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ChatGPT is a large language model trained on increasingly large datasets by OpenAI to perform language-based tasks. It is capable of answering multiple-choice questions, such as those posed by the Specialty Certificate Examination (SCE) in Dermatology. We asked two iterations of ChatGPT: ChatGPT-3.5 and ChatGPT-4 84 multiple-choice sample questions from the sample SCE in Dermatology question bank. ChatGPT-3.5 achieved an overall score of 63%, and ChatGPT-4 scored 90% (a significant improvement in performance; P  < 0.001). The typical pass mark for the SCE in Dermatology is 70–72%. ChatGPT-4 is therefore capable of answering clinical questions and achieving a passing grade in these sample questions. There are many possible educational and clinical implications for increasingly advanced artificial intelligence (AI) and its use in medicine, including in the diagnosis of dermatological conditions. Such advances should be embraced provided that patient safety is a core tenet, and the limitations of AI in the nuances of complex clinical cases are recognized. [ABSTRACT FROM AUTHOR]

Skin excision is the primary treatment for skin cancer. Complication rates from skin cancer excision are generally low but rates of complications may vary according to procedural complexity, site and patient factors. It is important that patients are fully informed through the consent process considering individual circumstances, the Montgomery ruling and material risks. The clinician must use an evidence-based approach to the consent process and assessment of risk. We have searched the literature and reviewed the current evidence regarding complications, and their incidence where data were available, following excisional skin surgery. This article aims to enable clinicians to better inform patients during the consent process about associated bleeding and infection risk. [ABSTRACT FROM AUTHOR]

Background There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed. Objectives To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS. Methods A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma. Twelve participating sites from England, Northern Ireland, Scotland and Wales provided data from 115 skin surgery lists involving 495 patients and 547 skin surgery procedures between 1 March 2022 and 30 June 2022. Results Mean total weight of nonsharps skin surgery waste was 0.52 kg per procedure (0.39 kg clinical waste, 0.05 kg general waste and 0.08 kg recycling waste). Data from a single site using disposable surgical instruments reported a mean of only 0.25 kg of sharps waste per procedure. The recycling rate ranged between 0% and 44% across the cohort with a mean recycling rate of 16%. Conclusions We advocate that staff transition to the British Society of Dermatological Surgery 2022 sustainability guidance, which made wide-ranging recommendations to facilitate staff to transition to sustainable practices in skin surgery. [ABSTRACT FROM AUTHOR]

Antithrombotic medication is taken by 14–22% patients undergoing skin surgery, with more patients now taking direct oral anticoagulants (DOACs). The latest evidence suggests that the risk of stopping DOACs perioperatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidelines suggest that clinicians could consider stopping DOACs in patients for 24–48 h, based on individual bleeding risk. We surveyed BSDS members to better understand clinical practice and guideline adherence with a view to updating the guidance. The results demonstrated that there is consistency among clinicians in the management of patients on more established antithrombotic agents, such as aspirin, clopidogrel and warfarin. However, there is a higher perceived risk of significant haematomas following higher-risk procedures such as larger flaps or grafts with DOACs vs. other antithrombotics postoperatively. Stopping DOACs perioperatively for 24–48 h for higher-risk procedures can be cautiously considered following an individual risk assessment and informed discussion with the patient. [ABSTRACT FROM AUTHOR]

Background: Absorbable or non-absorbable sutures can be used for superficial skin closure following excisional skin surgery. There is no consensus among clinicians nor high-quality evidence supporting the choice of suture. The aim of the present study was to determine current suture use and complications at 30 days after excisional skin surgery. Methods: An international, prospective service evaluation of adults undergoing excision of skin lesions (benign and malignant) in primary and secondary care was conducted from 1 September 2020 to 15 April 2021. Routine patient data collected by UK and Australasian collaborator networks were uploaded to REDCap©. Choice of suture and risk of complications were modelled using multivariable logistic regression. Results: Some 3494 patients (4066 excisions) were included; 3246 (92.9 per cent) were from the UK and Ireland. Most patients were men (1945, 55.7 per cent), Caucasian (2849, 81.5 per cent) and aged 75-84 years (965, 27.6 per cent). The most common clinical diagnosis was basal cell carcinoma (1712, 42.1 per cent). Dermatologists performed most procedures, with 1803 excisions (44.3 per cent) on 1657 patients (47.4 per cent). Most defects were closed primarily (2856, 81.9 per cent), and there was equipoise in regard to use of absorbable (2127, 57.7 per cent) or non-absorbable (1558, 42.2 per cent) sutures for superficial closure. The most common complications were surgical-site infection (103, 2.9 per cent) and delayed wound healing (77, 2.2 per cent). In multivariable analysis, use of absorbable suture type was associated with increased patient age, geographical location (UK and Ireland), and surgeon specialty (oral and maxillofacial surgery and plastic surgery), but not with complications. Conclusion: There was equipoise in suture use, and no association between suture type and complications. Definitive evidence from randomized trials is needed. [ABSTRACT FROM AUTHOR]

