Malignant melanoma in the hand: current evidence and recommendations.

Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges. Consequently, these tend to present at a later stage and are associated with a poorer prognosis. It is imperative that hand surgeons treat any pigmented hand lesion with suspicion to ensure rapid diagnosis and treatment. This article outlines the presentation of melanoma, and how to investigate suspicious pigmented lesions of the hand and digits. It guides hand surgeons in their approach to melanoma of the hand, outlining the multidisciplinary team approach as well as current standard surgical and reconstructive options to optimize outcomes.

Surgical Management of Enchondromas of the Hand: A 12-Year Experience.

Objective Enchondromas are benign tumours of hyaline cartilage most frequently arising in the bones of the hand and the optimum surgical management strategy for these is debated. We present an audit of the surgical management of 57 enchondromas referred to our tertiary hand surgery department over a period of 12 years (2008-2020) and describe our surgical technique for this procedure as well as a comparison with other studies in the literature. Materials and Methods Retrospective audit of our practice. Data were extracted from our institutional operative database to identify all patients undergoing surgical management of enchondromas during the time period. The individual electronic patient records were then evaluated to extract demographics and outcome data. Results Our results demonstrate excellent clearance of enchondroma (74% Tordai group 1 radiological resolution) with very low complication rates and no recurrence. Our results also emphasize the importance of surgical management of enchondromas to allow diagnosis of rare chondrosarcoma (3.5% in this study). Conclusion A larger randomized controlled trial is still required to adequately determine the differences between the surgical options available and determine the best possible surgical approach to these cases. Level of evidence is III.

Severe phytophotodermatitis from fig sap: a little known phenomenon.

A 46-year-old arborist with no medical history presented to the emergency department with a confluent blistering, erythematous, non-pruritic, painful rash covering both arms circumferentially and the back of his neck. He sought medical advice as his arms were becoming more painful and swollen with blister formation, despite aloe vera cream and wet towel wraps. He recalled that 2 days previously he had been pruning a fig tree on a hot sunny day. He was wearing a t-shirt and his forearms had been exposed to a large quantity of fig sap, while he was working under direct sunlight. On examination, there were several blisters with no superimposed infection. He was diagnosed with phytophotodermatitis and referred to a regional burns unit. He recovered well with simple dressings and a course of antibiotics. At present, he has made a good recovery with no long-term sequelae such as skin hyperpigmentation or hypopigmentation.

Variation in the clinical commissioning of surgery for three common hand conditions in England.

The surgical referral policies for patients with trigger finger, ganglion removal and Dupuytren's disease were collected for all Clinical Commissioning Groups in England. The aim was to assess whether there was variation in the policies across England, resulting in inequality in patients' access to surgery. Data were collected between October 2018 and January 2019 and compared with national guidelines. Analysis of the results showed that for all three conditions, surgical commissioning policies varied depending on the locality. The results also show that despite the existence of national guidelines, they are not implemented. This has the potential to lead to variation in surgical referral and access to services for patients in different localities in England.Level of evidence: III.