We report a case of a 25-year-old male with primary hidradenocarcinoma arising from the medial aspect of the left metatarsophalangeal joint who presented with palpable inguinal lymphadenopathy. The patient was able to give a corroborated history of the primary lesion being present for 4 years prior to the development of his groin swelling. Initial biopsy of the primary lesion suggested a malignant adnexal tumour. He underwent wide local excision of the primary lesion and therapeutic inguinal lymph node dissection. Review of the excision specimens established the diagnosis of hidradenocarcinoma. We discuss this case due to the rarity of the site of the tumour and demographics of the patient. There is limited data available on hidradenocarcinoma and there is no consensus on what should constitute standard identification and management.

The following are the chief contra¬ indications: Tn nephritis (some advise the use of neo¬ salvarsan when the renal lesion is luetic), myocarditis, chronic alcoholism, acute inflammation of the lungs and upper air-passages and gastric or duodenal ulcer. As to tabes and general paralysis in advanced stages, it is the opinion that they should be treated with this agent even though one is forced to give a small dose. In the incipient stages of these two diseases large doses can be given.With regard to the effect of neosalvarsan on the various lesions of lues most French syphiligraphers seem in accord with the conclusions of Brocq,7 who, while believing it to be a most efficient préparation, does not hesitate to say that a prolonged and intensive mercurial treatment should follow each course of injections. He also believes that the combined action of mercury and arsenic is infinitely superior to the employment of either one alone. Neosalvarsan is admitted to be equally as efficient as salvarsan without several of its disadvantages. SUMMARY 1. The initial dose of neosalvarsan in most cases should not exceed 0.45 gm.2. At least seven days should elapse before a second injection is given.3. If following several injections, signs of intolerance are noted, the dose should be kept at the same figure, and reduced if the symptoms do not disappear following further treatment.4. Distilled water is the best solvent. 5. Administration in concentrated solution seems to be the superior method.6. Distillation should be performed in an apparatus composed wholly of glass.7. The intravenous method is the one of choice.8. Continued headache should be regarded as indi¬ cating possible involvement of the nervous system.9. Neosalvarsan has a most efficient ally in mercury.802 West Madison Street.