A case series of skin necrosis following use of non invasive ventilation pressure masks.

Two cases of nasal skin necrosis secondary to pressure from the use of continuous positive airway pressure (CPAP) face masks are presented. Both developed skin necrosis as a result of wearing these masks over the nasal bridge. These cases highlight the need for clinical vigilance in application of CPAP masks, the need for monitoring the skin of the nose during CPAP use and the possible need for modifications in design to help prevent this serious complication.

A custom-made thermoplastic boot splint for the treatment of burns contractures of the feet in children.

Scald injuries to the feet are relatively common in young children. In a minority of cases, contracture formation can lead to permanent disability. We present a new technique, which provides a simple yet functional form of splintage in the treatment of the contractures.

Carcinoma of the parotid gland presenting as facial pain.

Facial pain is a common reason for patients seeking medical help. A patient is presented who gave a 5-month history of right-sided facial pain, which was subsequently diagnosed as carcinoma of the right parotid gland.

Axillary metastases from recurrent oral carcinoma.

The rationale for surgical treatment of head and neck cancer is based on a predictable pattern of metastasis. There is aberrant or unpredictable spread rarely and typically only in recurrent disease. There are few published reports to our knowledge of axillary metastases from squamous cell cancer (SCC) of the head and neck. We present a patient who developed axillary node disease on the other side after recurrence of a squamous cell carcinoma of the floor of the mouth. She died 11 months after excision of the recurrence.

A review of diagnostic imaging in melanoma.

The incidence of melanoma continues to rise, and is responsible for 50% of deaths related to skin cancer. Imaging plays a vital role in the diagnosis, assessment, treatment and follow-up of patients. Costs have risen dramatically over the last few years, largely due to increased use of newer technologies. This article examines the evidence for the use of radiological imaging in melanoma, in particular, ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), sentinel lymph node biopsy (SLNB), positron emission tomography (PET) and combined CT/PET. Recommendations are made on the basis of comparison of costs of imaging methods.

Merkel cell carcinoma: a report of 34 cases and literature review.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer, with unclear histogenesis. To date there is no consensus on the optimal treatment of this neoplasm, with controversy surrounding the use of radiotherapy and chemotherapy. There are also limited data on biological behaviour and prognosis, with reported survival ranging from 31% at three years to 74% at five years. METHOD: The medical records of 34 patients with a diagnosis of primary MCC, treated at two NHS trusts in Birmingham and Coventry, were reviewed. An extensive review of the English literature was also performed. RESULTS: MCC occurred predominantly in Caucasians (97%) with a mean age of 75 years. Identified risk factors were a previous history of SCC (37%), BCC (18%) and AK (20%). Ten percent of patients showed evidence of immunocompromise. Most tumours were located on the extremity, where they reached a mean size of 2.1cm. Fifty percent had regional metastasis during the course of their disease. A sub group analysis of the excision margins showed that a 2-cm excision margin, extending to the deep fascia, resulted in a 50% incomplete excision rate and a 33% local recurrence rate. In contrast a 3-cm margin including deep fascia resulted in no incomplete excisions and a 10.5% local recurrence rate Prognosis was poor with a 40% 3-year survival. Combining the data from two trusts has produced a relatively large series and highlighted differences in patient characteristics and management between the units. We advocate a 3-cm excision margin, including fascia wherever possible, combined with post-operative radiotherapy to offer the best chance of local control. Survival is fairly dismal and in keeping with the aggressive nature of this tumour. The respective roles of radiotherapy and chemotherapy remain controversial.

Cutaneous leishmaniasis.

The incidence of leishmaniasis is increasing globally due to population and environmental changes. Ease of worldwide travel and immigrant populations means that the UK surgeon is more likely to encounter cutaneous lesions. Two cases are presented and treatment options discussed.

Surgical treatment of locally recurrent malignant schwannoma of the lower leg.

This report describes a case of locally recurrent limb malignant schwannoma in a 74-year-old patient. The light microscopy and immunohistochemical findings are presented and current methods of surgical treatment reviewed. We describe treatment using wide local excision with frozen section control of the marginal nerves and present a 3-year follow-up.

Psychosocial benefits of sentinel lymph node biopsy in the management of cutaneous malignant melanoma.

Lymphoscintigraphy combined with sentinel lymph node biopsy has become a powerful and sensitive tool in establishing nodal spread in cutaneous melanoma, as well as in breast and other cancers. Although the technique is reliable and validated, there is, as yet, no proven clinical benefit. A suggested benefit of sentinel lymph node biopsy is that a negative biopsy may decrease the psychological morbidity associated with malignancy by reassuring the patient that he or she has localised disease. We studied a group of patients with cutaneous melanoma who underwent sentinel lymph node biopsy, and found that although they did gain some psychosocial benefit from the procedure, this was short term and they were still significantly concerned about their disease status.

Histological analysis of the greater auricular nerve and its use as a graft.

Many factors are involved in successful nerve grafting. Morphometric similarity between donor and recipient nerve is one of these factors. A histological study was undertaken to determine the suitability of the greater auricular nerve as a graft in head and neck surgery. Nerves were obtained from fresh human cadavers and evaluated for length, total cross-sectional area, total fascicular cross-sectional area and fascicular number, at three separate points along the nerve. Comparisons were made with similar studies of the sural and facial nerve. The study confirms the clinical view that the greater auricular nerve is ideal when short sections of graft are required in head and neck surgery.