The hallmark of pancreatic tumours, the desmoplastic reaction, provides a unique microenvironment that affects pancreatic tumour behaviour, its ability to grow and metastasize as well as resist the effects of chemotherapy. Complex molecular interactions and pathways give rise to the desmoplastic reaction. Breakdown or penetration of the desmoplastic reaction may hold the key to overcoming the limits of delivery of efficacious chemotherapy or the development of new targeted treatments. Herein we discuss such new developments to fight the desmoplastic reaction, including inhibitors of the epidermal growth factor, fibroblast growth factor, the hedgehog pathway, as well as new molecular targets like CD40 agonist and its effects on T cells, extracellular matrix modifying enzymes such as LOXL2 inhibitor and novel tumour penetrating peptides for delivery of drugs.

Although primary nodular amyloidosis is a rare entity it seems to be the most frequent presentation of penile-limited cutaneous disease, with a low incidence of systemic involvement.

A 16-year-old student presented with a 4-year history of an occasionally itchy rash on his right shoulder. He subsequently developed a similar eruption on the right submental region. He was otherwise healthy with no systemic symptoms. On examination, a large segmental area of non-scaly hyperpigmented macules on the anterior shoulder extending to the chest was seen (Fig. 1A). An erythematous inflammatory plaque was seen on the submental region (Fig. 1B).A punch biopsy was taken from both areas. The appearances were similar (Fig. 1C)

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