Malignant melanoma in an 8-year-old Caribbean girl: diagnostic criteria and utility of sentinel lymph node biopsy.

The incidence of malignant melanoma (MM) is continuing to rise, although childhood MM remains rare. We describe an 8-year-old Afro-Caribbean girl who developed a non pigmented lesion on the tip of her left thumb, which persisted despite treatment in primary care with cryotherapy. At biopsy she was found to have an acquired acral MM. She underwent amputation of the distal phalanx of her thumb, together with positive sentinel lymph node (SLN) biopsy and subsequent axillary lymph node clearance and adjuvant chemotherapy. MMs are very rare in this age and skin-type group, therefore requiring strict diagnostic criteria. These criteria include the distinction from MM mimics, especially Spitz tumours, and an appropriate use of staging techniques such as SLN biopsy to influence management.

Suppurating facial lesions may be a sign of dental infection.

We describe three cases of chronic dental sepsis presenting with facial suppuration (dentocutaneous sinus). Misdiagnosis may lead to unnecessary morbidity. Inappropriate hospital referral wastes resources.

A modified Bretteville technique for hypospadias.

A modified Bretteville technique for hypospadias repair is presented. This is a two-stage repair, utilising a preputial skin flap. The modification reduces the second stage to a day-case procedure. 40 cases are reported with good early functional and aesthetic results. The only major complications were two fistulae. There were no strictures.

Metastatic carcinoid of the breast: an unusual screen-detected breast cancer.

The breast is a rare site of metastasis. This case report is of a rare case of metastatic carcinoid tumour to the breast. The differentiation from primary breast carcinoid is discussed.

Audit of thermally injured children under 5 years of age.

One-third of all admissions to the Wessex Regional Burns Unit (WRBU) are children under 5 years of age. These patients constitute a disproportionately large part of the workload in terms of nursing and medical care. A review of children admitted to the WRBU over a 5-year period was undertaken. Information was stored in a computer database (dBASE-IV) to simplify data analysis and to develop a system of data collection which can be used for audit. Eighty-one per cent of injuries were due to scalds. The mean burn surface area (BSA) was 8 per cent, and 78 per cent of injuries were smaller than 10 per cent BSA. Skin grafting was required in 44 per cent of patients. The mean time to operation was 13 days after injury. Significant hypertrophic scarring occurred in 60 per cent of patients and 12 per cent of patients were readmitted for further surgical procedures. There was one death. In an extension to the main database, associations between clinical and physiological observations and morbidity were sought. The data suggest that behavioural changes, 'shock', profound lymphocytopenia and pyrexia greater than 39.5 degrees C should be treated as strongly suggestive of the development of complications in the early stages after injury.

A randomised controlled study to evaluate the effect of Naftidrofuryl in a rat ischaemic skin flap model.

The theoretical benefit of Naftidrofuryl in improving survival of ischaemic skin flaps was tested in a randomised controlled study using oral, intraperitoneal and local administration of the drug in three groups of Wistar rats. The vasodilator Naftidrofuryl was shown to be of no value in preventing distal necrosis in a rat skin flap model which has previously responded to pharmacological manipulation.