Our population-based study establishes epidemiological data on age-specific incidence rates, clinical presentation, Breslow microstaging, treatment and survival of nail apparatus melanoma (NAM) patients in England. Four cancer registries, covering a population of 10.6 million, recorded 105 cases of NAM during the period 1984-93. During the same decade there was a total of 7585 patients with cutaneous melanoma and NAM represents 1.4% of all cutaneous melanoma. The incidence rate of NAM in English patients is 0.1 per 100,000 of the population per annum. Amelanotic melanoma was the clinical presentation in 24 of our NAM cases. The overall prognosis is poor with an observed 5 year survival of only 51%. Patients with NAM less than 2.5 mm Breslow depth have a 5 year survival of 88% and are twice as likely to survive compared with those with tumours greater or equal to 2.5 mm in thickness (P < 0. 05). NAM patients are best managed by a multidisciplinary team approach in a few key skin cancer centres.

Frontal fibrosing alopecia (FFA) is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Despite a dramatic recent increase in incidence the aetiopathogenesis of FFA remains unknown. We undertake genome-wide association studies in females from a UK cohort, comprising 844 cases and 3,760 controls, a Spanish cohort of 172 cases and 385 controls, and perform statistical meta-analysis. We observe genome-wide significant association with FFA at four genomic loci: 2p22.2, 6p21.1, 8q24.22 and 15q2.1. Within the 6p21.1 locus, fine-mapping indicates that the association is driven by the HLA-B*07: 02 allele. At 2p22.1, we implicate a putative causal missense variant in CYP1B1 , encoding the homonymous xenobiotic- and hormone-processing enzyme. Transcriptomic analysis of affected scalp tissue highlights overrepresentation of transcripts encoding components of innate and adaptive immune response pathways. These findings provide insight into disease pathogenesis and characterise FFA as a genetically predisposed immuno-inflammatory disorder driven by HLA-B*07: 02.

In this review, the current state of knowledge concerning nail melanoma is summarized. The pathogenesis, histological findings, clinical presentation, treatment and prognosis of this rare form of cutaneous melanoma are discussed. Important clinical clues to the early diagnosis of nail melanoma are highlighted and recommendations to improve the management of patients are suggested.

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An eight-month-old, male domestic shorthair kitten developed progressive abdominal distension over a six-week period. Abdominocentesis revealed a fluid with high protein (3.8 g/dl) and moderate cellularity. Infectious, cardiovascular, and neoplastic causes of posthepatic obstruction were ruled out. Partial obstruction and stenosis of the caudal vena cava (CVC) at the level of the diaphragm were detected on a contrast venogram. Exploratory surgery revealed a fibrous, web-like membrane at the site of obstruction. Resection of the stenotic segment of the CVC was not possible because of the junction of the left hepatic veins and CVC just caudal to the lesion. A 3 by 6-mm, oval Dacron patch graft was sutured into the venotomy site. Postoperative complications included fever and leukocytosis, eosinophilic pleural effusion, and transient congestive heart failure associated with volume overload. The cat is normal 16 months after surgery, with no recurrence of ascites. This is the first reported case of Budd-Chiari syndrome (BCS) in a domestic kitten. Documented herein is the first successful treatment of BCS in a small animal using a vascular, prosthetic patch graft.

registered and, of these, 28% accurately reported a preregistered specific outcome. 4 The respective rates in this study (66% and 67%) are a notable improvement. This may reflect that our study assessed only high-impact-factor journals, the continued impact of policies mandating prospective trial registration, 5 and the increasing recognition of the importance of prospective trial registration by dermatology journals. 6 Discerning whether primary outcome discrepancies reflect benign variations in levels of detail or more sinister post hoc selection of results based on significance can be challenging. Of concern, previous work has associated discrepancies with an increased likelihood of larger effect sizes and statistically significant results. 7,8 Currently, the CONSORT guidelines acknowledge that changes to preregistered outcomes can occur, but that in such instances the change and rationale should be detailed in the manuscript. In the absence of an explanation, discrepancies should raise suspicion of bias.

This study compares the cutaneous reactivity between the hand and the back for 7 female patients with active hand eczema, who were found to be nickel-sensitive on routine patch testing with the European standard series. Patients were patch tested to a dilution series of nickel sulfate on the back in order to determine the threshold concentration for elicitation of allergic contact dermatitis, and based upon this result a lower concentration of nickel was then used for patch tests on the hand. We found that in the majority of patients (6/7) the cutaneous responsiveness of the hand was not increased compared with that of the back. However, the hand of 1 patient was more sensitive to nickel and patch testing was accompanied with a flare of her eczema, which suggests that cutaneous hyperreactivity may be important in individual patients with hand eczema.

The Fitzpatrick scale has been in use for skin colour typing according to the tanning potential of skin since its inception in [1975][1976]. Thomas Fitzpatrick developed the scale to classify persons with 'white skin' in order to select the correct amount of UVA in Joules/cm 2 for PUVA treatment for psoriasis. Since then, it has been widely used in Dermatology to gauge the skin's reaction to UV exposure, tanning potential, assessment of sunburn risk and amount of sun protection required for individual patients. However, the use of this scale has been of limited utility because of different self-perception in different areas of the world, particularly among those with skin of colour. Skin cancer risk is loosely inversely correlated with the initial genetic/inherent amount of melanin (most research has focused on eumelanin) present in the skin, although the pattern of exposure and amount of UV radiation required causing DNA damage varies widely according to different cancers. In this review, we have shown that the Fitzpatrick scale is neither correct nor adequate to reflect sunburn and tanning risk for skin of colour. Therefore, it may give both patients and physicians a false sense of security that there is little risk that people of colour can develop skin cancers. We have reviewed the small but not insignificant risk of skin of colour developing skin cancers and emphasise that there remains much research that needs to be done in this field. Abbreviations: Asian, persons tracing their origins to primarily Asian origins; Black, non-Hispanic persons of primarily African origins; Hispanic, Persons tracing their origins to primarily Central or South American origins; White, non-Hispanic persons of primarily European Caucasian origins. Peter Goon and Nick J. Levell are joint senior authors.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.