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Affiliation(s)
- Y. N. Lau
- Department of Dermatology; Ninewells Hospital and Medical School; Dundee; UK
| | - A. G. Affleck
- Department of Dermatology; Ninewells Hospital and Medical School; Dundee; UK
| | - C. J. Fleming
- Department of Dermatology; Ninewells Hospital and Medical School; Dundee; UK
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Hearn RMR, Fleming CJ. Current trends and controversies in cutaneous melanoma. Scott Med J 2010; 55:36-40. [PMID: 20533701 DOI: 10.1258/rsmsmj.55.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cutaneous melanoma is an emerging and complex health problem. Management may require the expertise of multiple specialties. Although the outlook for advanced disease remains very poor, there are major advances in the understanding of melanoma. The heterogeneous nature of melanoma is more apparent and as such it is becoming evident that in the future we will probably utilise multiple approaches to treat disease and treatments may be tailored to individual needs. We can anticipate that as technology improves and information continues to accrue, our increased understanding of melanoma will lead to improved treatment of advanced disease.
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Affiliation(s)
- R M R Hearn
- Department of Dermatology and Photobiology, Ninewells Hospital and Medical School, Dundee
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Berroeta L, Clark C, Dawe RS, Ibbotson SH, Fleming CJ. A randomized study of minimal curettage followed by topical photodynamic therapy compared with surgical excision for low-risk nodular basal cell carcinoma. Br J Dermatol 2007; 157:401-3. [PMID: 17573890 DOI: 10.1111/j.1365-2133.2007.07996.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. OBJECTIVES Assessment of histological and clinical response of surgically resectable LM after treatment with 5% imiquimod cream. METHODS Six patients with LM were treated with 5% imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. RESULTS Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. CONCLUSIONS Topical imiquimod cream merits further investigation as a new therapy for LM.
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Affiliation(s)
- C J Fleming
- Departments of Dermatology and Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Humphray SJ, Oliver K, Hunt AR, Plumb RW, Loveland JE, Howe KL, Andrews TD, Searle S, Hunt SE, Scott CE, Jones MC, Ainscough R, Almeida JP, Ambrose KD, Ashwell RIS, Babbage AK, Babbage S, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beasley H, Beasley O, Bird CP, Bray-Allen S, Brown AJ, Brown JY, Burford D, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Chen Y, Clarke G, Clark SY, Clee CM, Clegg S, Collier RE, Corby N, Crosier M, Cummings AT, Davies J, Dhami P, Dunn M, Dutta I, Dyer LW, Earthrowl ME, Faulkner L, Fleming CJ, Frankish A, Frankland JA, French L, Fricker DG, Garner P, Garnett J, Ghori J, Gilbert JGR, Glison C, Grafham DV, Gribble S, Griffiths C, Griffiths-Jones S, Grocock R, Guy J, Hall RE, Hammond S, Harley JL, Harrison ESI, Hart EA, Heath PD, Henderson CD, Hopkins BL, Howard PJ, Howden PJ, Huckle E, Johnson C, Johnson D, Joy AA, Kay M, Keenan S, Kershaw JK, Kimberley AM, King A, Knights A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd C, Lloyd DM, Lovell J, Martin S, Mashreghi-Mohammadi M, Matthews L, McLaren S, McLay KE, McMurray A, Milne S, Nickerson T, Nisbett J, Nordsiek G, Pearce AV, Peck AI, Porter KM, Pandian R, Pelan S, Phillimore B, Povey S, Ramsey Y, Rand V, Scharfe M, Sehra HK, Shownkeen R, Sims SK, Skuce CD, Smith M, Steward CA, Swarbreck D, Sycamore N, Tester J, Thorpe A, Tracey A, Tromans A, Thomas DW, Wall M, Wallis JM, West AP, Whitehead SL, Willey DL, Williams SA, Wilming L, Wray PW, Young L, Ashurst JL, Coulson A, Blöcker H, Durbin R, Sulston JE, Hubbard T, Jackson MJ, Bentley DR, Beck S, Rogers J, Dunham I. DNA sequence and analysis of human chromosome 9. Nature 2004; 429:369-74. [PMID: 15164053 PMCID: PMC2734081 DOI: 10.1038/nature02465] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Accepted: 03/08/2004] [Indexed: 11/09/2022]
Abstract
Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.
