J T Lear

Central Manchester University Hospitals NHS Foundation Trust, Manchester, England, United Kingdom

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Publications (134)675.13 Total impact

  • Journal of the European Academy of Dermatology and Venereology 10/2014; · 2.69 Impact Factor
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    ABSTRACT: Basal cell carcinoma (BCC) is a common malignancy with a good prognosis in the majority of cases. However, some BCC patients develop a more advanced disease that poses significant management challenges. Such cases include locally advanced, recurrent or metastatic BCC, or tumours that occur in anatomical sites where surgical treatment would result in significant deformity. Until recently, treatment options for these patients have been limited, but increased understanding of the molecular basis of BCC has enabled potential therapies, such as hedgehog signalling pathway inhibitors, to be developed. A clear definition of advanced BCC as a distinct disease entity and formal management guidelines have not previously been published, presumably because of the rarity, heterogeneity and lack of treatment options available for the disease. Here we provide a UK perspective from a multidisciplinary group of experts involved in the treatment of complex cases of BCC, addressing the key challenges associated with the perceived definition and management of the disease. With new treatments on the horizon, we further propose a definition for advanced BCC that may be used as a guide for healthcare professionals involved in disease diagnosis and management.British Journal of Cancer advance online publication, 11 September 2014; doi:10.1038/bjc.2014.270 www.bjcancer.com.
    British Journal of Cancer 09/2014; · 5.08 Impact Factor
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    ABSTRACT: Gorlin syndrome is an autosomal dominant disorder, characterized by multiple early-onset basal cell carcinomas (BCCs) and jaw keratocysts. Through association studies in cohorts of sporadic BCC, nine genetic variants have previously been identified to increase the risk of BCC. The nine SNPs were genotyped by Taqman allelic discrimination in 125 individuals with Gorlin syndrome. Kaplan-Meier survival curves and Cox proportional-Hazard regression analysis were applied to determine the association between genotypes and age of first BCC in individuals with Gorlin syndrome. The p.(Arg151Cys) variant in MC1R (rs1805007) was associated with an earlier median age of onset of BCC of 27 years (95% CI: 20-34) compared with 34 years (95% CI: 30-40) for wild-type individuals (hazard ratio (HR)=1.64, 95% CI: 1.04-2.58, P=0.034). The risk allele of the variant at the chromosome 5p15 locus encompassing TERT-CLPTM1L (rs401681) was also associated with an earlier median onset of BCC, 31 years (95% CI: 28-37) compared with 41 years (95% CI: 32-48, HR=1.44, 95% CI: 1.08-1.93, P=0.014). In individuals with a risk allele at either rs1805007 or rs401681 the median time to BCC was 31 years of age (95% CI: 28-34) compared with 44 years of age (95% CI: 38-53) in wild-type individuals (HR=2.48, 95% CI: 1.47-4.17, P=0.0002). Our findings may have implications for future personalized risk estimates and BCC screening strategies in individuals with Gorlin syndrome.European Journal of Human Genetics advance online publication, 27 August 2014; doi:10.1038/ejhg.2014.167.
    European journal of human genetics: EJHG 08/2014; · 3.56 Impact Factor
  • F R Ali, A Aslam, J T Lear
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    ABSTRACT: Sattler and colleagues' paper exploring the factors underlying lack of patient adherence to sun protective measures (1) overlooks a potentially critical facet, that of patient preference. Shared decision-making and promotion of patient choice are requisite to good practice, as discussed in a recent editorial (2) and stipulated in the UK dermatology specialty training curriculum. (3) This is perhaps best illustrated in dermatology by the realm of emollients, where patient concordance with prescribed therapy is greater when patients are encouraged to select the emollient of their choice, with patients often preferring lighter cream-based emollients to greasier ointments. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2014; · 3.76 Impact Factor
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    Thomas Dirschka, John T Lear
