RESUMO
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.
Assuntos
Dermatologistas , Consentimento Livre e Esclarecido , Padrões de Prática Médica , Pesquisas sobre Atenção à Saúde , Humanos , Reino UnidoRESUMO
BACKGROUND: The motivations for patients presenting to melanoma screening clinics (MSCs) with concerning skin lesions are poorly understood. Social media (SoMe) refers to online platforms designed to facilitate sharing of information with billions of users worldwide. There is evidence of patients posting skin lesion 'selfies' on SoMe, influencing internet searches. Interventions through SoMe may have positive impacts on health seeking behaviour. AIM: To identify the influence of SoMe on patients presenting to an MSC service, and to establish whether patients have been exposed to SoMe posts on skin cancer, from medical authorities or the public. METHOD: For this pilot study, qualitative data were collected from patient questionnaires over 7 consecutive weeks at MSCs in Newcastle upon Tyne hospitals. Questions involved demographics, factors influencing attendance, use of SoMe and exposure to content on skin lesions on SoMe. RESULTS: Questionnaires were collected from 249 patients across a range of ages. Self-examination of lesions was the most common driver. One person in the study population described SoMe as having motivated their attendance, while 30 patients recalled seeing posts from health authorities regarding skin cancer. Qualitative data indicated that patients could be influenced by targeted public health campaigns on SoMe. CONCLUSIONS: This study suggests that SoMe is not currently a major conscious driver to attend an MSC, even among SoMe-familiar populations. However, the fact that SoMe is ubiquitous in society, in conjunction with our qualitative data, may suggest that current strategies for SoMe melanoma information delivery are not of requisite quality to break through to target populations.
Assuntos
Detecção Precoce de Câncer , Promoção da Saúde/métodos , Melanoma/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Mídias Sociais , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários , Reino Unido , Adulto JovemRESUMO
BACKGROUND: Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma). Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis. AIM: The primary aim was to study the range of nail presentations and identify key patterns to aid in differential diagnosis. A secondary aim was to quantify the number of patients requiring surgery, indications for biopsy, and the incidence and characteristics of NAMM. METHODS: This was a prospective study of all referrals with nail apparatus pigmentation to a weekly dedicated melanoma screening clinic over a 6-month period. RESULTS: In total, 2246 patients were included. Of the 38 patients referred with nail pigmentation, 1 (2.6%) was diagnosed with NAMM and involved a fungating amelanotic lesion of the right hallux. The remaining patients were diagnosed with subungual haematoma (20/38; 52.6%), viral wart (2/38; 5.4%), acral fibrokeratoma (1/38; 2.6%), myxoid cyst (3/38; 7.9%), fungal nail infection (4/38; 10.5%), Pseudomonas nail infection (1/38; 2.6%), benign linear pigmentation (2/38, 5.3%), Bowen disease (1/38, 2.6%), psoriatic nail changes (2/38; 5.3%) and matrix malalignment (1/38; 2.6%). Of the eight patients (21.1%) who required surgery, five had a biopsy taken and three underwent surgery. Only 14 cases were followed up by Dermatology. NAMM accounted for 0.7% of all melanomas diagnosed. CONCLUSION: We illustrate the wide range of diagnoses for pigmented nail presentations and highlight the late presentation of advanced disease in a patient presenting with NAMM.
Assuntos
Dermoscopia/métodos , Melanoma/patologia , Melanoma/cirurgia , Doenças da Unha/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Melanoma/diagnóstico por imagem , Melanoma/epidemiologia , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico por imagem , Pigmentação , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/epidemiologia , Adulto Jovem , Melanoma Maligno CutâneoRESUMO
We review the anatomy of the frontal scalp in relation to the clinical features and surgical management of frontalis-associated lipoma. Awareness of this entity, coupled with sound regional anatomical knowledge, is essential to achieve good outcomes.
Assuntos
Neoplasias Faciais/cirurgia , Testa/anatomia & histologia , Lipoma/cirurgia , Neoplasias Cutâneas/cirurgia , HumanosAssuntos
Sarcoma/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Dedos , Humanos , MasculinoRESUMO
The nose is an important site of skin pathology and skin cancer in particular, underlining the importance of the nose to the practice of dermatology. This article is intended to serve as an overview of the anatomy of the nose for dermatologists and dermatological surgeons. Areas of clinical relevance are emphasized with examples.
Assuntos
Dermatologia , Nariz/anatomia & histologia , Anestesia Local/métodos , Humanos , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/cirurgia , Osso Nasal/anatomia & histologia , Osso Nasal/cirurgia , Cartilagens Nasais/anatomia & histologia , Cartilagens Nasais/cirurgia , Bloqueio Nervoso/métodos , Nariz/irrigação sanguínea , Nariz/inervação , Rinoplastia/métodosRESUMO
As the incidence of non melanoma skin cancer rises, dermatologists will increasingly be called upon to perform excisions in the head and neck region. Damage to the motor nerves of the head and neck represents an important adverse event for patients, and a source of litigation for surgeons. Understanding the anatomy of this region is key to counselling patients about the possibility of motor nerve injury associated with particular skin surgical procedures. We describe the anatomy of the motor nerves of the head and neck that are most vulnerable to injury during dermatological surgery. The consequences of injury are outlined, and the surface anatomy and anatomical landmarks that may be used to identify the relevant danger zones are described.
Assuntos
Traumatismos do Nervo Acessório/etiologia , Procedimentos Cirúrgicos Dermatológicos , Traumatismos do Nervo Facial/etiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Cabeça/inervação , Neurônios Motores , Pescoço/inervação , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Cabeça/cirurgia , Humanos , Pescoço/cirurgia , Neoplasias Cutâneas/cirurgiaAssuntos
Carcinoma Basocelular/cirurgia , Dermoscopia/métodos , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Carga TumoralAssuntos
Aneurisma/patologia , Doenças da Unha/patologia , Unhas/patologia , Aneurisma/cirurgia , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Unha/cirurgia , Unhas/irrigação sanguínea , Unhas/cirurgia , Polegar/irrigação sanguínea , Polegar/patologia , Resultado do TratamentoAssuntos
Anestesia Local/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Satisfação do Paciente , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/psicologia , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/psicologia , Segurança do Paciente , Neoplasias Cutâneas/psicologiaRESUMO
Calciphylaxis is a rare and potentially life-threatening condition. It is thought to result from arterial calcification causing complete vascular occlusion and subsequent cutaneous infarction. Most often, it is a complication of end-stage renal failure or hyperparathyroidism; without either of these associated conditions, it is extremely rare. We report a case of calciphylaxis in a 58-year-old white British man, who had received long-term oral prednisolone for asthma control, with prophylactic calcium supplementation. There was no history of renal failure, and the patient's parathyroid function was normal. He was found to be heterozygous for the Factor V Leiden mutation. The acute presentation was seemingly precipitated by an episode of trauma and subsequent compression bandaging. The patient responded promptly to intravenous sodium thiosulfate. To our knowledge, this is the first case with no history of renal failure and normal parathyroid function, precipitated by compression bandaging and with an associated Factor V Leiden mutation.