1
|
Wernham AGH, Oliphant T, Veitch D, Naysmith L, Varma S. National survey of UK Dermatologists demonstrates significant variation in how to obtain consent for dermatological procedures. Clin Exp Dermatol 2019; 45:576-579. [PMID: 31872451 DOI: 10.1111/ced.14164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
Consent must be undertaken prior to any dermatological procedure; however, in doing this, the clinician needs to ensure consent is valid and satisfies the principles of determining material risk. We aimed to assess variations in obtaining consent in the UK and understanding of material risk through a nationally distributed survey to members of the British Society for Dermatological Surgery and British Association of Dermatologists. Of 165 responses, we found that written consent was being obtained for all procedures in 73.9% of cases and typically at the time of procedure in the operating room/theatre (78.8%). Fifty-seven per cent of respondents were not familiar with the term 'material risk' and almost one-third were not aware of the Montgomery vs. Lanarkshire ruling, which replaced the Bolam test in 2015. We would encourage readers to be aware of these changes to consent law in the UK and how it might affect their approach to obtaining consent.
Collapse
Affiliation(s)
- A G H Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, West Midlands, UK.,Department of Dermatology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - T Oliphant
- Department of Dermatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Veitch
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham University Hospitals, QMC Campus, Nottingham, UK
| | - L Naysmith
- Department of Dermatology, Lauriston Building, Edinburgh, UK
| | - S Varma
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham University Hospitals, QMC Campus, Nottingham, UK
| |
Collapse
|
2
|
Kravvas G, Ball SL, Naysmith L. Assessing the efficacy of a 10-point referral tool in the triaging of pigmented lesions to a Dermatology clinic. An Bras Dermatol 2019; 93:932-933. [PMID: 30484550 PMCID: PMC6256226 DOI: 10.1590/abd1806-4841.20188079] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/16/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Georgios Kravvas
- Department of Dermatology, NHS Lothian, Edinburgh, United
Kingdom
| | | | - Lisa Naysmith
- Department of Dermatology, NHS Lothian, Edinburgh, United
Kingdom
| |
Collapse
|
3
|
Naysmith L. Cutaneous Malignancies. A surgical perspective. Acta Derm Venereol 2018. [DOI: 10.2340/00015555-2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Abstract is missing (Book review)
Collapse
|
4
|
Van-de-Velde V, Kravvas G, Ali G, Biswas A, Naysmith L. A solitary and tender acral papule in a young patient. Clin Exp Dermatol 2018; 43:630-632. [PMID: 29748978 DOI: 10.1111/ced.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- V Van-de-Velde
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - G Kravvas
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - G Ali
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Biswas
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Naysmith
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Tabor D, Ball S, Biswas A, Naysmith L. A Longstanding Nodule on the Temple: A Quiz. Acta Derm Venereol 2018; 98:471-472. [PMID: 29313053 DOI: 10.2340/00015555-2881] [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: 11/16/2022] Open
Affiliation(s)
- Dominic Tabor
- Department of Dermatology, Lauriston Building, Lauriston Place, EH3 9HA Edinburgh, Scotland.
| | | | | | | |
Collapse
|
6
|
Aguilar-Duran S, Panthagani A, Naysmith L, Holme SA. Reducing blood splatter in dermatological surgery: reply from the authors. Br J Dermatol 2017; 177:597. [PMID: 28477362 DOI: 10.1111/bjd.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S Aguilar-Duran
- Department of Dermatology, Royal Infirmary of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, U.K
| | - A Panthagani
- Department of Dermatology, Royal Infirmary of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, U.K
| | - L Naysmith
- Department of Dermatology, Royal Infirmary of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, U.K
| | - S A Holme
- Department of Dermatology, Royal Infirmary of Edinburgh, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, U.K
| |
Collapse
|
7
|
Hussain W, Affleck A, Al-Niaimi F, Cooper A, Craythorne E, Fleming C, Ghura V, Langtry J, Lawrence C, Loghdey S, Naysmith L, Oliphant T, Rahim R, Rice S, Sivaramkrishan M, Stables G, Varma S, Mallipeddi R. 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. Br J Dermatol 2017; 176:806-808. [PMID: 27377192 DOI: 10.1111/bjd.14843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- W Hussain
- Dermatology Surgical & Laser Unit (C4), Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K
| | - A Affleck
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - F Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
| | - A Cooper
- Dermatology Department, East Kent Hospitals University NHS Foundation Trust, Canterbury, CT1 3NG, U.K
| | - E Craythorne
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
| | - C Fleming
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - V Ghura
- Department of Dermatology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, U.K
| | - J Langtry
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - C Lawrence
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - S Loghdey
- Department of Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, U.K
| | - L Naysmith