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    ABSTRACT: Interest is increasing in the use of sequential or combined therapeutic modalities for spot or area treatment of actinic keratoses (AKs) to achieve complete sustained remission. For multiple lesions in a contained area, topical treatment offers less discomfort, better cosmesis and greater patient convenience than destructive/ablative techniques. Twelve patients with multiple grade I and II AK lesions of the scalp (cases 1-10) or the dorsum of the hand (cases 11 and 12), most with a history of recurrence, were treated with Solaraze gel (3% diclofenac sodium in 2.5% hyaluronic acid) twice daily for 12 weeks, followed by a 2-week treatment-free interval, then Actikerall cutaneous solution (5-fluorouracil 5 mg/g and salicylic acid 100 mg/g) once daily for up to 6 weeks as required. Sequential treatment provided complete (clinical and histological) clearance in 8/10 male patients. Two patients with numerous lesions had partial clearance (significant improvement) and the remaining few lesions were treated with erbium laser. Both female patients achieved complete clinical clearance with sequential treatment. Solaraze/Actikerall were well tolerated. A case of contact dermatitis with Solaraze resolved after discontinuation and the patient progressed to treatment with Actikerall. Local application site reactions resolved upon treatment completion. Topical lesion-directed sequential treatment with Solaraze/Actikerall is a rational approach to treat patients with multiple AKs. Sequential treatment produces excellent clearance rates which are accompanied by relevant improvement in patients' quality of life.
    Case Reports in Dermatology 05/2014; 6(2):164-8.
  • Clinical Practice. 05/2014; 11(3):295-306.
  • Transplantation 04/2014; 97(8):e48-50. · 3.78 Impact Factor
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    ABSTRACT: ANCA-associated vasculitis (AAV) encompasses a heterogeneous group of autoimmune inflammatory disorders, including Granulomatosis with Polyangiitis (GPA, previously Wegener's granulomatosis), Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA, previously Churg-Strauss syndrome). (1) AAV patients typically receive induction therapy with cyclophosphamide and corticosteroids, followed by long-term maintenance immunosuppression. A multi-disciplinary group including clinicians, research methodologists and patient representatives developed a self-report questionnaire for AAV patients, which sought to establish immunosuppression exposure, patients' knowledge of side-effects of these medications and previous diagnoses of skin malignancies together with skin surveillance uptake, dermatological follow-up and use of sun protective measures. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 02/2014; · 3.76 Impact Factor
  • Dermatology in Practice. 02/2014; 20(1):4-8.
  • Faisal R Ali, John T Lear, Neel Sharma
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    ABSTRACT: Mitigating the risk of skin cancer associated with thiopurine use.
    British journal of hospital medicine (London, England: 2005) 01/2014; 75(1):55-Unknown. · 0.25 Impact Factor
  • John T Lear
    The Lancet Oncology 12/2013; · 25.12 Impact Factor
  • N J Collier, F R Ali, J T Lear
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    ABSTRACT: Photodynamic therapy (PDT) is an established treatment for superficial basal cell carcinoma (BCC). Organ transplant recipients (OTRs) are at increased risk of BCC. We investigated the efficacy of PDT in OTRs and compared the recurrence rate to the non-transplanted population. We conducted a retrospective casenote review of all patients undergoing PDT for the treatment of BCC in our centre from 2003 to 2013. Three hundred and twenty-two BCCs from 103 patients underwent PDT during this period. There is no significant difference in BCC recurrence following PDT in OTRs (22.6 %) versus non-transplant patients (15.2 %) (p = 0.18). PDT is an efficacious treatment for BCC in OTRs with no significant evidence of inferiority compared to non-transplanted patients. Our findings require corroboration in a larger study.
    Lasers in Medical Science 10/2013; · 2.40 Impact Factor
  • Dermatology in Practice. 10/2013; 19(4):9-12.
  • F.R. Ali, J.T. Lear
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    ABSTRACT: Basal cell carcinoma (BCC) is the commonest cancer in the UK and its incidence is increasing. Vismodegib, a hedgehog pathway inhibitor, has recently been licensed by the US Food and Drug Administration for treatment of advanced BCC. Phase 2 trials have demonstrated efficacy in cases of locally advanced and metastatic BCC, as well as cases of hereditary basal cell naevus (Gorlin) syndrome. Side-effects are frequent and considerable and include myalgia, taste disturbance, alopecia, weight loss and fatigue. Further research is needed to investigate means of circumventing these side-effects and longitudinal data are required to assess the long-term benefit of and the nature of resistance to this novel class of agents. Alternative hedgehog inhibitors are currently in clinical development. We review the current data pertaining to this novel treatment modality and discuss the likely future role in the management of BCC.
    British Journal of Dermatology 07/2013; · 3.76 Impact Factor
