The COVID-19 pandemic has presented significant challenges for Dermatology services, particularly the diagnosis and management of malignant melanoma (MM). 1 Early detection and definitive surgical treatment are key to improving MM prognosis, and in England there is a suspected skin cancer referral pathway that facilitates specialist Dermatology assessment within two weeks. 2 Here, we describe the impact of COVID-19 on MM detection, based on data from the a Dermatology Department in central London.

Background. Educational videos improve patient knowledge of wound care and skin cancer. However, the effect of viewing an educational video at home before undergoing Mohs micrographic surgery (MMS) has not been demonstrated. Aim. To evaluate the use of an educational video to improve patient understanding of MMS. Methods. Patients scheduled to undergo MMS were randomized to receive standard patient education, or standard patient education with an additional video developed by the authors. The educational material was posted to patients along with the details of their MMS appointment. Both groups answered questionnaires to assess their knowledge of MMS, and to measure their anxiety and satisfaction. Results. Patients who watched the educational video scored higher on the knowledge questionnaire than did patients in the control group (0.8, 95% CI 0.3 to 1.4, P < 0.01), but were not statistically less anxious (À0.7, 95% CI À2.6 to 1.3, P = 0.50). Overall, patients undergoing MMS were satisfied. Conclusion. Home viewing of an educational video before MMS can improve patient understanding.

We report a case of membranous conjunctivitis and erythema multiforme major (EMM) after a coronavirus disease 2019 (COVID-19) diagnosis. A previously well 18-year-old man presented with increasingly erythematous eyes and oral and genital ulceration 2 weeks after confirmation of COVID-19 infection. Clinical examination showed sloughy membranous conjunctivitis with normal visual acuity. He was reviewed by dermatology and diagnosed with EMM secondary to severe acute respiratory syndrome coronavirus 2 infection. The symptoms resolved with oral and topical steroids, lubricants and chloramphenicol eye drops. Erythema multiforme has been reported in association with COVID-19, although the major form is rare. Ophthalmologists should consider current or previous COVID-19 infection in patients presenting with conjunctivitis or pseudomembrane formation. Prompt initiation of steroids aids resolution.

BACKGROUND Topical photodynamic therapy (PDT) and imiquimod 5% (IMQ) cream are established treatments for superficial basal cell carcinoma (sBCC). Both have high initial response rates and recurrence rates of up to 37%. Recent studies demonstrate that PDT and imiquimod may act on sBCCs via synergistic immunomodulatory pathways. OBJECTIVE To describe the sequential use of MAL-PDT and imiquimod 5% cream in the treatment of sBCCs and report treatment tolerability, cosmetic outcomes, and efficacy. MATERIALS AND METHODS This is a retrospective case series of patients presenting over a 2-year period with primary sBCC who underwent 2 cycles of topical MAL-PDT, followed by 6 weeks of imiquimod 5% cream. Outcome measures were resolution of the index lesion at 3 months, side effects, cosmetic outcome, and long-term recurrence (LTR). RESULTS A total of 17 consecutive patients (n = 17) with a combined 21 sBCCs (n = 21) were included. The median length of follow-up was 72 months (range 24–95 months). Long-term recurrence occurred in 2/21 lesions (10%). CONCLUSION Sequential use of PDT and imiquimod was well tolerated with good cosmetic outcomes. The 10% LTR rate is at the lower end of the range reported for single modality treatment; however, larger samples are required to evaluate efficacy differences.

A 70 year old man presented with a three month history of painful perianal ulceration. He was started on nicorandil to improve his angina control two months before the ulcers appeared. Ulceration is a rare but well recognised side effect of nicorandil. The ulcers can affect the oral and genital areas and are typically extremely painful. They have a sharp border and clean base, as seen in the patient. Topical treatments are ineffective, and stopping the use of nicorandil leads to rapid resolution. Although described, this disabling side effect is not well appreciated in the clinical setting. Patient consent obtained. Cite this as: BMJ 2013;346:f3686