- Department of Dermatology, Lauriston Building, Edinburgh, EH3 9HA, U.K
| | - T Oliphant
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - R Rahim
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - S Rice
- Dermatology Department, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, U.K
| | - M Sivaramkrishan
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - G Stables
- Dermatology Surgical & Laser Unit (C4), Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K
| | - S Varma
- Department of Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, U.K
| | - R Mallipeddi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, SE1 7EH, U.K
| |
Collapse
|
8
|
Aguilar‐Duran S, Panthagani A, Naysmith L, Holme SA. Incidence and risk factors of blood splatter in dermatological surgery: how protective are full facial masks? Br J Dermatol 2016; 176:275-277. [DOI: 10.1111/bjd.15009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S. Aguilar‐Duran
- Department of Dermatology Royal Infirmary of Edinburgh Edinburgh U.K
| | - A. Panthagani
- Department of Dermatology Royal Infirmary of Edinburgh Edinburgh U.K
| | - L. Naysmith
- Department of Dermatology Royal Infirmary of Edinburgh Edinburgh U.K
| | - S. A. Holme
- Department of Dermatology Royal Infirmary of Edinburgh Edinburgh U.K
| |
Collapse
|
9
|
Naysmith L. Surgery of the Skin. Third Edition. Acta Derm Venereol 2016. [DOI: 10.2340/00015555-2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Aldridge RB, Naysmith L, Ooi ET, Murray CS, Rees JL. The importance of a full clinical examination: assessment of index lesions referred to a skin cancer clinic without a total body skin examination would miss one in three melanomas. Acta Derm Venereol 2013; 93:689-92. [PMID: 23695107 DOI: 10.2340/00015555-1625] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traditional clinical teaching emphasises the importance of a full clinical examination. In the clinical assessment of lesions that may be skin cancer, full examination allows detection of incidental lesions, as well as helping in the characterisation of the index lesion. Despite this, a total body skin examination is not always performed. Based on two prospective studies of over 1,800 sequential patients in two UK centres we show that over one third of melanomas detected in secondary care are found as incidental lesions, in patients referred for assessment of other potential skin cancers. The majority of these melanomas occurred in patients whose index lesion turned out to be benign. Alternative models of care--for instance some models of teledermatology in which a total body skin examination is not performed by a competent practitioner--cannot be considered equivalent to a traditional consultation and, if adopted uncritically, without system change, will likely lead to melanomas being missed.
Collapse
Affiliation(s)
- R Benjamin Aldridge
- Department of Dermatology, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | | |
Collapse
|
11
|
|
12
|
Rees J, Naysmith L. In this issue: Reverse translation. Acta Derm Venereol 2010; 90:450-3. [PMID: 20814615 DOI: 10.2340/00015555-0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
13
|
Rees J, Naysmith L. In this issue: to expose or not to expose? Acta Derm Venereol 2010; 90:339. [PMID: 20574595 DOI: 10.2340/00015555-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
Rees JL, Waterston K, Naysmith L, Oh C, Hennessy A, Bisset Y, Diffey B, Ito S, Wakamatsu K. Red hair, fair skin and melanoma - melanocortin 1 receptor. Exp Dermatol 2008. [DOI: 10.1111/j.0906-6705.2004.0212g.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Waterston K, Naysmith L, Rees JL. Variation in Skin Thickness May Explain Some of the Within-Person Variation in Ultraviolet Radiation-Induced Erythema at Different Body Sites. J Invest Dermatol 2005; 124:1078. [PMID: 15854053 DOI: 10.1111/j.0022-202x.2005.23704.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
16
|
|
17
|
Abstract
We have studied the cutaneous response to ultraviolet radiation, measured objectively as erythema in a sample of 12 body sites on 15 Northern European subjects with multiple doses of ultraviolet B (UVB). Skin pigmentation and the development of photoadaptation in response to five repeated doses of irradiation at three body sites was also measured. We report striking differences of up to 5-fold at different body sites to the same challenge dose (p < 0.001) and demonstrate that for this population, site variation is just as important as between-person variation. Skin color at each body site is a strong predictor of response (p < 0.001) and that this cannot be attributed to vascular differences, but instead we believe it reflects site-specific variations in melanin pigmentation. We also observed similar but smaller within-person effects for responses to another inflammatory agent, dithranol (p < 0.01). Despite this, we did not find evidence for differences in the development of photoadaptation by body site. These results have clear clinical implications for the practice of phototesting prior to commencing phototherapy, for therapeutic failure in sites such as the legs in patients with psoriasis, and perhaps for melanoma body-site distribution.
Collapse
Affiliation(s)
- Karen Waterston
- Systems Group, Dermatology, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | | |
Collapse
|
18
|
Abstract
This review of ectodermal dyplasias (ED) presents the particular syndromes that might present to the otolaryngologist for management and discusses the ear, nose and throat manifestations of the condition.
