Basaloid squamous cell carcinoma (BSSC) is a rare and aggressive variant of squamous cell carcinoma (SCC). It has predilection for the upper aero digestive tract with common metastasis to regional lymph node and common distant metastasis to lungs. While metastasis to scalp has rarely been reported, primary occurrence of BSCC arising from scalp has hardly ever been reported. We are reporting a case of 70 year female patient, who presented with an ulceroproliferative growth in posterior scalp. Biopsy from the edge of growth was reported as malignant adnexal tumor. A wide local excision was done and that biopsy was reported as Basaloid squamous cell carcinoma. We intend to present this case, considering its rarity and its primary presentation in an very unusual and unique location for this variant.

Enterocutaneous fistula is an abnormal communication between two epithelialized surfaces, one of which is a hollow viscous organ. It most commonly occurs as a surgical complication. Other causes are trauma, malignancy, inflammatory bowel disease, ischemia. The great majority of enterocutaneous fistula are iatrogenic (75-85%) and rest (15-25%) occur spontaneously. Enterocutaneous fistula is the one of the most challenging conditions managed by General surgeon. The mortality rates vary in different series for patients, with enterocutaneous fistula and remains 5% to 15%.Here we report a rare presentation of enterocutaneous fistula.

Background: Proper documentation of the surgery done in the form of operative notes is a very important aspect of surgical practice. The aim of this clinical audit was to identify the existing standard of the operative notes written in a general surgical unit in a quaternary care hospital; and to compare it with the recommendations given by Royal College of Surgeons, England (in Good Surgical Practice, 2014) and if needed, to improve the standard of practice.Methods: In the first loop of this prospective audit, 75 consecutive operative notes which were written were compared with the RCS guidelines and the areas which had missing data were identified. These areas were informed to the residents, who are primarily involved in the documentation of the operative notes. The second loop of the audit was conducted after a gap of 4 months involving 75 consecutive operative notes again.Results: The areas which were initially deficient were better documented when analysed in the second loop.Conclusions: Documentation of operative notes does not always comply with the set guidelines as highlighted in the first loop of our audit. But by employing a clinical audit it is possible to identify the existing deficiencies and thereby improving the standards of practice. Also, operative note writing should be taught as part of surgical training. Definitions should be clearly provided, and specific guidelines should be established to improve the quality of the operative notes and their use to improve patient safety.