Men who are cured of a germ cell testicular cancer have a greatly increased risk of developing a second testicular cancer. Such patients should be informed of this risk and ideally kept under long-term surveillance.

Objective To re-evaluate a national prospective study in for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor comNew Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma pliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other chemotherapy at relapse. At 17 years and a median follow-up of 53 months, 242 of the 248 men are treatment protocols. Patients and methods Between 1980 and 1997, 248 disease-free and the disease-specific survival rate is 98%. men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and Conclusions This study shows that orchidectomy alone and treatment of relapses produces excellent longsurveillance, with treatment of relapses using combination chemotherapy.term results without the adverse eCects associated with retroperitoneal node dissection or elective chemoResults Seventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion therapy for high-risk cases. Keywords Stage I nonseminoma, testicular cancer, (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed surveillance, long-term follow-up, orchidectomy (P<0.001). VLI was the only identifiable risk factor ommend that high-risk patients should be oCered adju-

Basal cell carcinoma (BCC) accounts for 75% of all skin cancers and its incidence is rising by between 3-8% each year (Szeimies and Karrer, 2006). As a result, the development of new therapeutic strategies and treatment methods for the removal of BCC is crucial in combating what is a growing problem. Surgical techniques, such as Mohs micrographic surgery, cryotherapy/cryosurgery, curettage and carbon dioxide laser therapy, as well as non-surgical techniques, such as radiotherapy, are recognized as potential options. The aim of this article is to critically review some of the current literature in order to substantiate the efficacy of destructive and non-surgical techniques as reliable alternatives to surgery for the management/removal of BCCs. The success rate, cosmetic outcome, pain and discomfort, recurrence rates, and the cost associated with each method are explored and discussed. Results of the review indicate that no one treatment is completely superior. According to the research, simple excision and Mohs micrographic surgery provide the lowest recurrence rates. However, in relation to success rates, patients tolerance of the treatment and cosmetic outcomes, and depending on the type of BCC involved, other treatment methods do offer reliable alternatives.

A series of 115 patients with clinical Stage I non-seminomatous germ cell testicular tumours were managed with orchiectomy and close surveillance (median follow-up 36 months, range 3-119); 34 (29.5%) relapsed, 21 within 6 months, 29 within a year and the latest at 28 months. At relapse all patients were treated with platinum or analogue-based drug combinations, supplemented in 7 by retroperitoneal node dissection; 30 patients achieved durable remissions and 2 have had further relapses successfully treated. Two died; both had malignant teratoma intermediate with primary stage T1 and vascular and/or lymphatic invasion of primary tumour. At a median follow-up time of 36 months, the survivors (98.3%) demonstrate no evidence of disease, these results matching the outcome of other methods of management. Vascular and/or lymphatic invasion was associated with an enhanced relapse rate but specific histology, T stage of the primary and pre-orchiectomy serum alpha-fetoprotein status did not appear to favour relapse. The first sign of relapse was tumour marker alone in 10 patients, radiological features alone in 12, or both in 10 patients. However, in 2 cases the relapse was first detected clinically. Furthermore, pre-orchiectomy and relapse marker status did not correlate well. These points emphasise the importance of all aspects of follow-up, none of which can be safely omitted.