Introduction COVID-19, a worldwide pandemic, has enforced a national lockdown in the UK which produced a paradigm shift about the way medical practitioners would perform consultations and communication with their patients. Senior authors realised that in lockdown there was only one option to see a patient: virtual consultation via telecommunication technologies. This paper will discuss the current benefits and considerations of Telemedicine, particularly in plastic surgery, to decipher the next route of action to further validate its use for future implementation. Method A detailed literature review was carried out comparing papers from 1992 to 2020. A survey of 122 consultant plastic surgeons found an encouraging result as 70% positively embraced the suggestion of Telemedicine in their current practice. Discussion Telemedicine produced equal or improved patient satisfaction. Its utilisation reduced cost for patient, clinic and consultant. With accessibility to a large percentage of the population, Telemedicine enables infection control and adherence to social distancing during COVID-19. Considerations include dependability on internet access, legal aspects, cyber security and General Data Protection Regulation (GDPR), the inability to perform palpation or physical inspection and psychological impacts on the patient. Conclusion In modern times, Telemedicine has become more accessible and COVID-19 has made it more applicable than ever before. More in-depth research is needed for validation of this technique within plastic surgery. While maintaining quality of care and a vital role in social distancing, there is a strong need for standardisation of Telemedicine processes, platforms, encryption and data storage. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract Background Coronavirus infection Disease 19 impacted every part of the world and routine life. Recent report from the Office of national statistics in UK reported disproportionate death among Black Asian and minority ethnic (BAME) population. NHS is heavily relied on the BAME work force both in front line and in the community. We attempted to explore the beliefs and perception about reported worrying issue among BAME health work force in a Diverse city of Leicester. Methods This is a cross-sectional survey using 20 questions in an electronic format. The target population was identified through Leicester Asian Doctors Society and Leicester Asian Nurses Society. The questionnaire was then distributed electronically to the members. Survey questionnaire was accessed by 372, incomplete response (172) were excluded and 200 completed responses were analysed. Results Majority of BAME workforce are routinely involved in front line duties. More than 70% were anxious about their role during this pandemic. The Personal Protective Equipment (PPE) supply was adequate, and the support received from the local healthcare providers was more than satisfactory. The work force perceived co-morbidity, lack of PPE and testing were one of the few reasons for increased death in BAME. BAME group felt adequate provision of PPE, increased testing and improving mental health well-being is required to alleviate concerns and improve BAME working life in NHS. Conclusion BAME workforce are routinely involved in front line work and current anxiety level is very high. Adequate provision of mental health support with clear risk stratification for return to work is required urgently.

Unwanted hair is a common problem for which a variety of laser treatments is available. Laser treatment in dark-skinned individuals carries a higher risk of complications like hyperpigmentation and burn. The objective of this study was to evaluate efficacy and safety profile of laser-assisted hair removal in individuals with Fitzpatrick type IV-VI skin using long-pulsed Nd:YAG laser. Retrospective data was collected from 150 individuals with Fitzpatrick type IV-VI skin who underwent laser-assisted hair removal. This included area treated, fluence, number of treatments, and outcome. Data was also gathered on patient satisfaction and complications. The most common phototype was type IV (94%). The most frequently treated area was the face (84.7%) followed by the underarms and legs. Among the facial areas, the chin was the most frequently treated area followed by the upper lip and jaw line. The mean number of treatments was 8.9 (range 4-22). The maximum fluence averaged 26.8 Joules/cm(2) and was significantly higher for facial hair. Of the patients, 78.7% felt that their treatment was good or satisfactory. Mean hair reduction was 54.3%. Satisfaction from the treatment was significantly higher in individuals undergoing treatment of non-facial areas. Subsequent hair growth was slower and finer in 79.3% of the patients. There were no complications in 86% of the patients. All the complications were transient, with hyperpigmentation being the most frequent complication. Our results show that laser hair removal using the long-pulsed Nd:YAG laser is safe and effective in dark-skinned individuals with satisfactory results in most patients.

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, most often occurring in the elderly. Recurrence is frequent and in 40% of cases regional and distant metastases develop. Despite this, there have been reports of spontaneous regression. We report the first case of MCC with primary complete spontaneous regression of the nose in an 86-year-old woman following an incisional biopsy.PRESENTATION OF CASEAn 86-year-old woman presented with a violaceous lump on the left side of the nose measuring 25 × 25 mm. Incisional biopsy of the lesion showed MCC and immunohistochemistry confirmed diagnosis. Following an 8-week period the lesion completely disappeared and histology did not show any residual MCC but immunohistochemistry demonstrated a mixture of T and B cells.DISCUSSIONComplete spontaneous regression (CSR) is rare. The literature documents 22 similar cases of CSR of MCC. From this case report and previous literature the most likely reason for regression is a T-cell mediated immune response.CONCLUSIONTo the best of our knowledge, this is the first described case of MCC with primary CSR of the nose. Exact mechanism of regression remains unclear. Further research is needed in identifying pathway of immune response and possible immunotherapy as a cure.