Jim Muir

Mater Misericordiae University Hospital, Dublin, Leinster, Ireland

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Publications (15)20.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: An unstable solar lentigo is a solar lentigo with areas of melanocytic hyperplasia not extending past the margin of the lesion. They are discrete, macular, pigmented lesions arising on sun-damaged skin and a subset of typical solar lentigos. Clinically they differ from usual solar lentigines in often being solitary or larger and darker than adjacent solar lentigines. These lesions are of clinical importance as they can arise in close proximity to lentigo maligna and in a single lesion there can be demonstrated changes of solar lentigo, unstable solar lentigo and lentigo maligna. These observations led us to conjecture that unstable solar lentigos could be a precursor lesion to lentigo maligna. In this article we examine the possibility that lentigo maligna can arise within a solar lentigo through an intermediate lesion, the unstable solar lentigo. We propose that the histopathological recognition of this entity will allow for future research into its behaviour and thus management. We review difficulties in the diagnosis of single cell predominant melanocytic proliferations and the concept of unstable lentigo in view of the literature and clinical experience supporting the proposal of its recognition as a separate entity.
    No preview · Article · Feb 2016 · Australasian Journal of Dermatology
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    ABSTRACT: Objective: To identify the current scope of Tele-Derm, the types of dermatological complaints experienced in the rural primary care setting, and to assess the quality of patient clinical information provided to the consultant dermatologist. Design: Retrospective case analysis. Setting: Tele-Derm National is an initiative of the Australian College of Rural and Remote Medicine and has been providing online educational and consultational services in dermatology to doctors Australia-wide for over a decade. Participants: Patient cases that were submitted to Tele-Derm for specialist dermatologist advice. Interventions: Audit of submitted cases. Main outcome measures: The types of patient presentations and reason for submission for specialist opinion were analysed. The quality of clinical information provided was also evaluated. Results: A total of 406 cases submitted over 2012-2013 were analysed. Most patients were from the outpatient setting with 'rash' or dermatitis (66%). Almost one-third of patients were paediatric cases. The average time from submission to dermatologist reply was 5.5 hours. Clinical photos were provided in 83% of cases and 73% of these were assessed as being of good quality. Management advice was provided in 77% of cases, of which reference to the case-based learning modules on Tele-Derm was made in 21% of cases. Patient outcome was largely unknown (83%). Conclusion: This study identified some of the common dermatological complaints presenting to rural and remote primary care doctors in Australia. The unique addition of professional development in Tele-Derm can be used as an adjunct to advice provided to the rural doctors seeking advice for patient management.
    No preview · Article · Dec 2015 · Australian Journal of Rural Health
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    ABSTRACT: Background: The limitations of dermoscopy to accurately differentiate between pigmented lentigo maligna (LM) and pigmented actinic keratosis (PAK) might be related to the fact that most studies have focused on pigmented criteria only, without considering additional recognizable features. Objective: To investigate the diagnostic accuracy of established dermoscopic criteria for pigmented LM and PAK, but including in the evaluation features previously associated with non-pigmented facial AK. Methods: Retrospectively enrolled cases of histopathologically diagnosed LM, PAK and solar lentigo/early seborrheic keratosis (SL/SK) were dermoscopically evaluated for the presence of pre-defined criteria. Univariate and multivariate regression analyses were performed and ROC curves were used. Results: The study sample consisted of 70 LM, 56 PAK and 18 SL/SK. In a multivariate analysis, the most potent predictors of LM were grey rhomboids (6-fold increased probability of LM), non-evident follicles (4-fold) and intense pigmentation (2-fold). In contrast, white circles, scales and red colour were significantly correlated with PAK, posing a 14-fold, 8-fold and 4-fold probability for PAK, respectively. The absence of evident follicles represented also a frequent LM criterion, characterizing 72% of LM. Conclusion: White and evident follicles, scales and red colour represent significant diagnostic clues for PAK. Instead, intense pigmentation and gray rhomboidal lines appear highly suggestive of LM. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · British Journal of Dermatology
  • S. Andrews · N. Houston · J. Muir

    No preview · Article · May 2015 · Australasian Journal of Dermatology
  • S. Andrews · L. Byrom · J. Muir

    No preview · Article · May 2015 · Australasian Journal of Dermatology

  • No preview · Article · May 2015 · Australasian Journal of Dermatology
  • S. Andrews · C. Adikari · I. Strungs · J. Muir

