The presented letter discusses the diagnostic challenges posed by reactive angioendotheliomatosis (RAE) due to its similarities to other conditions. The authors delve into four cases of RAE, highlighting diverse clinical presentations and emphasizing the importance of accurate differentiation of this condition. This is crucial in aiding early diagnosis and optimizing outcomes for patients with RAE.

MySkinSelfie is a mobile phone application for skin self-monitoring, enabling secure sharing of patient-captured images with healthcare providers. This retrospective study assessed MySkinSelfie’s role in remote skin cancer assessment at two centres for urgent (melanoma and squamous cell carcinoma) and nonurgent skin cancer referrals, investigating the feasibility of using patient-captured images without dermoscopy for remote diagnosis. The total number of lesions using MySkinSelfie was 814, with a mean patient age of 63 years. Remote consultations reduced face-to-face appointments by 90% for basal cell carcinoma and by 63% for referrals on a 2-week waiting list. Diagnostic concordance (consultant vs. histological diagnosis) rates of 72% and 83% were observed for basal cell carcinoma (n = 107) and urgent skin cancers (n = 704), respectively. Challenges included image quality, workflow integration and lack of dermoscopy. Higher sensitivities were observed in recent artificial intelligence algorithms employing dermoscopy. While patient-captured images proved useful during the COVID-19 pandemic, further research is needed to explore the feasibility of widespread patient-led dermoscopy to enable direct patient-to-artificial intelligence diagnostic assessment.

In collaboration with the British Heart Rhythm Society (BHRS), the British Society for Dermatological Surgery (BSDS) has recently updated its guidance on the management of cardiac implantable electronic devices (CIEDs) around the time of dermatological procedures requiring electrosurgery. A section and comprehensive flowchart specific to dermatological surgery now exist in the national BHRS guidance. This letter brings the latest guidance to readers’ attention and outlines important changes that should streamline care for this cohort of patients.

MySkinSelfie is a mobile phone application for skin self-monitoring, enabling secure sharing of patient-captured images with healthcare providers. This retrospective study assessed MySkinSelfie's role in remote skin cancer assessment at two centres for urgent (melanoma and squamous cell carcinoma) and nonurgent skin cancer referrals, investigating the feasibility of using patient-captured images without dermoscopy for remote diagnosis. The total number of lesions using MySkinSelfie was 814, with a mean patient age of 63 years. Remote consultations reduced face-to-face appointments by 90% for basal cell carcinoma and by 63% for referrals on a 2-week waiting list. Diagnostic concordance (consultant vs. histological diagnosis) rates of 72% and 83% were observed for basal cell carcinoma (n = 107) and urgent skin cancers (n = 704), respectively. Challenges included image quality, workflow integration and lack of dermoscopy. Higher sensitivities were observed in recent artificial intelligence algorithms employing dermoscopy. While patient-captured images proved useful during the COVID-19 pandemic, further research is needed to explore the feasibility of widespread patient-led dermoscopy to enable direct patient-to-artificial intelligence diagnostic assessment. MySkinSelfie, a mobile phone application, facilitated remote skin cancer assessments via patient-captured images without dermoscopy. The study, involving 814 lesions, showed a 72-83% diagnostic concordance for basal cell carcinoma and urgent skin cancers. While reducing face-to-face appointments significantly, challenges persist with image quality and the absence of dermoscopy, indicating the need for further exploration into patient-led dermoscopy for direct patient-to-artificial intelligence diagnosis.

A 27-year-old Brazilian woman presented with a 7-month history of progressive pain, tingling, numbness, and weakness of the left upper limb, and paroxysmal dysesthesia affecting the left foot. On examination, there were erythematous, anesthetic patches of skin overlying the metacarpophalangeal joints and on the palmar surfaces of the hands (figure e-1 at [Neurology.org/nn][1]). There was congenital, bilateral campylodactyly and new flexion deformity of the fingers of the left hand with an incomplete range of passive extension. The intrinsic muscles of the left hand were wasted, particularly the thenar eminence and the dorsal interossei. Fasciculations were not observed. There was marked tenderness in the antecubital fossa and at the wrist, and the left superficial radial nerve was palpable. There was severe weakness of intrinsic finger movements, wrist flexion, and extension. Left upper limb reflexes were brisk and painful to percuss but tone, power, and reflexes including plantar responses were otherwise normal. Sensation to pinprick was reduced throughout the left hand with loss of temperature, vibration, and proprioceptive sensation distal to the wrist. Acknowledgment: The authors are grateful to the patient for her permission to publish the case report. They also acknowledge the support and expertise of Professor Diana Lockwood (London School of Hygiene and Tropical Health) whose advice regarding treatment and management has been greatly valued. C.M.R. is supported by the Burden Neurological Institute. [1]: /lookup/doi/10.1212/NXI.0000000000000236