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Publication Comparative analysis of the cost and carbon footprint of acne treatments in the NHS(Oxford University Press, 2025-06-11) Grover, Sarika; Hunt, William; Abbott, Rachel A.; de Berker, David; Griffiths, Tamara; Niebel, Dennis; Tso, Simon; George Eliot Hospital NHS Trust, Nuneaton; University Hospital of Wales, Cardiff; University Hospitals Bristol NHS Foundation Trust; British Association of Dermatologists, London; Northern Care Alliance NHS Foundation Trust, Salford; University of Manchester; University Hospital Regensburg, Germany; South Warwickshire University NHS Foundation Trust; Cardiff University; Dermatology; Potluru, Aparna; Vincent, Rosie; Nikookam, Yasmin; Punjabi, Sangeeta; Medical and Dental; Grover, SarikaA Letter to the Editor reporting a comparative analysis of the cost and carbon footprint of acne treatments in the NHS.Publication Environmental impact of dermatology and action towards it : a narrative review(Wiley, 2025-04-25) Niebel, Dennis; Tso, Simon; Rawlings Parker, Eva; Rosenbach, Misha; Tan, Eugene; Thio, Hok Bing; Coates, Sarah J.; Kronborg Andersen, Louise; Wheaton Wolstencroft, Paige; Hecker, Christina; Saha, Susanne; de Berker, David; University Hospital Regensburg, Germany; South Warwickshire University NHS Foundation Trust; Cardiff University; Vanderbilt University Medical Center, Nashville, USA; et al.; Dermatology; Medical and Dental; Tso, SimonThere is a dual interplay between the environment and healthcare, which is associated with around 6% of global greenhouse gas (GHG) emissions, high water consumption, and large volumes of waste. Dermatology encompasses peculiarities such as the extensive use of topicals and cosmeceuticals, specific procedural treatments, and a wide range of activities spanning from dermatopathology to the use of biologicals. Some of these aspects might bear a significant environmental footprint, which has been characterized insufficiently until this point. According to recent data, the greatest share of overall GHG emissions associated with outpatient dermatology is purchased goods and services, followed by patient travel and waste, paralleling the health sector overall. To address these topics, six working groups on climate change or sustainability exist within the following dermatology associations: the American Academy of Dermatology (AAD), the Australasian College of Dermatologists (ACD), the British Association of Dermatologists (BAD), the European Academy of Dermatology and Venerology (EADV), the German Society of Dermatology (DDG), and the International Society of Dermatology (ISD). Member activities include scientific projects (original research and review articles, symposia in national conferences), provision of educational materials for trainees and peers, and advocacy. Dermatologists should be familiar with the environmental and climate impact of daily practice and use available resources for more information. At this time, a significant gap exists between individual sustainability efforts and the integration of these practices into policy. We propose to strengthen international collaborations within the field to provide more sustainable dermatological care. Keywords: climate change; global warming; greenhouse gases; net zero; planetary health; sustainable healthcare.Publication Shifts in cutaneous melanocytic tumor diagnostic terminology : melanocytoma, MPATH-Dx V2.0 and the WHO Skin5(Wiley, 2025-04-04) Duncan, Lyn M.; Elder, David E.; Piepkorn, Michael W.; Knezevich, Stevan R.; Blokx, Willeke A. M.; Bosenberg, Marcus; Busam, Klaus J.; Carr, Richard; Cook, Martin G.; Gerami, Pedram; Ko, Jennifer; Landman, Gilles; Lazar, Alexander J.; Lowe, Lori; Mihic-Probst, Daniela; Schmidt, Birgitta; Shea, Christopher R.; Scolyer, Richard A.; Xu, Xiaowei; Elmore, Joann G.; Barnhill, Raymond L.; Massachusetts General Hospital, Boston, USA; Hospital of the University of Pennsylvania, Philadelphia, USA; University of Washington School of Medicine, Seattle, USA; South Warwickshire University NHS Trust; et al.; Cellular Pathology; Medical