Patient-initiated follow-up for high-risk cutaneous squamous cell carcinoma. How we do it and two years of outcome data.

Why do we follow-up patients with high-risk cutaneous squamous-cell carcinomas (cSCC)? Current guidance suggests we offer post-treatment follow-up appointments at regular intervals for 24 months. Is this to improve prognosis, provide psychological support or find the next cancer? Recent data confirms recurrence and metastasis to be rarer events. We question whether these follow-up practices are truly 'needed' by introducing an option of patient-initiated follow-up (PIFU). We enrolled 476 cSCC patients (January 2020 - January 2023) who fulfilled the definition of high-risk cSCC based on guidelines in use at the time. 59 patients were excluded. 53% (n=250) did not re-contact us during the 2-year period, with no clinical record of complications or recurrences. 35% (n=167) utilised the PIFU pathway, of which 119 patients only required 1 face-to-face appointment. 7 patients (1.5%) developed metastatic disease, 11 patients developed recurrence, and 68 patients developed cSCC at another site. All lesions were identified by the patient via PIFU. We saved 1250 follow-up appointments from those that did not contact us (n=250); financially equating to £181,462.50. Our data implies that PIFU can be considered safe alternative practice for patients with cSCC. Patients independently identified the need for review without scheduled follow-up, making these appointments available to other patient cohorts. Although follow-up appointments may provide mental health support, they can be inconvenient and not the ideal use of our health resources. Our findings support a call for revision of existing skin cancer health policies, to cope with and subsequently improve our practices, to better patient care.

Population dynamics and spatial structure of the grey rockcod (Lepidonotothen squamifrons) in the vicinity of Heard Island and the McDonald Islands.

The grey rockcod, Lepidonotothen squamifrons is an important prey species for seals, penguins and Patagonian toothfish (Dissostichus eleginoides) in the Southern Ocean. Across the Kerguelen Plateau, the species was fished to commercial extinction (ca. 152 000 tonnes between 1971 and 1978) prior to the declaration of the French Exclusive Economic Zone in 1979 and the Australian Fishing Zone in 1981. In this study we estimate; age, growth, maturity, sex ratio, body condition (weight-at-length), and population density of grey rockcod using data from 19 trawl surveys from 1990 to 2014. There appeared to be three distinct geographical populations, with differences in biological parameters within each population. This study has identified separate metapopulations within the southern region of the Kerguelen Plateau and we recommend that management should take into account the different characteristics of these populations, and that this meta-population structure may be a factor in why this species required several decades to show signs of recovery.

Patient-led teledermatology for skin lesion triage: a service evaluation of the DyplensTM dermoscope.

Despite the huge improvement in smartphone cameras, there has not been any real interest in the UK in pursuing patient-facing teledermatology within the sphere of skin lesion triage. High-specification dermoscopic images can be generated with smartphone attachments, but, to date, no formal clinical trial has been performed to establish the efficacy and feasibility of these consumer-level dermoscopes in skin lesion triage. The objectives of this study were to assess the ability of patients to capture dermoscopic images using a smartphone attachment, and to identify the safety and diagnostic accuracy of consumer-level dermoscopy in triaging out benign skin lesions from the 2-week-wait (2WW) cancer pathway. We recruited 78 patients already attending a face-to-face clinic at two locations. They were provided with instruction leaflets and asked to obtain dermoscopic and macroscopic images of their lesion(s) using their own smartphones. The images (and a brief history) were distributed to five experienced blinded assessors (consultants), who were asked to state their working diagnosis and outcome (reassurance, routine review or 2WW pathway), as they would in teledermatology. We compared their outcomes to the gold-standard in-person diagnosis and/or histological diagnosis, where available. The device achieved 100% sensitivity in diagnosing melanoma and squamous cell carcinoma (SCC). The specificity for the diagnoses of melanoma (89%) and SCC (83%) was high. The overall diagnostic accuracy was 77% for both benign and malignant lesions, The diagnostic accuracy was high for seborrhoeic keratosis (91%) and simple naevi (81%). Patient-captured dermoscopic images using bespoke smartphone attachments could be the future in safely triaging out benign lesions.

Measuring Intracellular Viscosity in Conditions of Hypergravity.

Gravity-sensitive cellular responses are regularly observed in both specialized and nonspecialized cells. One potential mechanism for this sensitivity is a changing viscosity of the intracellular organelles. Here, we report a novel, to our knowledge, viscosity-sensitive molecular rotor based on mesosubstituted boron-dipyrrin used to investigate the response of viscosity of cellular membranes to hypergravity conditions created at the large diameter centrifuge at the European Space Agency Technology Centre. Mouse osteoblastic (MC3T3-E1) and endothelial (human umbilical vein endothelial cell) cell lines were tested, and an increase in viscosity was found with increasing hypergravity loading. This response is thought to be primarily biologically driven, with the potential for a small, instantaneous physical mechanism also contributing to the observed effect. This work provides the first, to our knowledge, quantitative data for cellular viscosity changes under hypergravity, up to 15 × g.