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Affiliation(s)
- S J Humphray
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
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Abstract
BACKGROUND The subjective benefit of attendance at cosmetic clinics has not previously been reported. OBJECTIVES To assess the effect on perceived quality of life (QoL) of cosmetic camouflage advice. METHODS In a three-centre study, 135 individuals were invited to complete a dermatology-specific QoL measure, the Dermatology Life Quality Index (DLQI), before and 1 month after their first visit to a cosmetic camouflage clinic. RESULTS Eighty-two completed DLQI questionnaires were returned before the camouflage clinic appointment, and 56 corresponding questionnaires were returned 1 month after. The mean age of responders was 50 years, and the mean duration of their skin conditions was 15 years. The main conditions seen were pigmentary disorders (29%), scars (22%) and vascular disorders (13%). There was a significant difference in mean DLQI scores before and after the clinic visit (9.1 vs. 5.8, P = 0.0001). CONCLUSIONS When assessed at 1 month, attendance at a cosmetic camouflage clinic appears to improve QoL significantly.
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Affiliation(s)
- S A Holme
- Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, U.K.
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Abstract
BACKGROUND The ability of a physician to select individuals likely to benefit from patch testing depends on his or her ability to interpret responses to enquiries related to contact allergy. The significance of such responses to questions of nickel, fragrance and colophon allergy is unclear. OBJECTIVE The specificity, sensitivity and predictive value of questions relating to nickel, fragrance and colophony allergy were determined. METHOD A total of 258 patients attending for routine patch testing were questioned about skin reactions to nickel, fragrances and Elastoplast (Smith and Nephew Healthcare, Hull, England). All subjects were then patch tested to nickel, fragrance mix, and colophony. Responses to questions were compared with patch test results. RESULTS The sensitivity of questions relating to nickel, fragrance, and colophony was 82%, 49%, and 71%, respectively. The specificity of the same questions was 77%, 79%, and 90%; the positive predictive value was 54%, 46% and 29%, respectively. After adjustment to include clinical relevance, the sensitivity of nickel questions rose to 100%. CONCLUSION These data permit greater understanding of the role of patient history in selection of patients for patch testing.
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Affiliation(s)
- C J Fleming
- Department of Dermatology, Ninewells Hospital, Dundee, Scotland
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Abstract
We have surveyed Scottish dermatologists to establish the extent of patch testing, to assess the reasons for referral and to document resources and methods used by dermatologists. 104 questionnaires were sent to members of the Scottish Dermatological Society. 82 questionnaires (79%) were returned. 50% of respondents were consultants, 27% were trainees and 23% held staff grade or clinical assistant positions. The mean waiting time for a patch test appointment was 4.5 months. The most frequent reasons for patch testing were localized eczema, eczema not responding to conventional treatment, occupational eczema, history of contact sensitivity and eczema of uncertain cause. 17 of 82 respondents (21%) were the principal clinicians supervising patch testing in their hospitals. 11 of 17 read reactions at 2 and 4 days. Mean time spent on advising patients was 13 min per patients. 7 of 17 were dissatisfied with resources available for patient education and 16 of 17 felt they would benefit from a central source for patient information. Only 4 of 17 centres recorded patch test results on a database and 3 centres regularly reviewed their patch test results. In conclusion, we have identified areas of patch testing that require further improvement.
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Affiliation(s)
- J L Bong
- Contact Dermatitis Investigation Unit, Glasgow Royal Infirmary, Scotland, UK
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Abstract
We have examined evidence for familial disposition to nickel allergic contact dermatitis (Ni ACD). 258 patients attending for routine patch testing were recruited prospectively. 39 patients were diagnosed with Ni ACD. 31 of 209 1st-degree relatives (15%) of probands had a history of nickel hypersensitivity. 84 patients with no history of nickel hypersensitivity and negative patch tests to nickel were used as controls. 24 of 458 1st degree relatives of controls (5.2%) had a history of Ni ACD. The risk ratio for 1st degree relatives of a patient with Ni ACD is 2.83 (95% confidence intervals are 2.45, 3.27). This is the 1st study to present a statistic to represent risk to relatives of developing ACD. Relatives of patients with Ni ACD have an increased risk of developing the condition, but the genetic basis for this is not yet known. With currently available techniques, this value of relative risk makes a positional cloning approach to gene identification impractical.
