BAD 2026: Green takeaways
Hamzah Rafiq, Kareem Hassanin, Aaron Wernham, Richard Jerrom, David Veitch, Luke Brindley, Miriam Atikpo, DS20 Are pre-Mohs biopsies always necessary? A risk–benefit analysis from a regional UK Mohs centre, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.378, https://doi.org/10.1093/bjd/ljag086.378
What were the main findings?
- 71% of MMS cases had a pre-mohs biopsy
- 25% of biopsied lesions had documented scar
- Additional stage attributed to biopsy-related scar occurred in 3.7% of cases
- In 2 cases the biopsy provided false reassurance
What’s the take-home message?
- Restrict biopsy to cases of clinical uncertainty
- If performing a biopsy, a shave is preferable to a punch biopsy
Decarbonising opportunity
- Avoids consumables, waste, histopathological analysis associated with a skin biopsy (estimated carbon footprint of 4-5kgCO2e per biopsy)
- Co-benefits to patients and health system: avoid procedures, reduced pressure on pathology services
Bethany Mitchell, Alisha Imran, Walayat Hussain, Hayley Smith, Angana Mitra, BT09 Cutting out the clinic: evaluating a teledermatology-led tertiary urgent skin cancer service with a ‘direct-to-surgery’ pathway, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.611, https://doi.org/10.1093/bjd/ljag086.611
What were the main findings?
- Retrospective evaluation of 2WW dermatology pathway over a two-week period covering 544 referrals.
- 23% were booked direct to surgery.
- The direct to surgery pathway enabled faster intervention for both biopsy (14 days faster) and excisions (8 days faster).
What’s the take-home message?
- Departments should consider implementing direct to surgery pathways for suitable cases identified from teledermatology review.
Decarbonising opportunity
- Reduces patient travel for additional clinic appointment.
Rana Hasan, Anne Skellett, Sarah Dyson, BT12 An audit of teledermatology vs. face-to-face dermatology review: follow-up rates and management outcomes at a tertiary centre, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.614, https://doi.org/10.1093/bjd/ljag086.614
What were the main findings?
- Retrospective audit comparing outcomes for patients assessed via a teledermatology platform and a face-to-face 2WW clinic.
- BCC was the most common diagnosis on both teledermatology and F2F assessment followed by seborrheic keratosis.
- Discharge rates were similar for virtual and F2F assessments (20.6% V 24%)
- No significant difference in requests for surgical management between F2F and teledermatology cohorts (63.8% V 63.4%)
- Only 1.6% of teledermatology patients required subsequent in-person review
What’s the take-home message?
- Supports the use of teledermatology as an effective pathway for USSC referrals with comparable outcomes in terms of follow-up, discharge and surgical management.
Decarbonising opportunity
- Images taken in primary care or the community reduce patient travel for face-to-face assessment.
DS22 - The impact of sterile versus non-sterile gloves on surgical site infection rates following minor procedures in a tertiary dermatology centre. Kuo et al. Norfolk and Norwich University Hospitals NHS Foundation Trust.
What were the main findings?
- No significant difference in surgical site infection following minor dermatology procedures (punch biopsy, shave excision and curettage) with sterile versus non-sterile glove use (388 procedures total).
What’s the take home message?
- Non-sterile glove use is suitable for minor dermatology procedures (punch biopsy, shave biopsy/excision, curettage) when used with strict hand hygiene and aseptic non-touch technique.
Decarbonising opportunity
- Non-sterile gloves have a lower environmental impact in comparison with sterile gloves https://doi.org/10.1016/j.jhin.2021.10.001
- Switching to non-sterile gloves will reduce the environmental impact of minor skin procedures
Aparna Potluru, Matthew Scorer, DS19 Wide local excision for melanoma in situ of the trunk and limbs: when is enough enough?, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.377, https://doi.org/10.1093/bjd/ljag086.377
What were the main findings?
- In this retrospective review of cases of melanoma in situ on the trunk and limbs there were no recurrences in patients who did not have a wide local excision (although long term follow-up was limited)
What’s the take home message?
- This suggests further research on the benefits of wide local excision for melanoma in situ is needed and a personalised, patient-centred approach is needed for management decisions.
Decarbonising opportunity
- Depending on further research and long-term follow-up there may be potential to safety reduce procedures in selected cases.
BT14 Results from the National Teledermatology Standards Audit. Fordham et al.
What were the main findings?
- Images are better quality when taken by secondary care, whether in hubs or hospitals.
- Frailty scores documented in only 26.8% of referrals.
- Median time for diagnosis is shorter for USSC pathways compared to A&G.
What’s the take home message?
- Further training could improve image taking quality in primary care, enabling image capture closer to home.
- Frailty scores should be included with all skin lesion referrals.
Decarbonising opportunity
- Taking images in primary care reduces patient travel to centralised locations, however high image-quality is needed for accurate remote lesion triage and diagnosis.
Claudine Howard-James, Nnedimma Ozoani, Eimear Gilhooley, DS16 The cost of convenience: single-use vs. multiuse dermatological surgery sets in a tertiary dermatology department in Ireland, British Journal of Dermatology, Volume 195, Issue Supplement_1, June 2026, ljag086.374, https://doi.org/10.1093/bjd/ljag086.374
What were the main findings?
- Re-usable surgical sets were more economically cost-effective and environmentally friendly than single-use sets.
What’s the take home message?
- Where possible, use re-usable instead of single use surgical instruments for skin procedures.
Decarbonising opportunity
- Using re-usable instead of single use surgical instruments reduces the associated carbon footprint of skin surgery.
- Opportunities for reducing the carbon footprint of steam sterilisation have been suggested: DOI: 10.1071/AH15142
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