and Dental; Carr, RichardIn this Special Issue of the Journal of Cutaneous Pathology in memory of Dr. Martin C. Mihm, Jr, we highlight his many contributions over more than 50 years to the catalog of specific melanocytic tumor terminology. Dr. Mihm was an active participant in the International Melanoma Pathology Study Group (IMPSG). Discussions led to proposed recommendations for changes in the terminology of melanocytic tumors and their standardized diagnostic reporting. Histopathological reports of melanocytic tumors provide critical information that guides patient counseling and therapy. Importantly the pathology report must relay whether the melanocytic tumor is benign, intermediate, or malignant, and when appropriate, indicate diagnostic and/or prognostic uncertainty. Recent shifts in diagnostic terminology include the recommended use of the term "melanocytoma" to describe a morphologically and genetically defined subset of intermediate risk melanocytic tumors with higher (although still very low) risk of progression compared with benign nevi. Melanocytomas are distinguished from melanocytic tumors of uncertain malignant potential (MELTUMP) which are histopathologically indeterminate or uncertain tumors. In the setting of a broad lexicon for the reporting of melanocytic tumors, an assessment tool has been developed to map existing diverse terminologies into distinct hierarchical classes. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) V2.0 provides a four-tiered classification scheme that is tiered by risk of tumor progression and recommended treatment. The purpose of this review is to report these shifts in diagnostic terminology, discussed and reviewed at the annual workshop of the IMPSG, in Edinburg, Scotland, in November 2022. This discussion included the use of the term melanocytoma, and the use of the MPATH-Dx V2.0 classification and terminology for melanocytic tumors. Dr. Mihm was diligent in his attention to specific terminology, in his memory we aim to recommend terminology that improves communication in the care of those diagnosed with melanocytic tumors. Keywords: Spitz; melanocytoma; melanoma; nevus; terminology.Publication Variability in triple bottom line commitments of multinational pharmaceutical and cosmeceutical companies : insights from 2023 corporate and ESG reports(Oxford University Press, 2025-03-21) Grant, Rebecca; Niebel, Dennis; Hunt, William; Tso, Simon; South Warwickshire University NHS Foundation Trust; University Hospital Regensburg, Germany; New Zealand Dermatology and Skin Cancer Centre, Wellington, New Zealand; Cardiff University; Dermatology; Kamp, Erin; Ali, Fatima; Medical and Dental; Grant, Rebecca; Tso, SimonThe triple bottom line is a framework for evaluating organisational performance incorporating environmental, social and economic impacts. This study examined the triple bottom line commitments of multinational corporates operating in the dermatology field with a specific focus on environmental goals. A convenience sample of 10 pharmaceuticals and 6 cosmeceuticals corporates were included in this study. We performed a retrospective secondary data analysis of their published 2023 corporate annual reports and environmental, social and governance (ESG) reports, and reviewed their commitments. Results showed all corporates except 3 pharmaceuticals (81%; 13/16) published a target year to reach carbon net zero or neutrality for GHG scopes 1 and 2 (median year = 2040; range = 2025-2050; 95% confidence interval (CI) = 2035-2045). All corporates except 4 pharmaceuticals (75%; 12/16) published a target year to reach carbon net zero or neutrality for GHG scope 3 (median year = 2043; range 2026-2050; 95% CI = 2038-2047). All net zero or carbon neutrality plans identified have outlined the potential inclusion or actual utilisation of carbon offsetting schemes or carbon removal schemes in achieving their goals. All corporates except one (84.4%; 5/6) cosmeceuticals are part of the EcoBeauty Consortium. This study highlighted variability in their ambitions in environmental goals.Publication Digital papillary