Research – Advancing the Science of Dermatology

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that causes painful nodules and tunnels in areas with apocrine glands. This condition greatly affects patients’ quality of life. Mild cases of HS are typically treated with topical antibiotics, while moderate to severe cases require long-term systemic antibiotics such as tetracyclines or a combination of clindamycin and rifampicin. Recently, adalimumab, a monoclonal antibody targeting TNF, has become a significant advancement in HS treatment.

This study aims to understand the molecular mechanisms behind HS by collecting skin biopsies from affected and unaffected areas of patients’ skin. By using advanced techniques like RNA sequencing and Spatial Transcriptomics, the study seeks to identify key molecular pathways and genetic markers associated with HS. This understanding could lead to the development of more effective, targeted therapies.

The primary objective is to identify unique cell clusters and interactions related to HS’s epithelialized tunnels compared to inflammatory nodules. Secondary objectives include assessing how these cellular interactions change in response to adalimumab therapy and comparing responders to non-responders of the treatment.

Dr. John Frew will lead the study at The Skin Hospital in Darlinghurst and Westmead, involving 10 patients diagnosed with HS. Participants must be over 18, able to consent, and meet specific criteria regarding disease severity and previous treatments.

This research is poised to provide valuable insights into HS, potentially paving the way for new therapeutic approaches that improve outcomes and quality of life for HS patients.

Dermatologists at The Skin Hospital (TSH) are conducting a study to better understand the outcomes of patients who undergo Mohs procedures. The Mohs Microscopic registry collects comprehensive data to improve patient management and treatment, leading to better long-term outcomes. This registry includes information on demographics, skin tumour characteristics, recurrence rates, and surgical outcomes. By forming a centralized database, the registry provides valuable resources for researchers focused on Mohs surgery and patient care improvements.

The registry aims to identify trends and characteristics that could enhance diagnosis, treatment, and post-operative management for Mohs surgery patients. Data on skin cancer recurrence rates after Mohs surgery will help in finding ways to reduce recurrence in specific cancers. Additionally, the registry will support global collaboration among dermatologists and researchers to standardize diagnoses and improve future surgical techniques.

Non-melanoma skin cancers are prevalent in Australia, and while surgical excision is common, Mohs surgery offers tissue-sparing benefits. The registry serves as a high-quality data resource for studying practice patterns, patient outcomes, and conducting quality control initiatives. This registry enables longitudinal analysis of Mohs procedures in Australia, aiding in the understanding and improvement of surgical outcomes over time.

Sub-projects:

• Part A: The Skin Hospital provision of Mohs micrographic procedure services to patients outside of metropolitan Sydney.
• Factors Associated with Patient-Initiated Communication after Mohs Micrographic Procedure in an Australian Population
• An analysis of scalp tumours treated by MMS at a large Australian centre

For vitiligo that is refractory to conservative treatment modalities, surgical treatment may be indicated. Surgical treatment aims to transfer melanocytes (pigment-producing cells) from normal skin to skin affected by vitiligo. We are currently in the process of analysing the transfer of non-cultured epidermal melanocyte suspension for the treatment of vitiligo. The aim of this pilot case series is to see if we can provide a more precise and cost-effect technique for this procedure and to improve cosmetic results.

Researchers: Dr Brent Doolan, Dr Janice Yeon, Dr Chelsea Jones, Ms Joanne Mamo, Ms Michelle Weaich, Ms Glenda Newman and Dr Monisha Gupta.

Melanoma is the third most common cancer for Australian men and women and is expected to cause death in one Australian every five hours. Histopathology is the current gold-standard diagnostic test. Current diagnosis relies heavily on dermoscopy and subjective clinical judgement, confirmed by histological diagnosis. Reflectance Confocal Microscopy (RCM) is a newer technology. It allows for bedside in vivo microscopic assessment of atypical cells within lesions, assisting identification of cutaneous malignancy.

