Background: Acral lentiginous melanoma (ALM) is an uncommon, cutaneous malignant tumour which may arise on the foot. Its relative rarity, atypical appearance and late presentation frequently serve as poor prognostic indicators.

Malignant melanoma is a life threatening skin tumour which may arise on the foot. The prognosis for the condition is good when lesions are diagnosed and treated early. However, lesions arising on the soles and within the nail unit can be difficult to recognise leading to delays in diagnosis. These guidelines have been drafted to alert health care practitioners to the early signs of the disease so an early diagnosis can be sought.

Background: Human papilloma virus (HPV) infects keratinocytes of the skin and mucous membranes, and is associated with the induction of cutaneous warts and malignancy. Warts can induce significant morbidity and disability but most therapies, including cryotherapy, laser, and radiofrequency devices show low efficacy and induce discomfort through tissue destruction. Microwaves are readily capable of passing through highly keratinised skin to deliver energy and induce heating of the tissue in a highly controllable, uniform manner. Objectives: To determine the effects of microwave on cutaneous HPV infection. Materials & methods: We undertook a pilot study of microwave therapy to the skin in 32 consecutive individuals with 52 recalcitrant long-lived viral cutaneous warts. Additionally, we undertook a molecular characterisation of the effects of microwaves on the skin. Results: Tissue inflammation was minimal, but 75.9% of lesions cleared which compares favourably with previous studies showing a clearance rate of 23-33% for cryotherapy or salicylic acid. We show that microwaves specifically induce dendritic cell cross-presentation of HPV antigen to CD8+ T cells and suggest that IL-6 may be important for DC IRF1 and IRF4 modulation to enhance this process. Conclusion: Keratinocyte-skin dendritic cell cross-talk is integral to host defence against HPV infections, and this pilot study supports the concept of microwave induction of anti-HPV immunity which offers a promising approach for treatment of HPV-induced viral warts and potentially HPV-related cancers.

There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.

BackgroundOnychomycosis is a common nail pathology which has proven to be a treatment challenge to healthcare professionals. Antifungal drugs have been the mainstay of therapy for many years. Recently, laser technologies have been introduced as a treatment for onychomycosis avoiding the disadvantages of systemic and topical drug therapies, offering a rapid treatment for an often persistent nail condition. The purpose of this study was to review published evidence regarding the effectiveness of laser technologies in the treatment of onychomycosis.MethodsThe primary question for this review was “what evidence is there for the use of lasers in the treatment of onychomycosis”? A systematic literature search of published papers indexed on Pubmed and Web of Science® was undertaken in June 2014 for original, published research. The primary outcome measures for efficacy were mycological cure and clearance of the affected nail (clinical cure).ResultsThis review returned a total of twelve eligible published studies evaluating the use of lasers in the treatment of onychomycosis. Two were randomised controlled trials, four were comparative design studies (with no placebo/control groups) and the remainder were case series. The level of evidence was generally low level reflecting predominantly small sample size and lack of control groups. The results from studies were conflicting and follow up periods for patients in studies were generally short. Many studies excluded patients with severe or dystrophic onychomycosis.ConclusionsThe evidence pertaining to the effectiveness of laser treatment of onychomycosis is limited and of poor methodological quality. Future studies using a randomised controlled trial designs with larger study populations and clear procedures are required to permit a full evaluation of this emerging technology.

Human Papilloma Virus (HPV) related verrucae pedis persist, seemingly evading host immune surveillance, yet sometimes disappear with inflammation. The absence, or reduction, of a cellular immune response may explain why verrucae treatments are not uniformly successful and treatment can be difficult even in immune-competent individuals. Little investigation has been undertaken into the potential benefit and efficacy of needling verrucae, a treatment modality causing HPV infected keratinocyte destruction in addition to inducing an assumed enhanced immune response. A review of clinical practice is presented, reporting the treatment method and results of data collected from a retrospective review of 45 patients. Thirty-one (69%) cases demonstrated complete resolution of verrucae following needling treatment. Three patients demonstrated reduction in size and pain whilst 11 showed no improvement. No adverse events were noted. Needling may have a place in the management of verrucae pedis in an adult population but a large scale study utilising objective measures and a control intervention would provide more detailed efficacy data along with a greater understanding of the effects of this treatment on long term immunity.

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Malignant melanoma is the most common primary malignant tumour arising on the foot. Where improvements in the prognosis have been observed for patients with melanoma elsewhere on the skin, pedal lesions are still frequently delayed in presentation through neglect or misdiagnosis. Detection of foot melanoma relies on the health care practitioner's skills and observations in recognising early changes. Recent publications have documented the use a dermoscopy as a tool to improve recognition of such suspicious lesions. This paper reviews current literature with a special emphasis of its potential applications on plantar and nail unit melanoma. Data from these studies suggest that the technique is a useful and significant adjunct to clinical examination, which ultimately may lead to earlier recognition of this aggressive tumour.