adenocarcinoma(Oxford University Press, 2025-02-25) Haines, Adrian; Cooke, Abigail; Tso, Simon; South Warwickshire University NHS Foundation Trust; Dermatology; Medical and Dental; Cooke, Abigail; Tso, SimonExtract: Patient viewpoint My name is Adrian and I want to share my journey as I would like to reach out to others who may be living with this rare and under-researched cancer. At times, my family and I have felt very isolated and lonely on our journey. This is due to a lack of scientific information about the prognosis and therapeutic options, and patient support groups specific to this rare cancer. Sharing my experience and reaching out to others is part of my coping strategy, as sometimes it feels like my life is ‘put on hold’ when a new growth or spread is discovered. My story starts around 2005 when I had a slow-growing lump on my right thumb. It was not particularly uncomfortable although over time it did start to look unsightly and was becoming more noticeable. Eventually the lump was removed and I was informed that the biopsy result showed that it was ‘borderline cancerous’. As it was borderline, no further follow-ups or tests were arranged and I continued on with my life.Publication Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma(Elsevier, 2023-07-20) Carr, Richard; Mesiano, Domenico; Heffron, Cynthia; Radonic, Teodora; Wiggins, James; Tso, Simon; Agrawal, Rishi; Cheung, Elaine; Slater, David N.; Nichols, Linda; Craig, Paul; South Warwickshire University NHS Foundation Trust; Cork University Hospital, Ireland; Amsterdam University Medical Center, Netherlands; New Cross Hospital, Wolverhampton; Queen Elizabeth Hospital, Hong Kong; Chesterfield Royal Hospital; University of Warwick; Cheltenham General Hospital; Cellular Pathology; Dermatology; Medical and Dental; Carr, Richard A.; Mesiano, Domenico; Wiggins, James; Tso, SimonKeratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity. Keywords: CDNK2A; Keratoacanthoma; Ki-67; cutaneous squamous cell carcinoma; elastic van Gieson; p16; p53.Publication Dermatological societies and their climate change and sustainability commitment through 2024(Wiley, 2025-06) Niebel, Dennis; Tso, Simon; Rawlings Parker, Eva; Rosenbach, Misha; Tan, Eugene; Thio, Hok Bing; Coates, Sarah; Andersen, Louise Kronborg; Wolstencroft, Paige W.; Hecker, Christina; Saha, Susanne; de Berker, David; University Hospital Regensburg, Germany; South Warwickshire University NHS Foundation Trust; Cardiff University; Vanderbilt University Medical Center, Nashville, USA; University of Pennsylvania, USA; UNSW Medicine, Sydney, Australia; Erasmus University, Rotterdam, The Netherlands; University of California, San Francisco, USA; Aleris Privat Hospital, Esbjerg, Denmark; Stanford University School of Medicine, California, USA; AGN e.V., Freiburg, Germany; University Hospitals Bristol and Weston NHS Trust; Dermatology; Medical and Dental; Tso, SimonA Letter to the Editor exploring the climate change and sustainability commitments of dermatological societies internationally.Publication Changes in skin research funding : the emergence of environmental sustainability criteria in the research competition assessment process(Oxford University Press, 2025-03-18) Badawy, Hannah; Harvey, Jane; Rajan, Neil; Stuart, Beth; Tso, Simon; South Warwickshire University NHS Foundation Trust; Nottingham University; Newcastle University; British Society for Investigative Dermatology; Queen Mary University of London; UK Dermatology Clinical Trials Network; Cardiff University; British Association of Dermatologists; Dermatology; Medical and Dental; Badawy, Hannah; Tso, SimonA Letter to the Editor discussing environmental sustainability criteria introduced by funders of dermatology research into their research competition assessment processes.Publication Relative carbon footprint differences between National Institute for Health and Care Excellence melanoma follow-up pathways 2015 and 2022(Oxford University Press, 2024-05-21) Grover, Sarika; Patel, Nikesh; Tso, Simon; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Cardiff University; Dermatology; Medical