Project 1:

RCM has been widely adopted internationally; however, the use of RCM in Australia has been limited by a lack of access to confocal specialists. Remote RCM utilises a cloud-based platform where a technician (non-confocal specialist) captures and uploads the images, which are then interpreted asynchronously by a confocal specialist. We hope that this model will increase accessibility to RCM. Through a multi-centre cross-sectional diagnostic study, involving four sites and 200 patients, we will assess the diagnostic accuracy of this model compared to current practice for RCM. We will also assess potential barriers to implementation and access, specifically the acceptability, appropriateness and feasibility of this model through a process evaluation.

This program of research will provide reliable and definitive estimates of the test performance of a remote model. If proven accurate, this new tool has the potential to reduce the number of unnecessary excisions, as well as costs and morbidity for patients. We will also determine the potential barriers, challenges, and facilitators of implementing this new tool in the real-life settings.

The is a collaborative study with sites across Melbourne, Brisbane and Sydney. The participating organizations include The Alfred and Princess Alexandra Hospitals, The Skin Hospital, SMDC and Melanoma Institute of Australia.

Researchers: Dr Genevieve Ho, Prof Pascale Guitera, Dr Rhonda Harvey et al

Project 2:

Topic: A pilot study of Reflectance Confocal Microscopy of Basal Cell Carcinoma in pre-operative surgical mapping prior to Mohs Micrographic Procedure

Project description: This study assesses the usefulness of reflectance confocal microscopy (RCM) in delineating tumour margins prior to Mohs micrographic procedure. RCM is a non-invasive diagnostic device that allows visualisation of the skin at a cellular level. The study investigates if it can more accurately measure the pre-operative tumour size compared to current techniques and potentially reduce the surgical defect.

Researchers: Dr Andrea Tomizawa, Dr Simon Lee, Dr William Ryman, Dr Nicholas Stewart, Dr Gilberto Bonilla, Dr Matthew Lin, Dr Rodrigo Schwartz, Dr Genevieve Ho, Dr Minal Dalvi (project manager)

Topics:

Part A: The Skin Hospital provision of Mohs micrographic procedure services to patients outside of metropolitan Sydney.

Part B: Defect size correlation to postcodes of patients outside of metropolitan Sydney.

Researchers: Dr Er Tsing Vivian Tng, Dr Gilberto Moreno Bonilla, Dr Simon Lee, Dr Rhonda Harvey, Dr Janice Yeon, Dr Chelsea Jones, Dr Minal Dalvi (project manager)

Topic: Folliculitis Spinulosa Decalvans: The forgotten cicatricial alopecia

Project description: There is limited knowledge on scarring alopecias with paediatric onset. The cases cited in the literature can often be diagnosed late or misdiagnosed as folliculitis decalvans or other scarring alopecias. This study will bring to the forefront this forgotten clinical entity of a severe type of scarring alopecia, often presenting in childhood and shed light on the clinical/histological and genetic characteristics.

This study is a collaborative initiative between researchers at The Skin Hospital, Sinclair Dermatology and Royal Melbourne Hospital.

Researchers: Dr Yong Kho, Bevin Bhoyrul, Dr Andrew Awad, Dr Mike Sladden, Prof Ingrid Winship, Dr Leila Asfour

Mohs micrographic procedure is increasingly used for the surgical excision of skin cancers, particularly recurring lesions or those located on anatomically sensitive areas. The investigators seek to assess patient-initiated communication post operation in an effort to improve patient education and experience after MMS.

Researchers: Dr Kevin Phan, Dr Minal Dalvi, Dr Matthew Lin

Topic: An analysis of scalp tumours treated by MMS at a large Australian centre

Project description: There is little research data on the characteristics of scalp tumors treated with Mohs Micrographic procedure. This study will evaluate the characteristics of Mohs procedure cases

Researchers: Dr Gilberto Moreno, Dr Thomas Stewart, Dr Chelsea Jones, Dr Simon Lee