1
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Neumann I, Patalay R, Kaushik M, Timlin H, Daniel C. Treatment of periocular lentigo maligna with topical 5% Imiquimod: a review. Eye (Lond) 2023; 37:408-414. [PMID: 35835989 PMCID: PMC9905524 DOI: 10.1038/s41433-022-02165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
Lentigo Maligna is a benign subtype of melanoma in situ and can progress to lentigo maligna melanoma, which is invasive. Complete surgical excision is the gold standard of treatment but requires large margins. If affecting the peri-ocular region, surgical excision leads to extensive defects, complex reconstructions, and functional impairment of the protection of the ocular surface. Here we review the reported literature about the use of Imiquimod 5% topical cream for lentigo maligna of the eyelid, the treatment outcomes, side effects and tolerance. In addition, the side effects of imiquimod treatment of non-LM lesions are described to help better inform the decision-making process. Treatment for peri-ocular Lentigo maligna showed a 56-86% complete treatment response and a 90% tolerability rate. However, reported treatment protocols vary and histopathological confirmation of clearance was only obtained in 56%. Further studies are required to determine the optimal treatment protocol to maximise clearance rates. Overall, Imiquimod was well tolerated in the peri-ocular area.
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Affiliation(s)
- Inga Neumann
- Adnexal Department, Moorfields Eye Hospital, London, UK.
| | - R Patalay
- Dermatology Department, Guys and St. Thomas Hospital, London, UK
| | - M Kaushik
- Adnexal Department, Moorfields Eye Hospital, London, UK
| | - H Timlin
- Adnexal Department, Moorfields Eye Hospital, London, UK
| | - C Daniel
- Adnexal Department, Moorfields Eye Hospital, London, UK
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2
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Wan B, Ganier C, Du-Harpur X, Harun N, Watt FM, Patalay R, Lynch MD. Applications and future directions for optical coherence tomography in dermatology. Br J Dermatol 2020; 184:1014-1022. [PMID: 32974943 DOI: 10.1111/bjd.19553] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive optical imaging method that can generate high-resolution en face and cross-sectional images of the skin in vivo to a maximum depth of 2 mm. While OCT holds considerable potential for noninvasive diagnosis and disease monitoring, it is poorly understood by many dermatologists. Here we aim to equip the practising dermatologist with an understanding of the principles of skin OCT and the potential clinical indications. We begin with an introduction to the technology and discuss the different modalities of OCT including angiographic (dynamic) OCT, which can image cutaneous blood vessels at high resolution. Next we review clinical applications. OCT has been most extensively investigated in the diagnosis of keratinocyte carcinomas, particularly basal cell carcinoma. To date, OCT has not proven sufficiently accurate for the robust diagnosis of malignant melanoma; however, the evaluation of abnormal vasculature with angiographic OCT is an area of active investigation. OCT, and in particular angiographic OCT, also shows promise in monitoring the response to therapy of inflammatory dermatoses, such as psoriasis and connective tissues disease. We additionally discuss a potential role for artificial intelligence in improving the accuracy of interpretation of OCT imaging data.