and Dental; Patel, Nikesh; Tso, SimonA Letter to the Editor reporting a comparison of the carbon footprint differences in South Warwickshire between the 2015 and revised 2022 melanoma follow-up pathways recommended by the National Institute for Health and Care Excellence (NICE).Publication A non-inferiority clinical trial comparing probiotics and oral corticosteroids for the management of acute exacerbation of atopic dermatitis patients(Oxford University Press, 2024-04-06) Gamal, Nahla A.; Shoaib, Mohammed A.; Farag, Azza G.; Stark, Richard; Tso, Simon; Menoufia University, Shebin El-Kom, Egypt; South Warwickshire University NHS Foundation Trust; University of Warwick; Dermatology; Medical and Dental; Gamal, Nahla A.; Tso, SimonA prospective controlled pilot study on the feasibility of utilization of a probiotic mixture for management of acute exacerbation of atopic dermatitis (AD). Patients were allocated to either standard of care (SOC) therapy with tapering dose of steroids or a probiotic mixture over 3 weeks. After the 3-week intervention, patients on steroids achieved significantly higher clinical response rates and significantly deeper response as measured by the change in SCORAD score. No gut microbiome changes could be appreciated in either group after the treatment period. We could conclude that probiotics cannot replace SOC therapy for the management of acute exacerbation of AD.Publication Reflection on the environmental sustainability of cosmeceutical samples received by delegates at the EADV Congress 2023(Wiley, 2025-03) Salimi, Maryam; Tso, Simon; South Warwickshire University NHS Foundation Trust; Cardiff University; Dermatology; Medical and Dental; Salimi, Maryam; Tso, SimonA Letter to the Editor reflecting on the environmental sustainability of cosmeceutical samples received by delegates at the European Academy of Dermatology and Venereology (EADV) Congress 2023.Publication National epidemiology of digital papillary adenocarcinoma in England 2013-2020 : a population-based registry study(Oxford University Press, 2024-10-24) Andrew, Kashini; van Bodegraven, Birgitta; Vernon, Sally; Balogun, Mariam; Craig, Paul; Rajan, Neil; Venables, Zoe C.; Tso, Simon; Sandwell and West Birmingham Hospitals NHS Trust; British Association of Dermatologists, London; NHS England; Worcestershire Acute Hospitals NHS Trust; Gloucestershire Hospitals NHS Foundation Trust; Newcastle University; University of East Anglia; Norfolk and Norwich University Hospitals NHS Foundation Trust; Cardiff University; South Warwickshire University NHS Foundation Trust; Dermatology; Medical and Dental; Tso, SimonBackground: Digital papillary adenocarcinoma (DPA), formerly known as aggressive DPA, is a rare adnexal cancer of sweat gland differentiation with metastatic potential. DPA epidemiology and patient outcome data are prerequisites for developing diagnostic and therapeutic guidance, which are lacking for this rare cancer. Objectives: To report the incidence, patient demographics and treatment of patients with DPA in England from 1 January 2013 to 31 December 2020 using national cancer registry data. Methods: DPA diagnoses in England during 2013-2020 were identified from the National Cancer Registration and Analysis Service dataset using morphology and behaviour codes. These were registered from routinely collected pathology reports, along with cancer outcomes and services datasets. The 2013 European age-standardized incidence rates (EASRs) were calculated. Results: In total, 36 cases of DPA (7 in women and 29 in men) were diagnosed. The median age at diagnosis for the cohort was 54 years (interquartile range 46-64). The most frequently affected sites were the upper limbs (81%). All patients in the cohort received surgical excisions. The EASR was 0.10 (95% confidence interval 0.07-0.14) per 1 000 000 person-years. Conclusions: This study reports the incidence and variation of DPA in England between 2013 and 2020. DPA was more common in older men and predominantly affected the upper limbs. This finding supports the need to develop a national policy for the reporting and management of DPA as well as development of a clinical guideline.Publication Is it time for international consensus clinical guideline development for digital papillary adenocarcinoma?