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A sentinel lymph node biopsy is a surgical staging procedure performed for patients with primary cutaneous melanoma who are clinically lymph-node negative to determine whether there is low volume nodal metastasis in the draining lymph node field. A systematic review was recently performed to update the Australian clinical practice guidelines for the diagnosis and management of melanoma, addressing the question, 'When is a sentinel lymph node biopsy indicated?' This article discusses the findings of the systematic review and the evidence base for the updated guidelines.

Our results support the recognition of a distinct group of melanoma that mimics metastatic melanoma, but is associated with a relatively favourable outcome. The group of putative primary dermal melanoma is likely to be heterogenous, including cases of primary nodular melanoma in which epidermal connection has not been identified, metastatic melanoma with an occult primary lesion and true primary dermal melanoma.

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The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.

Juvenile melanoma remains a rarity in Western Australia despite a very high incidence of adult melanoma. Unlike in adults, no definitive risk factors have been established. A significant proportion of this cohort had a pre-existing naevus and while most melanomas occurred in sun-exposed areas in light-skinned individuals the association between sunburn and melanoma was not strong.

PurposePost operative monitoring is crucial for the success of microsurgical free tissue transfer. Sophisticated and expensive methods are available for monitoring. We propose a novel technique using digital photography and the internet as a reliable and cost effective method to monitor free tissue transfers. Methods163 micro-vascular procedures were monitored using this technique over 8 months. Serial photographs taken to show flap color. Capillary refill time, pin prick-bleed time and color and hand held Doppler signal was recorded in the movie mode of a standard 5 mega pixel camera with duration of 15 seconds. Data was sent to the surgeon at regular intervals and or as deemed necessary. ResultsAnalysis of the 67 cases is presented. 5 re-explorations were done. The early diagnosis of venous congestion was possible using this technique. Timely intervention contributed to the success of the re-explorations and these flaps could be salvaged. The file size of images was in the range of 1 MB-6 MB. The file size of an entire set of images ranged about 7 MB-9 MB. These were sent across the ADSL internet lines. ConclusionThe use of the digital images and the internet allow reconstructive surgeons to have a reliable picture of the state of their free tissue transfers. This permits decrease in observer error and saves valuable time which otherwise needs to be spent to verify situations of doubt and offers an ideal solution to the logistic problem of having to visit the patient in case of doubt.Calcium Alginate dressings have been used for many years as the standard dressing for donor sites. They require a secondary absorbent dressing which is not waterproof, will frequently leak blood and are difficult to remove and heal. Polyurethrane film dressings have also been used routinely with excellent healing rates, are waterproof, but highly prone to leakage.We present the results of a prospective randomized controlled trial using a new dressing, Tegaderm Absorbent, which provides all the regular benefits of a Polyurethrane film dressing but with absorptive capacity. Tegaderm Absorbent (TA) consists of a conformable acrylic pad enclosed between 2 layers of transparent film. The film in contact with the wound surface is perforated to allow uptake of the wound fluid by the absorptive acrylic pad.Forty patients were randomized to receive either Tegaderm Absorbent (3M) or Kaltostat Alginate dressing (Convatec)/gauze/combine/Mefix dressing.Twenty females and 16 men, with a mean age of 72 years (11-94 years), 19 with TA and 17 with Kaltostat, completed the trial. TA dressings were significantly easier to apply (89% vs. 31% very easy to apply), less painful on the first two days postoperatively (mean pain score 0.3 vs. 1.9 at Day 1 and 0.2 vs 2.7 Day 2), were easier and less painful to remove (mean pain score 0.5 vs. 2.9), healed quicker (99.7% vs. 58.9% healed at 10-16 days) and were more convenient for the patients to manage. Eight dressings leaked in the Kaltostat group and 5 in the TA group. To avoid this a dressing change may be...