Introduction The management of melanocytic nevi involves many various practitioners with a high number of patients. Data on failure to achieve goals of treatment are scarce. We aimed to determine percentage of incompletely excised nevi and the risk factors responsible. Materials and Methods In this retrospective cohort study, histology reports of all melanocytic nevi excised within our department between January 2014 and June 2015 were considered. Those aimed for stage excision and those with inconclusive histology reports were excluded. Patients' age, sex, anatomical location of the lesion, its size, as well as source of specimen (general surgical outpatients, surgical oncology outpatients, and operating room), and performing surgeon (trainee vs. consultant) were recorded. Chi-square test was used for statistical analysis with a p-value of < 0.05 considered significant. Results A total of 739 nevi in 541 patients were analyzed. Positive margins were found in 80 (11%) of all specimens. There was significantly increased rate of incomplete excision of nevi from the facial area (42%; p < 0.001) versus other areas and, surprisingly, those excised in the operating room under general anesthesia (19%; p = 0.009). Nevi excised at our surgical oncology outpatients had the lowest rate (8%, p = 0.013) of incomplete excisions. There were no statistically significant differences in other variables. Conclusion We identified facial location and operating room environment as risk factors for incomplete excision of melanocytic nevi. We suggest that human factors play a key role in achieving a good quality of service.

IntroductionNecrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum.Case presentationWe report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome.ConclusionsFournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

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Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services/appropriate surgical training for general surgical trainees.