Collapse
Affiliation(s)
- Robert Mills
- Otolaryngology Unit, University of Edinburgh, UK.
| | | | | |
Collapse
|
19
|
|
20
|
Naysmith L, Waterston K, Ha T, Flanagan N, Bisset Y, Ray A, Wakamatsu K, Ito S, Rees JL. Quantitative measures of the effect of the melanocortin 1 receptor on human pigmentary status. J Invest Dermatol 2004; 122:423-8. [PMID: 15009725 DOI: 10.1046/j.0022-202x.2004.22221.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Variation in human hair and skin color is the most striking visible aspect of human genetic variation. The only gene known to exert an effect on pigmentary within the normal population is the melanocortin-1 receptor (MC1R). Previous studies have used a Mendelian framework to relate MC1R genotype to phenotype, by measuring pigmentary status using categorical scales. Such approaches are inadequate. We report results using direct measures of hair color using objective colorimetric dimensions and HPLC determined hair melanins. We have linked MC1R genotype with chemical measures of melanin quantity and type and objective phenotype measures of color. MC1R genotype was predictive of hair melanin expressed as the ratio of the loge of eumelanin to pheomelanin ratio, with a dosage effect evident: MC1R homozygote mean, 1.46; heterozygote, 4.44; and wild type, 5.81 (p<0.001). Approximately 67% of the variance in this model could be accounted for in terms of MC1R genotype. There was also a relation between MC1R status and hair color, most prominently for the b* axis (p<0.001), but also for the a* and L* scales (L*a*b*, CIE). We show for one of the most polymorphic human traits that it is possible to demonstrate meaningful relations between various physical characteristics: DNA sequence diversity, hair-wavelength-specific reflectance patterns, and chemical melanin assays.
Collapse
Affiliation(s)
- Lisa Naysmith
- Systems Group, Dermatology, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ha T, Javedan H, Waterston K, Naysmith L, Rees JL. The relationship between constitutive pigmentation and sensitivity to ultraviolet radiation induced erythema is dose-dependent. Pigment Cell Res 2003; 16:477-9. [PMID: 12950723 DOI: 10.1034/j.1600-0749.2003.00076.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The relationship between skin colour and experimental exposure to ultraviolet radiation (UVR) B, with response measured as erythema was studied. Two reflectance methods were used to measure skin colour--tristimulus colorimetry using a Minolta instrument (summarized as the alpha characteristic angle) and the melanin index based on the Diastron reflectance instrument. As expected both measures are highly correlated (0.91). A dose-dependent relationship between skin colour measured as the alpha characteristic angle and UVR was established, with the gradient increasing from 0.99 at 119 mJ to 2.7 at 300 mJ, with the relevant standard errors being 0.39 and 0.47, respectively. Similarly, for the melanin index (where the scale goes in the opposite direction) the gradient differs between -0.49 for 119 mJ and -0.91 for 300 mJ, with the standard errors being 0.14 and 0.17 respectively. The proportion of variation explained is also greater at higher UVR challenge doses. Studies relating UVR sensitivity and pigmentation need to take account of the dose of UVR administered.
Collapse
Affiliation(s)
- Thomas Ha
- Department of Dermatology, University of Edinburgh, Edinburgh, UK
| | | | | | | | | |
Collapse
|
22
|
Ha T, Naysmith L, Waterston K, Oh C, Weller R, Rees JL. Defining the quantitative contribution of the melanocortin 1 receptor (MC1R) to variation in pigmentary phenotype. Ann N Y Acad Sci 2003; 994:339-47. [PMID: 12851334 DOI: 10.1111/j.1749-6632.2003.tb03198.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The melanocortin 1 receptor (MC1R) is a key determinant of pigmentary phenotype. Several sequence variants of the MC1R have been described, many of which are associated with red hair and cutaneous sensitivity to ultraviolet radiation even in the absence of red hair. Red hair approximates to an autosomal recessive trait, and most people with red hair are compound heterozygote or homozygous for limited numbers of mutations that show impaired function in in vitro assays. There is a clear heterozygote effect on sun sensitivity (even in those without red hair) and with susceptibility to the most common forms of skin cancer.
Collapse
Affiliation(s)
- T Ha
- Dermatology, University of Edinburgh, Edinburgh EH3 9YW, United Kingdom
| | | | | | | | | | | |
Collapse
|
23
|
Naysmith L, Waterston K, Rees JL. 231st General Meeting of the SDS Edinburgh 8 February 2001. Clin Exp Dermatol 2002. [DOI: 10.1046/j.1365-2230.2002.1041911.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
|