Cm Lawrence

Generation and Characterization of Multipotent Stem Cells from Established Dermal Cultures

Human multipotent skin derived precursor cells (SKPs) are traditionally sourced from dissociated dermal tissues; therefore, donor availability may become limiting. Here we demonstrate that both normal and diseased adult human dermal fibroblasts (DF) pre-cultured in conventional monolayers are capable of forming SKPs (termed m-SKPs). Moreover, we show that these m-SKPs can be passaged and that cryopreservation of original fibroblast monolayer cultures does not reduce m-SKP yield; however, extensive monolayer passaging does. Like SKPs generated from dissociated dermis, these m-SKPs expressed nestin, fibronectin and versican at the protein level. At the transcriptional level, m-SKPs derived from normal adult human DF, expressed neural crest stem cell markers such as p75NTR, embryonic stem cell markers such as Nanog and the mesenchymal stem cell marker Dermo-1. Furthermore, appropriate stimuli induced m-SKPs to differentiate down either mesenchymal or neural lineages resulting in lipid accumulation, calcification and S100β or β-III tubulin expression (with multiple processes). m-SKP yield was greater from neonatal foreskin cultures compared to those from adult DF cultures; however, the former showed a greater decrease in m-SKP forming capacity after extensive monolayer passaging. m-SKP yield was greater from adult DF cultures expressing more alpha-smooth muscle actin (αSMA). In turn, elevated αSMA expression correlated with cells originating from specimens isolated from biopsies containing more terminal hair follicles; however, αSMA expression was lost upon m-SKP formation. Others have shown that dissociated human hair follicle dermal papilla (DP) are a highly enriched source of SKPs. However, conversely and unexpectedly, monolayer cultured human hair follicle DP cells failed to form m-SKPs whereas those from the murine vibrissae follicles did. Collectively, these findings reveal the potential for using expanded DF cultures to produce SKPs, the heterogeneity of SKP forming potential of skin from distinct anatomical locations and ages, and question the progenitor status of human hair follicle DP cells.

Effect of tissue shrinkage on histological tumour‐free margin after excision of basal cell carcinoma

Backgroundu2002 Histology reports of skin tumour excisions frequently describe a histological margin significantly less than the planned surgical excision margin.

Preoperative integrity of skin surface predicts infection risk

Heal and colleagues report a reduced risk of wound infection with topical antibiotics after minor skin surgery.1 However, the control group had a high risk of infection and the influence of pre-existing carriage of skin pathogens, as shown by the appearance of the lesion’s surface, was not considered.nnOur prospective study shows that patients whose lesion preoperatively had …

Safety, complications and patients’ acceptance of Mohs micrographic surgery under local anaesthesia: results from the U.K. MAPS (Mohs Acceptance and Patient Safety) Collaboration Group

By virtue of its tissue sparing properties and assessment of 100% of the margin of excised specimens, MMS is regarded as the gold-standard surgical treatment of high-risk non-melanoma skin cancers of the head and neck. From its original inception in the 1940s, modern day MMS has evolved to become a fresh tissue surgical technique, using frozen section margin control performed under local anaesthesia in an out-patient or day-case setting. n nIn the UK, the increasing burden of skin cancer has resulted in a greater demand for MMS with over 32 units across the country providing the technique. n nThis article is protected by copyright. All rights reserved.

Long-term follow-up of imiquimod-treated lentigo maligna

DS01 Proposal for National Dermatology Surgery Safety Standards: development of a dermatology surgery standard operating policy with mandatory training of staff may be an important tool to prevent wrong-site surgery R. Bhutani, C. Machin, G. Stables, V. Goulden and A. Mitra Chapel Allerton Hospital, Leeds, U.K. Wrong-site surgery (WSS) is the second most common reported adverse event, and accounts for 20% of National Health Service dermatology legal claims. WSS is more of a risk in dermatology because of the difficulties in identifying skin biopsy sites, including variance of individual documentation; time lag between initial consultation and surgical procedure, often by different clinicians; and multiple lesions in close proximity confounded by background secondary changes. It has been shown that up to one-third of dermatology patients are unable accurately to identify their own initial skin biopsy site. We reported two cases of WSS in 2012 at our centre, where 5200 local-anaesthetic skin surgeries are performed per year. Our initial written local surgical standard operating procedure (SOP) was produced in 2013 with introduction of a surgical checklist and the development of triplicate carbon copies of a combined surgery/photography booking form, which included large body maps to facilitate transmission of correct site identification and documentation across all multiprocedural teams. Despite this we experienced two further cases of WSS in 2014. We present the subsequent procedural changes made through our clinical governance processes to prevent further WSS and improve our patient safety and quality standards. This includes the introduction of a ‘double check policy for lesion marking’, where photographers are instructed to send patients back to the clinician if the site is not properly marked with an arrow. Use of a mirror is mandatory to reconfirm the site with the patient prior to photography and surgery, and there is a final ‘surgical pause’ where the assistant calls out and reconfirms the site and procedure with the patient and surgeon. Human factor training is being organized. Our trust has now mandated annual training in our SOP for all multidisciplinary staff involved. Specific educational intervention using a training session has been associated with reduction in WSS in a dental outpatient setting. Following our first training in 2015, improvement in lesion marking was demonstrated from a photography audit. We have also developed an interactive, scenario based e-learning dermatology SOP module to ensure that training is updated and maintained in a robust manner. This will also generate measurable evaluation outcomes that can be linked to appraisals. In 2015 National Safety Standards for Interventional Procedures were produced, but these are not specific to dermatology. We propose that our speciality produces National Safety Standards for Dermatology Surgery with standardization of local SOPs and consideration of mandatory SOP training, which could reduce WSS and deliver a safer consistent patient service across the U.K.

