Challenges in staging and surveillance of patients with neurofibromatosis and cutaneous malignant melanoma.

Malignant melanoma is a skin neoplasm with a rising trend of incidence. Positron Emission Tomography in combination with Computed Tomography (PET-CT) imaging is an essential diagnostic tool for both staging and surveillance of melanoma patients; especially in metastatic disease, where prognosis is poor. We report a case of a patient with known Neurofibromatosis type 1 (NF-1) who presented to the Skin Cancer Multidisciplinary meeting with 11 mm Breslow thickness malignant melanoma of the left forearm. His extensive dermal neurofibromatoses proved a diagnostic challenge to the team. There have been published studies linking NF-1 with malignant melanoma. However the incidence and significance of this has yet to be established. We also discuss the use of PET-CT imaging and skin surveillance in the monitoring and staging of this patient.

Management of recurrent vault prolapse.

In the ageing female population, recurrent vaginal vault prolapse is a significant healthcare burden. There is limited evidence regarding the optimal management strategy for recurrent vault prolapse. This paper aims to discuss treatment modalities available for recurrent vault prolapse. A literature search and analysis was performed using Medline, PubMed, Cochrane database, current texts and references from relevant articles. We found inconclusive evidence supporting conservative, mechanical and some surgical options for treating recurrent vault prolapse; including iliococcygeal fixation, McCall culdoplasty, and infracoccygeal sacropexy. Sacrospinous ligament fixation (SSLF), sacrocolpopexy, mesh implants and colpocleisis are shown to have good outcomes in Level II studies. Nevertheless, the first two are associated with haemorrhage, dyspareunia and scarring whilst colpocleisis is limited to selected patients. More well-designed studies are required for recurrent vault prolapse. Current evidence suggests SSLF, and sacrocolpopexy are alternative surgical options to colpocleisis in treating recurrent vault prolapse. Randomised trials are required to determine the efficacy and safety of trocar-guided mesh kits.