(Oxford University Press, 2025-05-23) Tso, Simon; Andrew, Kashini; Craig, Paul; Gee, Bruce; Unter, Simon; Venables, Zoe; Rajan, Neil; South Warwickshire University NHS Foundation Trust; Cardiff University; Gloucestershire Hospitals NHS Foundation Trust; NHS England; University of East Anglia; Norfolk and Norwich University Hospitals NHS Foundation Trust; Newcastle University; Dermatology; Medical and Dental; Tso, Simon; Andrew, Kashini; Gee, Bruce; Unter, SimonA Letter to the Editor responding to a paper by Joshi and Kimyai-Asadi on digital papillary adenocarcinoma.Publication X-linked dominant protoporphyria : response to “Cutaneous porphyrias part 1”(Wiley, 2014-12-17) Shipman, Alexa R.; Shipman, Kate E.; South Warwickshire University NHS Foundation Trust; New Cross Hospital, Wolverhampton; Dermatology; Medical and Dental; Shipman, Alexa R.This comment piece responds to: Horner ME, Alikhan A, Tintle S, Tortorelli S, Davis DM, Hand JL. Cutaneous porphyrias part I: epidemiology, pathogenesis, presentation, diagnosis, and histopathology. Int J Dermatol. 2013 Dec;52(12):1464-80. doi: 10.1111/ijd.12305.Publication An unusual case of multiple facial papules?(Oxford University Press, 2015-06) Powell, J. B.; Szczecinska, W.; Gazzani, P.; Miller, J.; Dzwoniakiewicz, H.; Snead, D.; Carr, R.; Ilchyshyn, A.; Worcestershire Royal Hospital; South Warwickshire University NHS Foundation Trust; Histopathology; Medical and Dental; Carr, R.Case report of a 38-year-old woman presenting with a 2-year history of multiple asymptomatic facial papules.Publication Multiple synonyms and misguided therapies : a history of lichen sclerosus(Wiley, 2015-07-07) Hayes, E.; Sharma, A.; Humphreys, F.; South Warwickshire University NHS Foundation Trust; University of Warwick; Dermatology; Medical and Dental; Hayes, E.; Sharma, A.Historical Archives poster abstract H16 of the British Association of Dermatologists 95th Annual Meeting, Manchester, UK, 7-9 July 2015.Publication Identifying key components for a psychological intervention for people with vitiligo(Wiley, 2015-07-07) Ahmed, A.; Steed, E.; Burden-Teh, E.; Shah, R.; Tour, S.; Sanyal, S.; Whitton, M.; Batchelor, J.; Bewley, A.; Royal Free Hospital, London; Queen Mary University of London; Nottingham University Hospitals NHS Trust; Royal London Hospital; University of Nottingham; South Warwickshire University NHS Foundation Trust; Dermatology; Medical and Dental; Sanyal, S.Bristol Cup poster abstract P112 (also Psychodermatology UK Oral Abstract PS08) of the British Association of Dermatologists 95th Annual Meeting, Manchester, UK, 7-9 July 2015.Publication Angiotensin receptor antagonist treatment, melanoma incidence and ethnicity(Wiley, 2015-11-09) Unter, S.; Shipman, A.; South Warwickshire University NHS Foundation Trust; Dermatology; Medical and Dental; Unter, S.; Shipman, A.A Letter to the Editor discussing angiotensin receptor antagonist treatment, melanoma incidence and ethnicity.Publication Swollen and tender left nipple(Oxford University Press, 2015-10-07) Sanyal, S.; Bedlow, A.; Turnbull, N.; Carr, R.; Sandwell and West Birmingham NHS Trust; South Warwickshire University NHS Foundation Trust; Auckland Dermatology, New Zealand; Dermatology; Histopathology; Medical and Dental; Bedlow, A.; Carr, R.Case report of a 43‐year‐old man presenting with a 3‐week history of a swollen and tender left nipple.Publication Neuroendocrine carcinoma in situ in association with bowenoid epidermal dysplasia and squamous cell carcinoma(Wiley, 2016-07-04) Tsang, Y. W.; Taibjee, S.; Carter, J.; Carr, R.; University Hospital Coventry and Warwickshire NHS Trust; Dorset County Hospital; South Warwickshire University NHS Foundation Trust; Dermatology; Pathology; Medical and Dental; Carter, J.; Carr, R.British Society for Dermatopathology abstract DP08 of the British Association of Dermatologists 96th Annual Meeting, Birmingham, U.K., 5-7 July 2016.