Following up patients with cutaneous squamous cell carcinoma: 5-year data from a tertiary university centre

DS01 Proposal for National Dermatology Surgery Safety Standards: development of a dermatology surgery standard operating policy with mandatory training of staff may be an important tool to prevent wrong-site surgery R. Bhutani, C. Machin, G. Stables, V. Goulden and A. Mitra Chapel Allerton Hospital, Leeds, U.K. Wrong-site surgery (WSS) is the second most common reported adverse event, and accounts for 20% of National Health Service dermatology legal claims. WSS is more of a risk in dermatology because of the difficulties in identifying skin biopsy sites, including variance of individual documentation; time lag between initial consultation and surgical procedure, often by different clinicians; and multiple lesions in close proximity confounded by background secondary changes. It has been shown that up to one-third of dermatology patients are unable accurately to identify their own initial skin biopsy site. We reported two cases of WSS in 2012 at our centre, where 5200 local-anaesthetic skin surgeries are performed per year. Our initial written local surgical standard operating procedure (SOP) was produced in 2013 with introduction of a surgical checklist and the development of triplicate carbon copies of a combined surgery/photography booking form, which included large body maps to facilitate transmission of correct site identification and documentation across all multiprocedural teams. Despite this we experienced two further cases of WSS in 2014. We present the subsequent procedural changes made through our clinical governance processes to prevent further WSS and improve our patient safety and quality standards. This includes the introduction of a ‘double check policy for lesion marking’, where photographers are instructed to send patients back to the clinician if the site is not properly marked with an arrow. Use of a mirror is mandatory to reconfirm the site with the patient prior to photography and surgery, and there is a final ‘surgical pause’ where the assistant calls out and reconfirms the site and procedure with the patient and surgeon. Human factor training is being organized. Our trust has now mandated annual training in our SOP for all multidisciplinary staff involved. Specific educational intervention using a training session has been associated with reduction in WSS in a dental outpatient setting. Following our first training in 2015, improvement in lesion marking was demonstrated from a photography audit. We have also developed an interactive, scenario based e-learning dermatology SOP module to ensure that training is updated and maintained in a robust manner. This will also generate measurable evaluation outcomes that can be linked to appraisals. In 2015 National Safety Standards for Interventional Procedures were produced, but these are not specific to dermatology. We propose that our speciality produces National Safety Standards for Dermatology Surgery with standardization of local SOPs and consideration of mandatory SOP training, which could reduce WSS and deliver a safer consistent patient service across the U.K.

Mohs micrographic surgery is the required treatment for periocular microcystic adnexal carcinoma to maximize the possibility of tumour clearance

DS01 Proposal for National Dermatology Surgery Safety Standards: development of a dermatology surgery standard operating policy with mandatory training of staff may be an important tool to prevent wrong-site surgery R. Bhutani, C. Machin, G. Stables, V. Goulden and A. Mitra Chapel Allerton Hospital, Leeds, U.K. Wrong-site surgery (WSS) is the second most common reported adverse event, and accounts for 20% of National Health Service dermatology legal claims. WSS is more of a risk in dermatology because of the difficulties in identifying skin biopsy sites, including variance of individual documentation; time lag between initial consultation and surgical procedure, often by different clinicians; and multiple lesions in close proximity confounded by background secondary changes. It has been shown that up to one-third of dermatology patients are unable accurately to identify their own initial skin biopsy site. We reported two cases of WSS in 2012 at our centre, where 5200 local-anaesthetic skin surgeries are performed per year. Our initial written local surgical standard operating procedure (SOP) was produced in 2013 with introduction of a surgical checklist and the development of triplicate carbon copies of a combined surgery/photography booking form, which included large body maps to facilitate transmission of correct site identification and documentation across all multiprocedural teams. Despite this we experienced two further cases of WSS in 2014. We present the subsequent procedural changes made through our clinical governance processes to prevent further WSS and improve our patient safety and quality standards. This includes the introduction of a ‘double check policy for lesion marking’, where photographers are instructed to send patients back to the clinician if the site is not properly marked with an arrow. Use of a mirror is mandatory to reconfirm the site with the patient prior to photography and surgery, and there is a final ‘surgical pause’ where the assistant calls out and reconfirms the site and procedure with the patient and surgeon. Human factor training is being organized. Our trust has now mandated annual training in our SOP for all multidisciplinary staff involved. Specific educational intervention using a training session has been associated with reduction in WSS in a dental outpatient setting. Following our first training in 2015, improvement in lesion marking was demonstrated from a photography audit. We have also developed an interactive, scenario based e-learning dermatology SOP module to ensure that training is updated and maintained in a robust manner. This will also generate measurable evaluation outcomes that can be linked to appraisals. In 2015 National Safety Standards for Interventional Procedures were produced, but these are not specific to dermatology. We propose that our speciality produces National Safety Standards for Dermatology Surgery with standardization of local SOPs and consideration of mandatory SOP training, which could reduce WSS and deliver a safer consistent patient service across the U.K.

