The incidence and outcome of metastatic squamous cell carcinoma of the skin is poorly documented. This study, undertaken in a population accessible to long‐term follow‐up, documents the metastatic aspects of squamous cell carcinoma of the skin of the trunk and limbs. In a review of 695 cases, metastases occurred in 34 cases, with a metastatic rate of 4.9%, an overall mortality of 3.4%, and a 70.6% mortality in the metastatic group. Forty‐six per cent of overall mortality was associated with inoperable or recurrent regional disease without evidence of distant metastases. The risk factors associated with the development of metastatic disease were; delayed presentation: large neglected lesions: misdiagnosis; and multiple treatments to the primary lesions. In this series no correlation was found between the histological degree of differentiation of the primary tumour and the development of metastases. The mean latent period between treatment of the primary and the diagnosis of metastases was 11 months. Histopathological review of the regional lymph nodes in the operable group showed that adverse pathology such as multiple nodes, extracapsular spread, vascular and perineural invasion. were associated with regional recurrence and short survival. Twenty‐one patients with operable metastases had a mean survival of 53.8 months. This was compared with 13 patients with inoperable disease, in whom the mean survival was 12.2 months (P< 0.05).

The technique of sequential clipping and elevation of all layers of the abdominal wall during the insertion of the Hasson cannula allows for safer entry into the peritoneal cavity.

Renal failure is a well‐documented complication of abdominal aortic aneurysm surgery. This study examined the use of pre‐operative cteatinine levels as a predictor of the development of acute postoperative renal failure. There was a statistically significant association between raised pre‐operative creatinine levels and the subsequent development of acute renal failure (p < 0.05). The results of this study demonstrate the need for particular attention to be diverted to the protection of renal function in patients with pre‐operative raised creatinine levels.

We report an incidentally discovered mass in the sphenoid sinus in a patient with beta thalassaemia and sickle-cell disease which proved to be an isolated site of extramedullary haematopoiesis in the skull.

A male patient recently presented to our Unit with anterior spinal artery syndrome involving his lower limbs.This neurological condition was an unusual manifestation of an infrarenal abdominal aortic aneurysm with local dissection occluding the infrarenal lumbar arteries. The incidence, anatomy, aetiology, and management of the condition associated with aortic aneurysms are described.