Summary Background  Patients with metastatic skin disease in malignant melanoma can be difficult to treat effectively, often requiring repeated treatments with different modalities in an attempt to control their disease. Treatment of nonsurgically resectable melanoma deposits is unsatisfactory, as they are often multiple and recurring. Anecdotal evidence from individual use of imiquimod in superficial metastases and intralesional interleukin (IL)‐2 in subcutaneous deposits suggests that the combination may be more effective in bulky subcutaneous disease. Objectives  To investigate the combination of topical imiquimod and, for selected lesions, intralesional IL‐2, to treat a small cohort of patients with accessible melanoma metastases resistant to other treatments. Methods  Thirteen patients were recruited: all had evidence of multiple cutaneous and/or subcutaneous metastases. Imiquimod was applied to the metastases on a daily basis for 4 weeks, before the introduction of intralesional IL‐2. This was injected up to three times a week, into selected lesions, with 0·1 mL injected per lesion at a concentration of 3·6 MIU mL−1, a total of 1 mL being given at each session. The treated lesions were assessed individually at intervals of 3 months. Results  Thirteen patients were treated, with 10 being eligible for assessment. In total, 182 lesions were treated: 137 purely cutaneous lesions and 41 subcutaneous lesions. Overall, a clinical response was seen in 92 lesions (50·5%) with 74 (40·7%) of these being a complete response (CR) with 91% of the CRs being in the cutaneous lesions. New lesions did appear during the treatment course; however, patients with cutaneous disease experienced a marked slowing of the appearance of new cutaneous lesions. No cutaneous lesions that responded reappeared on cessation of treatment. Conclusions  The combination of imiquimod and IL‐2 is effective in controlling this mixed cutaneous and subcutaneous disease, and is well tolerated. Imiquimod alone is often enough to elicit a response in purely cutaneous lesions. The addition of intralesional IL‐2 increases the response rates in subcutaneous lesions, and in otherwise refractory cutaneous lesions.

Uncertainty concerning the use, efficacy and possible adverse effects of clostridial vaccination in goats prompted a study of the injection site reactions and antibody responses in 40 goats and 40 sheep. The vaccines used were Covexin 8, Heptavac and Tasvax 8. In all the animals swellings averaging 2.5 cm in diameter were present at the injection site seven days after vaccination and were still apparent 28 days after vaccination. The injection site reactions could not be attributed to faulty vaccination technique because they did not occur in a control group injected with sterile water. By 14 days the reactions were significantly larger in sheep than in goats and by 28 days the reactions to Covexin 8 were larger than those to the other vaccines in sheep and goats. Serum antibody was present in all groups before vaccination and, with the exception of the goats vaccinated with Heptavac, increased 14 days after vaccination. The increase was greater in sheep than in goats. By 28 days antibody levels had declined in all but the sheep vaccinated with Heptavac in which a further increase occurred. At that time, the antibody levels in vaccinated sheep were still higher than in the unvaccinated sheep whereas the antibody levels in vaccinated goats were no longer different from those in the control goats. These results suggest that there is a difference between the vaccines used and between the responses of the two species and support the clinical observation that the protection afforded to goats by multivalent clostridial vaccines is poorer than that afforded to sheep.