Electrosurgical resurfacing of rhinophyma: long-term follow-up, surgical outcomes and patient satisfaction

DS01 Proposal for National Dermatology Surgery Safety Standards: development of a dermatology surgery standard operating policy with mandatory training of staff may be an important tool to prevent wrong-site surgery R. Bhutani, C. Machin, G. Stables, V. Goulden and A. Mitra Chapel Allerton Hospital, Leeds, U.K. Wrong-site surgery (WSS) is the second most common reported adverse event, and accounts for 20% of National Health Service dermatology legal claims. WSS is more of a risk in dermatology because of the difficulties in identifying skin biopsy sites, including variance of individual documentation; time lag between initial consultation and surgical procedure, often by different clinicians; and multiple lesions in close proximity confounded by background secondary changes. It has been shown that up to one-third of dermatology patients are unable accurately to identify their own initial skin biopsy site. We reported two cases of WSS in 2012 at our centre, where 5200 local-anaesthetic skin surgeries are performed per year. Our initial written local surgical standard operating procedure (SOP) was produced in 2013 with introduction of a surgical checklist and the development of triplicate carbon copies of a combined surgery/photography booking form, which included large body maps to facilitate transmission of correct site identification and documentation across all multiprocedural teams. Despite this we experienced two further cases of WSS in 2014. We present the subsequent procedural changes made through our clinical governance processes to prevent further WSS and improve our patient safety and quality standards. This includes the introduction of a ‘double check policy for lesion marking’, where photographers are instructed to send patients back to the clinician if the site is not properly marked with an arrow. Use of a mirror is mandatory to reconfirm the site with the patient prior to photography and surgery, and there is a final ‘surgical pause’ where the assistant calls out and reconfirms the site and procedure with the patient and surgeon. Human factor training is being organized. Our trust has now mandated annual training in our SOP for all multidisciplinary staff involved. Specific educational intervention using a training session has been associated with reduction in WSS in a dental outpatient setting. Following our first training in 2015, improvement in lesion marking was demonstrated from a photography audit. We have also developed an interactive, scenario based e-learning dermatology SOP module to ensure that training is updated and maintained in a robust manner. This will also generate measurable evaluation outcomes that can be linked to appraisals. In 2015 National Safety Standards for Interventional Procedures were produced, but these are not specific to dermatology. We propose that our speciality produces National Safety Standards for Dermatology Surgery with standardization of local SOPs and consideration of mandatory SOP training, which could reduce WSS and deliver a safer consistent patient service across the U.K.

Eyelid basal cell carcinoma

We read with interest the paper by Hamada et al ,1 which draws a number of conclusions from a 5 year follow up study of 69 periocular basal cell carcinomas (BCCs) treated by conventional surgery and, in particular, suggests that there is no place for Mohs micrographic surgery (MMS) in patients with periocular BCCs. MMS is the serial saucerisation excision with mapped horizontal tissue sections examining 100% of the surgical margins to produce histological evidence of tumour negative margins. Unfortunately, the data included in the paper are incomplete and if such conclusions are to be considered, then further clarification is required.nnRisk of BCC recurrence relates directly to the nature of the tumours treated.2 The principal risk factors for recurrence include previous treatment, large tumour size, and an infiltrative or micronodular histological growth pattern. No information is given on the first two factors and the histological subtype was non-specified in approximately 45% of cases. We calculate from the data provided that the authors experienced a 19% 5 year recurrence rate in patients with a histologically infiltrative BCC.nnIf most of the “non-specified” tumours in Hamada’s series were small nodular tumours, as the paper implies, then Hamada’s series also differs significantly from other larger series in that it represents a group of patients with an inherently better prognosis. Other comments hint at this, in that 76% of BCCs were on the …