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    ABSTRACT: BACKGROUND: Patients with Gorlin syndrome develop multiple basal cell carcinomas (BCC), for which treatment is often difficult. Methylaminolevulinate-photodynamic therapy (MAL-PDT) is approved for the treatment of superficial and nodular BCCs in Canada and several European countries. OBJECTIVES: To establish consensus recommendations for the use of MAL-PDT in patients with Gorlin syndrome. METHODS: The Gorlin consensus panel was comprised of 7 dermatologists who had treated a total of 83 patients with Gorlin syndrome using MAL-PDT. Consensus was developed based on the personal experience of the expert and results of literature review (on PUBMED using the keywords 'MAL' and 'PDT' and 'Gorlin' or 'naevoid basal cell carcinoma syndrome'). RESULTS: Consensus was reached among the experts and the literature review identified 9 relevant reports. The experts considered MAL-PDT a generally effective and safe therapy for treatment of BCC in Gorlin syndrome. For superficial BCC (sBCC), all sizes can be treated, and in nodular BCC (nBCC), better efficacy can be achieved in thinner lesions (<2 mm in thickness). MAL-PDT treatment schedule should be performed according to labelling although in individual cases, it may be adapted and performed on a monthly basis based on clinical assessment. Follow-up should be related to frequency of recurrence, and severity, number and location of lesions. Multiple lesions and large areas may be treated during the same session; however, adequate pain management should be considered. CONCLUSIONS: MAL-PDT is safe and effective in patients with Gorlin syndrome. Utilization of these recommendations may improve efficacy and clearance rates in this population.
    Journal of the European Academy of Dermatology and Venereology 04/2013; · 2.69 Impact Factor
  • F R Ali, J T Lear
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    ABSTRACT: We read with interest the recent paper in this journal which sheds further light upon the reduced mortality observed amongst individuals suffering from dermatitis herpetiformis.(1) Whilst Hervonen and collegues corroborate previous findings of reduced smoking and lower rates of hyperlipidemia amongst patients with dermatitis herpetiformis, they do not account for socioeconomic class in their analysis. A retrospective review of case records previously reported the association of development of dermatitis herpetiformis with both reduced prevalence of cardiovascular disease and higher social class.
    British Journal of Dermatology 03/2013; · 3.76 Impact Factor
  • Clinical and Experimental Dermatology 03/2013; · 1.33 Impact Factor
  • Faisal Ali, John T Lear
    The New Zealand medical journal 01/2013; 126(1380):83-85.
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    ABSTRACT: Solid organ transplant recipients are predisposed to actinic keratoses (AK) and nonmelanoma skin cancers, owing to the lifelong immunosuppression required. Today, increasing numbers of organ transplants are being performed and organ transplant recipients (OTRs) are surviving much longer. Photodynamic therapy (PDT) is proving a highly effective treatment modality for AK amongst this susceptible group of patients. Following an overview of the pathogenesis of AK amongst OTRs, the authors review current safety and efficacy data and how this relates to the role of PDT for the treatment of AK in OTRs.
    BioMed research international. 01/2013; 2013:349526.
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    ABSTRACT: Actinic keratoses (AK) are the most common premalignant pathology seen in dermatological practice and represent a burgeoning burden upon health services. Increasingly recognized is the damage to surrounding, perilesional skin, forming the premise for field-directed therapy. Ingenol mebutate gel is a novel agent for field-directed treatment of AK, requiring only 2 or 3 days of application. Following an overview of existing treatment modalities, the authors review recent trials and safety data pertaining to the use of ingenol mebutate gel and discuss its role in the treatment of AK.
    Dermatology and therapy. 12/2012; 2(1):8.

Publication Stats

2k Citations
675.13 Total Impact Points

Institutions

  • 2007–2014
    • Central Manchester University Hospitals NHS Foundation Trust
      • • Department of Dermatology
      • • Department of Anaesthesia (Manchester Royal Infirmary)
      Manchester, England, United Kingdom
  • 2000–2014
    • The University of Manchester
      • • Centre for Dermatology
      • • Psychology Research Group
      Manchester, England, United Kingdom
  • 2011
    • Salford Royal NHS Foundation Trust
      Salford, England, United Kingdom
  • 1996–2009
    • University Hospital Of North Staffordshire NHS Trust
      • • Department of Dermatology
      • • Department of Urology
      Stoke-on-Trent, ENG, United Kingdom
  • 1996–2006
    • Keele University
      • Institute for Science and Technology in Medicine
      Newcastle under Lyme, ENG, United Kingdom
  • 1995–2002
    • Staffordshire and Stoke-On-Trent Partnership NHS Trust
      Newcastle-under-Lyme, England, United Kingdom
  • 1999
    • Heinrich-Heine-Universität Düsseldorf
      • Institut für Physikalische Chemie
      Düsseldorf, North Rhine-Westphalia, Germany
    • University of Bristol
      Bristol, England, United Kingdom