No abstract

Metastatic melanoma is a fatal malignancy with a high mortality and morbidity. Since the early 1970s, available medical therapies were limited in improving survival. Surgery represented the best chance for a cure. However, surgery could only be offered to selected patients. The current landscape of treatment has radically evolved since the introduction of targeted and immunotherapies including BRAF and MEK inhibitors, and checkpoint blockers, like PD-1 and CTLA-4 antibodies. These new therapies have seen survival rates matching, and in some cases surpassing, that of surgery. Anti-PD1 and CTLA-4 combination treatments are associated with severe side effects and BRAF and MEK inhibitor combinations may trigger initial tumour responses but prolonged use have resulted in the development of resistant tumour clones and disease relapse. This review examines the role of pulmonary metastasectomy for lung metastasis from malignant melanoma in the current landscape of effective targeted therapy and immunotherapy.

Emphysematous pyelonephritis (EPN) is a severe urinary tract infection (UTI) that causes kidney necrosis by gas‐producing bacteria. Escherichia coli is most implicated. Type‐2 diabetes mellitus (T2DM) is a common predisposing factor. Necrotising fasciitis (NF) is an uncommon complication of EPN that has severe consequences. It is easily missed due to rarity. We present the case of an 82‐year‐old female nursing home resident with T2DM that presents with NF of the left flank following EPN of the left kidney that has penetrated through the superior lumbar triangle. This is the first time this anatomical pathway has been implicated in NF secondary to EPN in the English literature.