Summary Merkel cell carcinoma (MCC) of the skin is a rare, aggressive form of skin cancer that metastasizes to other parts of the body. This cutaneous neuroendocrine tumour mainly affects older people, with most cases generally occurring over the age of 50 years. Merkel cell polyomavirus has been shown to induce gene mutations resulting in this skin cancer, with immunosuppression and ultraviolet radiation being other key risk factors in its pathogenesis. MCC is clinically seen as a rapidly enlarging, isolated, irregular erythematous nodule typically found on sun‐exposed sites. Diagnosis is through clinical examination followed by tissue biopsy, which demonstrates characteristic histopathological neuroendocrine features. Immunohistochemistry plays a crucial role in diagnosis with the characteristic perinuclear staining with cytokeratin‐20 helping to differentiate it from other morphologically similar tumours. Sentinel lymph node biopsy and imaging is essential for staging and determining prognosis. Surgical excision is the mainstay of treatment for localized disease although adjuvant radiotherapy is often required. Metastatic disease involves a very poor prognosis, and immune checkpoint inhibitors have recently shown promise in the treatment of metastatic disease. Avelumab, a monoclonal antibody that binds to the programmed death‐1 receptor, has been approved by the National Institute for Health and Care Excellence and shown encouraging survival outcomes. It provides an option for treating metastatic carcinoma in adults after they have failed ≥ 1 line of chemotherapy for metastatic disease.

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Thalidomide is a medication that has been in existence for over half a century, and has proven to be useful and effective in severe dermatological conditions. For dermatologists, the ability of thalidomide to reduce the levels of the cytokine tumour necrosis factor-a, along with its immunomodulatory and anti-angiogenic properties, is of great significance, with the added advantage of being an oral medication. Its use is of course strictly monitored, owing to its potential adverse effects (AEs), particularly teratogenicity, with precautions taken to ensure its safe and correct use by both prescriber and patient. In this review, we look at the background and mechanism of action of thalidomide, provide an overview of conditions it can be used for with case examples, explain the potential AEs and monitoring requirements, and discuss future developments.

The current monkeypox epidemic is a major public health concern as the global outbreak continues to grow. We present a case report to highlight the salient points for dermatologists. Human monkeypox is a zoonosis caused by monkeypox virus, belonging to the Orthopoxvirus genus and is a close relative of the variola virus. Pleomorphic skin lesions appear ranging from macules, papules, vesicles, pustules, some of which may appear umbilicated before crusting over. Dermatologists play a key role in early recognition of new cases, aiding diagnoses leading to prevention of disease spread through identification and isolation, contact tracing and education.

Teledermatology has been defined as using technology‐enabled healthcare delivery models to provide dermatology patient care, from a distance 1,2 . The increasing use of teledermatology has primarily been driven by a significant rise in demand on dermatology departments and a shortage of consultant dermatologists in the United Kingdom 3 . The British Association of Dermatologists supports the use of teledermatology as a means of improving access to dermatology professionals 4 . Currently, teledermatology in the NHS plays a particularly important role in triaging referrals on the skin cancer 2‐week‐wait (2ww) pathway, given the necessity for rapid lesion assessment, the ever‐increasing volume of 2ww referrals received by dermatology departments, and the significant proportion of benign lesions referred that do not require a face‐to‐face consultation. Skin cancer 2ww referrals to our centre have sharply increased by 44.1% over the last two years, and in the 12 months preceding the UK COVID‐19 lockdown (March 2019 to February 2020) represented 41.8% of all referrals to the dermatology department. Teledermatology for 2ww referrals was implemented at our centre in 2019 to manage this demand.