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With specialization still in its infancy, Victorian surgeons were often concerned with the diagnosis and care of skin disorders. The careers of three London surgeons from successive generations, Sir James Paget, Sir Jonathan Hutchinson and Edward Nettleship are discussed with emphasis on their mutual influence and contributions to dermatology. Nettleship's original description of urticaria pigmentosa and his research into the inheritance of albinism are reviewed in more detail.

A patient with bilateral hilar lymphadenopathy due to sarcoidosis presented with erythema nodosum on the shins and upper arms and an unusual annular eruption resembling erythema annulare centrifugum on the head and neck. Biopsy of the latter showed a leucocytoclastic angiitis.

212 epitheliomata developed in two unrelated women with self-healing epitheliomata of Ferguson-Smith. Most of the lesions appear on the face, often in crops; they enlarge over 4 weeks and, without treatment, resolve over 4 months to leave a ragged scar. One of the patients developed an unusual syringoma, a papillary carcinoma of the thyroid and a mucosal squamous cell carcinoma which failed to involute spontaneously. Cytogenetic studies did not reveal any abnormality of DNA repair. Surgical excision of the epitheliomata is successful but time consuming. X-irradiation should not be used, but cryotherapy of early lesions is helpful. One patient, treated with etretinate for 24 months, has developed only 8 epitheliomata over this time, compared with 23 in the previous 24 months. Etretinate therefore appears to prevent new lesions from developing.