSCC (50.36 [42.36-59.86] vs. 50.28 [27.71-91.23]). This signal persisted despite comparison to an aggregate of other medications used to treat basal cell carcinoma (BCC) (11.56 [9.51-14.05] vs. 9.71 [1.25-75.43]). LIMITATIONS: Retrospective nature predisposed to bias. CONCLUSIONS: Vismodegib has a significantly higher ROR for alopecia and taste symptoms, while sonidegib was associated with neutropenia, which is a novel finding. Both HIs are associated with an increased ROR for cSCC, which persists despite stringent controls and does not parallel total cSCC cases reported to FAERS. These data suggest that HIs increase the risk of cSCC above the baseline expected in this patient population.
Male genital lichen sclerosis (mGLS) is a chronic progressive inflammatory disease with potential complications including urethral strictures and penile cancer. Despite its clinical significance, the molecular mechanisms...Male genital lichen sclerosis (mGLS) is a chronic progressive inflammatory disease with potential complications including urethral strictures and penile cancer. Despite its clinical significance, the molecular mechanisms underlying mGLS remain poorly understood, and male-specific data are limited. This systematic review consolidates current evidence on tissue-based gene and protein expression in mGLS, aiming to identify commonly investigated biomarkers and highlight gaps in the literature. Using the JBI Sumari interface, our research strategy identified a total of 24 studies with considerable variability in targets and methodologies. Only a small subset of 12 genes and proteins was assessed and only one gene, p16, was assessed across multiple studies, limiting the strength of conclusions. QIAGEN Ingenuity Pathway Analysis was used to explore canonical pathways and disease associations linked to reported biomarkers. While preliminary patterns suggest involvement of inflammatory and fibrotic pathways, further research is needed to validate these findings and assess their diagnostic, prognostic or therapeutic potential. This review provides a foundation for future studies focused on improving molecular understanding and clinical management of mGLS.
This study aimed to identify the proportion of patients with vitiligo reporting new-onset disease or changes in disease status following COVID-19 vaccination or infection using an online survey. Among 114 respondents, ov...This study aimed to identify the proportion of patients with vitiligo reporting new-onset disease or changes in disease status following COVID-19 vaccination or infection using an online survey. Among 114 respondents, over half reported no new-onset vitiligo or a change in vitiligo status following COVID-19 vaccination or infection; however, a sizeable minority reported worsening of vitiligo, smaller numbers reported new-onset disease, and few reported improvement. Larger studies are needed to clarify whether these associations are coincidental or reflect underlying pathological processes.
Total Body Photography has undergone substantial technological advancement, now embracing high-resolution digital imaging, 3D reconstruction and the potential applications of artificial intelligence (AI), and mobile inte...Total Body Photography has undergone substantial technological advancement, now embracing high-resolution digital imaging, 3D reconstruction and the potential applications of artificial intelligence (AI), and mobile interoperability. However, its broader implementation is tempered by logistical hurdles as well as concerns regarding cost-effectiveness. This article traces its historical trajectory, evaluates its current clinical utility, and explores future applications.
BACKGROUND/OBJECTIVES: Cutaneous manifestations of Waldenstrom's macroglobulinaemia (WM), a rare B-cell lymphoproliferative disorder, present a diagnostic challenge. The intent of this article is to raise awareness to cl...BACKGROUND/OBJECTIVES: Cutaneous manifestations of Waldenstrom's macroglobulinaemia (WM), a rare B-cell lymphoproliferative disorder, present a diagnostic challenge. The intent of this article is to raise awareness to clinicians of a potentially overlooked condition, particularly in the context of patients with a monoclonal IgM paraproteinaemia, but also to describe the diagnostic complexity of the disease from a clinicopathological perspective. METHODS: We describe the clinical presentation and histopathological findings of two patients with cutaneous involvement of WM. RESULTS: Cutaneous presentations included erythematous and salmon pink plaques, which were either tender or non-tender. Histopathology analysis in both cases demonstrated direct lymphocytic infiltration by malignant lymphocytes of WM, with case 1 demonstrating aberrant CD10 expression. CONCLUSION: The broad cutaneous signs of WM are sparsely described in the literature, and these can even precede formal diagnosis. Ongoing clinical suspicion is warranted from both a clinical and histopathological perspective where patients present with a monoclonal IgM paraproteinemia.
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous adverse drug reactions associated with high morbidity and mortality. Current treatment regimens are largely supportive, and evi...Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous adverse drug reactions associated with high morbidity and mortality. Current treatment regimens are largely supportive, and evidence for adjunctive systemic therapies remains limited. Recent research has implicated the Janus Kinase (JAK) signal transducer and activator of transcription (STAT) pathway in SJS/TEN pathogenesis, raising interest in JAK inhibitors as potential targeted therapies. This scoping review aimed to evaluate the existing literature on the use of JAK inhibitors in the management of SJS/TEN, summarise clinical outcomes and identify key research gaps. This scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search of Medline, Web of Science, Embase and Scopus was conducted from inception up to 12 June 2025. Nine studies were included, comprising eight case reports and one translational research study, reporting on 15 patients (median age 45 years) treated with ruxolitinib (n = 7), tofacitinib (n = 5) or abrocitinib (n = 3). Most cases involved severe or treatment-refractory disease. Among the eight cases where time to re-epithelialisation was reported, six described 20%-30% re-epithelialisation by day 7 and one described 95% re-epithelialisation by day 16. No JAK inhibitor-related adverse events were reported. Preclinical studies supported a mechanistic role for the JAK/STAT pathway in keratinocyte apoptosis and inflammation. JAK inhibitors show promise as a novel therapeutic approach in SJS/TEN; however, current evidence is limited by small sample sizes, disease severity, concomitant therapies and potential publication bias. Well-designed prospective trials are needed to determine efficacy, safety and optimal use in this life-threatening condition.