    No preview · Article · May 2015 · Australasian Journal of Dermatology
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    ABSTRACT: We present the case of a 74-year-old female who developed linear IgA bullous dermatosis secondary to vancomycin. Vancomycin is the most commonly reported medication associated with drug-induced linear IgA dermatosis. Reexposure to vancomycin generally should be avoided; however, it may be appropriate in certain circumstances.
    No preview · Article · Jul 2014 · Infectious Disease in Clinical Practice
  • Lisa Byrom · Tania Zappala · Jim Muir
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    ABSTRACT: Ophthalmic preparations are commonly used medications that have been implicated in causing a variety of dermatological reactions. These reactions include toxic epidermal necrolysis, anaphylaxis, fixed drug eruption, lichenoid drug reaction and local and systemic contact dermatitis. This article reviews the dermatological and systemic reactions associated with ophthalmic preparation use and highlights the need for a thorough medication history to be done for all patients presenting with a suspected drug reaction.
    No preview · Article · Feb 2014 · Australasian Journal of Dermatology
  • Lisa Byrom · Tania Zappala · Jim Muir
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    ABSTRACT: We present a case of a 15-year-old boy who developed toxic epidermal necrolysis (TEN) from sulfacetamide eyedrops. He presented with conjunctival injection and an erythematous rash that rapidly progressed to epidermal necrosis of over 30% of his body. A skin biopsy revealed an acute lichenoid reaction pattern consistent with TEN. After 22 days in hospital, he was left with significant scarring to his eyes, mouth and anogenital areas. An extensive search for an infective aetiology was negative. Previously exposed to bactrim tablets, he used Bleph-10 eyedrops 3 days before admission to hospital. The patient had a strong family history of sulphur allergy. The onset of TEN after topical administration of medication has been reported rarely in the literature. This case highlights the need for a thorough medication history that includes topical preparations.
    No preview · Article · Aug 2012 · Australasian Journal of Dermatology
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    ABSTRACT: The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED. This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed. A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review. The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED.
    No preview · Article · Oct 2011 · Emergency medicine Australasia: EMA
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    ABSTRACT: No abstract available.
    No preview · Article · Mar 2011 · Dermatology
  • Karl Rodins · Lisa Byrom · Jim Muir
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    ABSTRACT: We present a case of a 49-year-old man who presented with a solitary atypical pigmented lesion with a surrounding halo of dermatitis. Dermoscopy showed a pigment network at the periphery with areas of scar-like depigmentation, negative pigment network and erythema. The lesion was treated preoperatively with a potent topical corticosteroid resulting in a reduction of inflammation. Histology showed an early Clark level 1 melanoma arising within a severely dysplastic compound melanocytic naevus. There was an adjacent perivascular chronic inflammatory cell infiltrate with occasional eosinophils. Minimal, though definite spongiosis with parakeratosis was also present. The scar was subsequently re-excised achieving appropriate excision margins for melanoma in situ. Six months later, there was recurrence of dermatitis at the scar with no evidence of recurrent melanoma. To our knowledge, melanoma with Meyerson phenomenon has not been reported in the literature. This case highlights that all lesions should be evaluated on clinical and dermoscopic grounds regardless of the presence or absence of eczema. Our case adds yet another entity that may display Meyerson phenomenon and consequently a halo of eczema cannot be considered a reassuring sign when evaluating melanocytic lesions.
    No preview · Article · Feb 2011 · Australasian Journal of Dermatology
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    ABSTRACT: The early diagnosis of melanoma is critical to achieving reduced mortality and increased survival. Although clinical examination is currently the method of choice for melanocytic lesion assessment, there is a growing interest among clinicians regarding the potential diagnostic utility of computerised image analysis. Recognising that there exist significant shortcomings in currently available algorithms, we are motivated to investigate the utility of lacunarity, a simple statistical measure previously used in geology and other fields for the analysis of fractal and multi-scaled images, in the automated assessment of melanocytic naevi and melanoma. Digitised dermoscopic images of 111 benign melanocytic naevi, 99 dysplastic naevi and 102 melanomas were obtained over the period 2003 to 2008, and subject to lacunarity analysis. We found the lacunarity algorithm could accurately distinguish melanoma from benign melanocytic naevi or non-melanoma without introducing many of the limitations associated with other previously reported diagnostic algorithms. Lacunarity analysis suggests an ordering of irregularity in melanocytic lesions, and we suggest the clinical application of this ordering may have utility in the naked-eye dermoscopic diagnosis of early melanoma.
    Full-text · Article · Oct 2009 · PLoS ONE
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    ABSTRACT: Tele-dermatology has comparable diagnostic accuracy to face-to-face consultation. Skin emergencies need rapid turnaround. Tele-dermatology can reduce patient morbidity from skin emergencies. Tele-dermatology is cost effective in skin emergencies. Tele-dermatology is an under-utilised service, particularly for skin emergencies. The technical requirements for tele-dermatology may be limited to a digital camera and effective telecommunication. Most dermatological investigation and treatment can be carried out easily by medical practitioners and medical staff in A and E units.
    No preview · Article · Jan 2009

Publication Stats

44 Citations
20.45 Total Impact Points

Institutions

  • 2011-2014
    • Mater Misericordiae University Hospital
      Dublin, Leinster, Ireland
  • 2009-2011
    • University of Queensland
      • Dermatology Research Centre
      Brisbane, Queensland, Australia