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Affiliation(s)
- B Wan
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK
| | - C Ganier
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK
| | - X Du-Harpur
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK.,The Francis Crick Institute, 1 Midland Road, London, UK
| | - N Harun
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK
| | - F M Watt
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK
| | - R Patalay
- St John's Institute of Dermatology, King's College London, London, UK
| | - M D Lynch
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK.,St John's Institute of Dermatology, King's College London, London, UK
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3
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Patalay R. Which method is better for the diagnosis of basal cell carcinoma: biopsy vs. reflectance confocal microscopy? Br J Dermatol 2020; 184:590. [PMID: 33140421 DOI: 10.1111/bjd.19571] [Citation(s) in RCA: 2] [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] [Received: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Affiliation(s)
- R Patalay
- Department of Dermatology, Guy and St Thomas' NHS Foundation Trust, London, UK
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4
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Nicholson P, Ali FR, Patalay R, Craythorne E, Mallipeddi R. Patient perceptions of Mohs micrographic surgery during the COVID-19 pandemic and lessons for the next outbreak. Clin Exp Dermatol 2020; 46:179-180. [PMID: 32803789 PMCID: PMC7460918 DOI: 10.1111/ced.14423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- P Nicholson
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - F R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - R Patalay
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - E Craythorne
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - R Mallipeddi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
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5
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Swan BC, Patalay R, Mallipeddi R. Antiseptic use in Mohs micrographic surgery: British Society for Dermatological Surgery and Australasian College of Dermatologists survey. Br J Dermatol 2020; 183:568-569. [PMID: 32167582 DOI: 10.1111/bjd.19029] [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: 11/27/2022]
Affiliation(s)
- B C Swan
- Dermatology Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Patalay
- Dermatology Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Mallipeddi
- Dermatology Surgery and Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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6
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Gollins CE, Shah A, Sinha K, Khan S, Paul N, Meeajun B, Abbott RA, Blasdale C, Cooper H, Harwood CA, Ismail F, Lear JT, Mackintosh L, McCormack S, Perrett CM, Proby CM, Durack A, Patalay R, Matin RN. Feasibility of a trial to evaluate nicotinamide for chemoprevention of skin cancers in organ transplant recipients in the UK. Br J Dermatol 2020; 183:394-396. [PMID: 32119116 DOI: 10.1111/bjd.18982] [Citation(s) in RCA: 2] [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: 11/29/2022]
Affiliation(s)
- C E Gollins
- UK Departments of Dermatology:, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London
| | - A Shah
- Basildon University Hospital, Basildon and Thurrock Hospitals NHS Foundation Trust
| | - K Sinha
- Basildon University Hospital, Basildon and Thurrock Hospitals NHS Foundation Trust
| | - S Khan
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - N Paul
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - B Meeajun
- Dermatology, Whittington Hospital, Whittington Health NHS Trust, London
| | - R A Abbott
- University Hospital of Wales, Cardiff and Vale University Health Board
| | - C Blasdale
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - H Cooper
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust
| | - C A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - F Ismail
- Royal Free London NHS Foundation Trust
| | - J T Lear
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust
| | | | | | - C M Perrett
- University College Hospital, University College London Hospitals NHS Foundation Trust
| | - C M Proby
- Ninewells Hospital and Medical School, University of Dundee
| | - A Durack
- Cambridge University Hospitals NHS Foundation Trust
| | - R Patalay
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R N Matin
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
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7
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Sinha K, Ali F, Orchard G, Rickaby W, Shams M, Mallipeddi R, Patalay R. Use of a novel 1-hour protocol for rapid frozen section immunocytochemistry, in a case of squamous cell carcinoma treated with Mohs micrographic surgery. Clin Exp Dermatol 2018; 43:454-457. [PMID: 29396855 DOI: 10.1111/ced.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
For squamous cell carcinoma (SCC) treated using Mohs micrographic surgery (MMS), interpretation of haematoxylin and eosin-stained frozen sections can be challenging. In these situations, ancillary use of immunostaining is a useful tool for the Mohs surgeon. However, use of immunostaining in MMS laboratories is limited, mainly because current manual immunostaining platforms are subject to operator error, and automated immunostaining, albeit accurate, is too slow for inclusion in MMS. In this report, we describe a novel 1-hour protocol for rapid frozen section immunocytochemistry, using the pancytokeratin markers AE1/AE3. This protocol has been specifically designed to integrate the speed of manual techniques and the accuracy of automated platforms, making it a valuable addition to the MMS laboratory. We propose that in selected or histologically challenging cases, there is a role for the use of this novel protocol, allowing the Mohs surgeon to more confidently declare tumour clearance, thus preventing further unnecessary surgery and preserving healthy tissue.
