Sixty-two patients with 67 large or poorly defined skin tumours predominantly on the head and neck (58 basal cell carcinomas) were treated by excision of the lesion and allowing the defect created to heal by second intention. Histological control of the adequacy of excision was monitored using routine vertical sections of formalin-fixed tissue. Further re-excisions were performed in 17 patients in whom tumour extended up to or within 1 high power field (approximately 0.44 mm) of the excision margin. The formalin-fixed specimens ranged from 6-60 (mean 21) mm in diameter and 2-12 (mean 5) mm in depth. After one excision the time to complete re-epithelialization was directly proportional to the surface area (r = 0.73) and ranged from 13 to 60 days (mean 33 days). Measurements of the movements of fixed reference points tattooed at the wound edges in six patients showed that movement of surrounding tissue into the defect accounted for 39-62% (mean 45%) of the reduction in surface area of the defect during healing. Post-operative complications were rare and the cosmetic results were considered good or excellent in 48 patients, fair in nine and poor, i.e. requiring corrective surgery, in three patients. Poor results were due to distortions of free margins, e.g. lower eyelid and nasal margin. The major benefit of this technique is the ease with which further excisions can be performed when histologically indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Nail thickness and mass (dry weight/unit surface area) of 21 toenails, removed from 19 patients after accidental injury, were measured over the mid point of the lunula, at the nail plate immediately distal to the lunula and at the distal end of the nail bed. Nail thickness increased from 43% of the final thickness over the mid-point of the lunula to 81% at its distal margin, the remaining increase in thickness being formed by the nail bed. The changes in nail mass were comparable. We conclude that ventral nail produced by the nail bed comprises about one-fifth of the terminal nail thickness and mass.

We report three cases of eccrine poroma, present for many years, in which features were seen suggesting transformation from a benign to a malignant tumour. These changes ranged from in situ Bowenoid dysplasia to frankly invasive squamous carcinoma. The most helpful diagnostic feature in distinguishing the origin of the tumours was the presence of strong cytoplasmic staining for carcinoembryonic antigen (CEA) in cells surrounding, and giving rise to, neoplastic ducts and clefts. Dermatopathologists examining eccrine poromata should examine the lesions carefully for any evidence of malignant change.

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Plasma immunoreactive (3-melanocyte 3timulating hormone (p-MSH) concentrations were greatly increased in patients with chronic renal failure. There was no correlation between the severity of the renal failure or the degree of pigmentation and the plasma p-MSH levels.