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Affiliation(s)
- C J Fleming
- Department of Dermatology, Western Infirmary, Glasgow Royal Infirmary, Scotland, UK
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Fleming CJ, Bong JL, Forsyth A. International Nomenclature cosmetic ingredient awareness in Scotland. Br J Dermatol 1999; 141:880-1. [PMID: 10583171 DOI: 10.1046/j.1365-2133.1999.03173.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C J Fleming
- Contact Dermatitis Investigation Unit, Glasgow Royal Infirmary, Glasgow, UK
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Abstract
The results of patch testing with a series containing components of cigarettes and matches were reviewed. 2 years were reviewed, 1987 and 1997. 314 patients were patch tested to this series, 203 in 1987 and 111 in 1997. 31 patients had clinically relevant positive reactions to the series, 25 in 1987 and 6 in 1997. 26 patients had relevant positive tests to cigarette components in the series. There were 14 relevant positive reactions to phosphorus sesquisulfide in 1987 and one in 1997. All patients with relevant positive reactions to red match tips also had reactions to phosphorus sesquisulfide. There was a significant association between cigarette and fragrance hypersensitivity. The eczema in 3 of 4 patients who stopped smoking improved. A series containing match heads, smoked cigarette filters and remnants of tobacco from smoked cigarettes may be useful in smokers with eczema of the face, neck or hands.
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Affiliation(s)
- G Dawn
- Contact Dermatitis Investigation Unit, Glasgow Royal Infirmary, UK
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Fleming CJ, Sinclair DU, White EJ, Winchester B, Whiteford ML, Connor JM. A fucosidosis patient with relative longevity and a missense mutation in exon 7 of the alpha-fucosidase gene. J Inherit Metab Dis 1998; 21:688-9. [PMID: 9762612 DOI: 10.1023/a:1005405222252] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C J Fleming
- Department of Dermatology, Glasgow Royal Infirmary, UK
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Affiliation(s)
- C J Fleming
- Contact Dermatitis Investigation Unit, Glasgow Royal Infirmary, UK
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Affiliation(s)
- B Gibson-Smith
- Contact Dermatitis Investigation Unit, Glasgow Royal Infirmary, Scotland, UK
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Affiliation(s)
- T W Lucke
- Department of Dermatology, Western Infirmary, Glasgow, UK
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Affiliation(s)
- T W Lucke
- Department of Dermatology, Western Infirmary, Glasgow, UK
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Affiliation(s)
- C J Fleming
- Department of Dermatology, Western Infirmary Glasgow, UK
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Abstract
Nineteen patients with psoriasis vulgaris and no other cause for systemic complement activation were studied for evidence of such activation. There was a marked elevation in serum C5b-9 complexes with no other significant complement abnormalities, and no correlation between C5b-9 levels and disease activity. This is the most detailed study of complement in psoriasis yet attempted and confirms that complement activation is a feature of psoriasis vulgaris.
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Affiliation(s)
- C J Fleming
- University Department of Dermatology, Western Infirmary, Glasgow, Scotland, UK
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Fleming CJ, Hunt MJ, Salisbury EL, McCarthy SW, Barnetson RS. Minocycline-induced hyperpigmentation in leprosy. Br J Dermatol 1996; 134:784-7. [PMID: 8733393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 36-year-old man was treated with dapsone, rifampicin and clofazimine for borderline lepromatous leprosy. After 9 months, his leprosy plaques became progressively more red and after 23 months, the clofazimine was stopped and he was given minocycline instead. Six weeks later, he developed blue-black pigmentation in his leprosy lesions. The histology was consistent with minocycline-induced hyperpigmentation. This is the first report of minocycline-induced pigmentation in leprosy. We suggest it is important to consider this side-effect before the administration of minocycline in leprosy, particularly if it is prescribed in place of clofazimine.
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Affiliation(s)
- C J Fleming
- Department of Dermatology, Royal Prince Alfred Hospital, New South Wales, Australia
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Abstract
We describe a case of chrysiasis in a 54-year-old woman. The diagnosis was confirmed by light microscopy, transmission electron microscopy, and radiographic microanalysis. The condition developed after a relatively low dose of gold. We propose that chrysiasis developed because of the patient's exposure to the intense UV light in Australia.
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Affiliation(s)
- C J Fleming
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Fleming CJ. Kellogg Foundation sponsors interdisciplinary experience in migrant health care. NP News 1995; 3:1, 6. [PMID: 7767827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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