Dear Editor, Scalp defects not amenable to direct closure following dermatological surgery can be left open for secondary intention healing (SIH) or can be repaired with a flap or a graft. We aimed to inform design and determine the feasibility of conducting a randomized controlled trial (RCT) comparing full-thickness skin graft (FTSG) with SIH for small-moderate sized scalp wounds not amenable to primary closure (SCALP study). [Extracted from the article]

Https://doi.org/10.1093/ced/llac089 Dear Editor, The National Health Service (NHS) has a commitment to achieve net zero for the carbon emission it directly controls and is able to influence by 2040 and 2045, respectively.[1] Engagement with sustainability is a key pillar of professional development in dermatology enshrined in the British Society of Dermatological Surgery sustainability guidance 2022 and in the training curriculum for postgraduate doctors.[2] There is a paucity of literature examining the environmental impact of delivering medical education. For the purpose of this study we have only examined the additional consumables used within a skin surgery facility by trainer and trainee in a supervised skin surgery setting as compared with the same procedure theoretically being carried out by the trainer without the presence of a trainee. Sustainability in delivering skin surgery training: additional resources consumed and opportunities for environmental gain using the Healthcare Environmental Performance Tool. [Extracted from the article]

Our letter highlights some of the key changes and updates to the British Society for Dermatological Surgery antithrombotic and skin surgery guidance in 2023. An updated flowchart advises clinicians on assessing bleeding risk and when discontinuation of antithrombotics can be considered. [ABSTRACT FROM AUTHOR]

Dear Editor, Skin lesion excision is performed frequently,1 and the clinical2 and health economic burdens3 are increasing commensurate with skin cancer incidence.4,5 Absorbable sutures (AS), including rapidly absorbable sutures or nonabsorbable sutures (NAS), can be used for epidermal closure following excisional skin surgery. The CANVAS clinician survey assessed current opinions on suture use in the UK/Republic of Ireland and Australia/New Zealand as part of the feasibility work for a randomized controlled trial (RCT) comparing AS and NAS. In conclusion, the COVID-19 pandemic has led to clinicians reporting a change in epidermal suture preference from NAS to AS, particularly in the UK/Republic of Ireland, possibly due to geographical variation in COVID-19 rates. [Extracted from the article]

Abstract Background There has been a consistent rise in bottled water consumption over the last decade. Little is known about the health beliefs held by the general public about bottled water as this issue is not addressed by the existing quantitative literature. The purpose of this study was to improve understanding of the public's health beliefs concerning bottled mineral water, and the extent to which these beliefs and other views they hold, influence drinking habits. Methods A qualitative study using semi-structured interviews, with 23 users of the Munrow Sports Centre on the University of Birmingham campus. Results Health beliefs about bottled water could be classified as general or specific beliefs. Most participants believed that bottled water conferred general health benefits but were unsure as to the nature of these. In terms of specific health beliefs, the idea that the minerals in bottled water conferred a health benefit was the most commonly cited. There were concerns over links between the plastic bottle itself and cancer. Participants believed that bottled water has a detrimental effect on the environment. Convenience, cost and taste were influential factors when making decisions as to whether to buy bottled water; health beliefs were unimportant motivating factors. Conclusion The majority of participants believed that bottled water has some health benefits. However, these beliefs played a minor role in determining bottled water consumption and are unlikely to be helpful in explaining recent trends in bottled water consumption if generalised to the UK population. The health beliefs elicited were supported by scientific evidence to varying extents. Most participants did not feel that bottled water conferred significant, if any, health benefits over tap water.