A 58-year-old man presented with a 4-month history of a rapidly enlarging asymptomatic tumour on the scalp vertex. Six years earlier, the patient had undergone subtotal gastrectomy for a presumed gastrointestinal stromal tumour (GIST). The tumour extended to the peritoneal surfaces, and foci of vascular invasion were also seen. No adjuvant treatment was given. Owing to diagnostic difficulties with the scalp tumour, a comparison was made with the previous gastric neoplasm. Both had features consistent with glomus tumour, which suggested a revised diagnosis of primary malignant gastric glomus tumour with subsequent cutaneous metastasis to the scalp some years later. This case highlights the features of glomus tumours and is a reminder that although rare, glomus tumours can be malignant and have the potential to metastasize. To our knowledge, this is the only reported case of a primary gastric glomus tumour with secondary metastasis to the skin.

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Full-thickness skin graft is an effective method of repairing defects on the lower leg after removal of cutaneous lesions. The aftercare of FTSG was acceptable with 86% of patients requiring 5 or fewer visits to secondary care.

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Background. We conducted a re-audit of the surgical practice of UK dermatologists for the treatment of nonmelanoma skin cancer and examined changes with reference to our previous audit in 2014. The audit was supplemented by a detailed assessment of completeness of the histopathology reports for each tumour. Methods. UK dermatologists collected data on 10 consecutive nonmicrographic excisions for basal cell carcinoma (BCC) and 5 for squamous cell carcinoma (SCC). Data were collected on site, preoperative diagnosis, histological diagnosis, proximity to previous scars, and histological deep and peripheral margins. Results. In total, 222 responses were received from 135 centres, reporting on 3290 excisions. Excisions from the head and neck accounted for 56.7% of cases. Tumour diameter (mean AE SD) was 11.4 AE SD 7.1 mm (maximum size 100 mm) and 97% of cases were primary excisions. BCCs and SCCs respectively accounted for 65.7% and 26.8% of total cases. Of the suspected BCCs and SCCs, 95.8% and 80.4%, respectively, were confirmed histologically. All margins for any tumour were clear in 97.0% of cases, and complication rate in the audit was < 1%. Of the 2864 histology reports evaluated, only 706 (24.6%) contained all core data items; 95% of these were structure (synoptic) reports. Commonly omitted items were level of invasion, risk and T stage, which were absent from 35.7%, 64.2% and 44.1% of reports, respectively. Conclusions. Diagnostic accuracy and complete excision rates remain high. Complication rates may be under-reported owing to lack of follow-up. Histopathology reporting has a greater chance of being complete if reports are generated on a fieldbased platform (synoptic reporting).

The majority of excisions for NMSC are for BCC and SCC. Our figures for diagnostic accuracy are at the upper range of previously published figures. Most patients were not followed up in secondary care, hence complication rates may be under-reported.

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