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Affiliation(s)
- K Sinha
- Dermatology Surgery and Laser Unit, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - F Ali
- Dermatology Surgery and Laser Unit, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - G Orchard
- St John's Histopathology Department, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - W Rickaby
- St John's Histopathology Department, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - M Shams
- St John's Histopathology Department, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - R Mallipeddi
- Dermatology Surgery and Laser Unit, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
| | - R Patalay
- Dermatology Surgery and Laser Unit, St John's Institute, Guys and St Thomas' NHS Trust, London, UK
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8
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Craythorne E, Patalay R, Mallipeddi R. Confocal microscopy facilitates the 'one-stop-chop'. Br J Dermatol 2017; 177:614-615. [PMID: 28940273 DOI: 10.1111/bjd.15766] [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: 11/28/2022]
Affiliation(s)
- E Craythorne
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - R Patalay
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - R Mallipeddi
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
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9
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Edwards SJ, Osei-Assibey G, Patalay R, Wakefield V, Karner C. Diagnostic accuracy of reflectance confocal microscopy using VivaScope for detecting and monitoring skin lesions: a systematic review. Clin Exp Dermatol 2017; 42:266-275. [PMID: 28218469 DOI: 10.1111/ced.13055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Skin cancer is one of the most common cancers in the UK. Patients with suspicious skin lesions are assessed clinically with/without dermoscopy, and lesions still considered suspicious are then surgically removed or have the diagnosis confirmed by a punch biopsy. AIM To evaluate the diagnostic accuracy of the in vivo VivaScope© reflective confocal microscopy (RCM) system, a noninvasive technology designed to provide a more accurate presurgical diagnosis, leading to fewer biopsies of benign lesions, or to provide greater accuracy for lesion margins. METHODS MEDLINE, EMBASE and the Cochrane Library were searched to identify studies evaluating dermoscopy plus RCM, or RCM alone, with histopathology as the reference test. Clinical experts were also contacted for information on unpublished studies. RESULTS Eleven studies met the inclusion criteria but were too heterogeneous to be combined by meta-analysis. Results indicated that VivaScope subsequent to dermoscopy may improve diagnostic accuracy of malignant melanomas compared with dermoscopy. For margin delineation, the data suggest that mapping using VivaScope 1500 for lentigo maligna (LM) and LM melanoma may improve accuracy in terms of complete excision of lesions compared with dermoscopically determined margins. For basal cell carcinoma, the limited data show high diagnostic accuracy with both VivaScope 1500 and VivaScope 3000. Evidence on the effectiveness of VivaScope in diagnosing cutaneous squamous cell carcinomas was very limited. CONCLUSION The use of VivaScope 1500 following dermoscopy may improve patient care and management of suspicious skin lesions, although the generalizability of these results to the UK population remains unclear.
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Affiliation(s)
- S J Edwards
- BMJ Technology Assessment Group, BMJ, London, UK
| | | | - R Patalay
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - V Wakefield
- BMJ Technology Assessment Group, BMJ, London, UK
| | - C Karner
- BMJ Technology Assessment Group, BMJ, London, UK
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10
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Ali FR, Al-Niaimi F, Craythorne EE, Patalay R, Mallipeddi R. Patient satisfaction and the waiting room in Mohs surgery: appropriate prewarning may abrogate boredom. J Eur Acad Dermatol Venereol 2017; 31:e337-e338. [PMID: 28107578 DOI: 10.1111/jdv.14132] [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: 11/27/2022]
Affiliation(s)
- F R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - F Al-Niaimi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - E E Craythorne
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Patalay
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - R Mallipeddi
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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11
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Affiliation(s)
- D Trokoudes
- Department of Dermatology, St John's Institute of Dermatology, Guy's Hospital, Great Maze Pond' London, SE1 9RT, UK
| | - J Weir
- Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
| | - A Chu
- Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
| | - R Patalay
- Department of Dermatology, St John's Institute of Dermatology, Guy's Hospital, Great Maze Pond' London, SE1 9RT, UK
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12
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Patalay R, Fields P, Kazmi M, Francis ND, Bunker CB. A psoriasiform rash. Clin Exp Dermatol 2010; 35:209-10. [PMID: 20447087 DOI: 10.1111/j.1365-2230.2009.03244.x] [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: 11/27/2022]
Affiliation(s)
- R Patalay
- Department of Dermatology, Hammersmith Hospital, London, UK.
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