SummaryBackground There is a dearth of information on the precise pathogenesis of hidradenitis suppurativa (HS), but immune dysregulation is implicated. Objectives To determine the nature of the immune response in HS. Methods Skin biopsies -lesional, perilesional (2 cm away) and uninvolved (10 cm away) -were obtained from patients with HS and healthy controls. The expression of various cytokines was determined by enzyme-linked immunosorbent assay, flow cytometry and real-time polymerase chain reaction. Results The expression of the inflammatory cytokines interleukin (IL)-17, IL-1b and tumour necrosis factor-a was enhanced in lesional skin of patients with HS. In addition, IL17A and IL1B mRNA were enhanced in clinically normal perilesional skin. CD4 + T cells produced IL-17 in HS, while CD11c + CD1a À CD14

This study assesses whether the routine submission of mastectomy scars for histologic examination at the time of delayed breast reconstruction is useful. A retrospective review was performed of all delayed breast reconstructions for breast cancer performed by a single surgeon over a 5-year period from January 2000 to December 2004. One hundred eighty-eight patients underwent delayed breast reconstruction during this period, and of these, 133 scars (1 patient had bilateral scars excised) were submitted for histology where the reconstruction was performed by either transversus rectus abdominus muscle flap (TRAM) or latissimus dorsi myocutaneous flap (LDF) +/- implant. Fifty-six patients had reconstruction performed by tissue expander through the inframammary crease where the original mastectomy scar was not excised and were excluded from the study. One mastectomy scar specimen showed a 2-mm suspicious area of invasive ductal carcinoma consistent with same histopathology at the time of mastectomy. This study corroborates evidence that it is questionable whether routine histopathology of mastectomy scar at the time of delayed breast reconstruction should not be a standard practice.

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BackgroundKeratinocyte cancers are increasing in incidence in Ireland and are more common in older age, necessitating multidisciplinary specialist input and treatment often is a greater burden for patients. The coronavirus disease 2019 (COVID‐19) allowed us to restructure our interspecialty treatment pathways to reduce healthcare contact for patients.ObjectivesThe aim of this study was to establish whether a revised interspecialty pathway reduced the time‐to‐treatment completion (days) and treatment burden (defined as total healthcare encounter days).MethodsPatients with keratinocyte cancer under the care of dermatology and plastic surgery at St Vincent's University Hospital Dublin from July to December 2020 inclusive were identified in the Hospital‐Inpatient Enquiry database. Treatment burden was captured as the number of total days with a healthcare encounter and time‐to‐treatment completion was captured as the time from initial dermatology review to complete excision by plastic surgery.ResultsForty patients with 49 keratinocyte cancers were referred by dermatology to plastic surgery from July to December 2020. Thirty‐nine patients with 48 keratinocyte cancers were included in the analysis. The new referral pathway reduced the time‐to‐treatment completion from a mean of 164 to 75 days (p = 0.04). Treatment burden reduced from a mean of 5.4 to 3.5 (p = 0.002) total healthcare encounter days.ConclusionsMultidisciplinary input to establish a more efficient referral pathway for patients with keratinocyte cancer has successfully reduced the time‐to‐treatment completion and the treatment burden for our patients. This approach reduced the risk of exposure to COVID‐19 for patients and frees up valuable healthcare resources to treat these increasingly frequent malignancies.

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