Nonpigmented intradermal malignant melanoma with cribiform, myxoid, and spindle cell growth patterns.

We describe an unusual variant of intradermal malignant melanoma without any junctional component. The lesion differed from other intradermal melanomas in that it was devoid of pigmentation and was composed of mainly spindle-shaped cells. Within the lesion, there were areas of pseudoglandular and myxoid changes resembling the rare myxoid melanoma. In addition to this, there were areas with an alveolar-like architecture containing nested groups of cells.

Undiagnosed coarctation of the aorta as a cause of aortic dissection in the young.

A 35-year-old man presented to the Emergency Department with a history of severe acute central chest pain and simultaneous bilateral paralysis the legs with double incontinence. There was no significant past medical or family history. A CT scan showed a thoracic dissection of the aorta extending from the aortic root to the aortic bifurcation and in to the common iliac arteries. The patient was consented for an axillo-femoral bypass and was taken to theatre and operated on for 7 hours. The patient unfortunately died under anaesthesia. A hospital post-mortem was requested to identify the cause of the dissection. The patient's heart was sent to a cardiac pathologist who identified an undiagnosed coarctation of the aorta. Genetic testing was negative for Marfan syndrome.As a result of the post-mortem, it was recommended that first degree relatives of the deceased undergo ultrasound examination of the cardiovascular system as appropriate to exclude coarctation of the aorta.

Scrotal carcinoma: a reminder of a disappearing occupational disease.

A 55-year-old man presented with a 12 month history of a gradually enlarging eroded lesion on his right scrotum. The patient was a 15-20 cigarettes a day lifelong smoker. Initial histological examination showed a benign squamous lesion. Repeat biopsy at 3 months now showed a poorly differentiated squamous cell carcinoma. Occupational enquiry revealed a long history of exposure to mineral oils. The carcinogenic properties of mineral oils is well recognised and is strongly linked with squamous cell carcinoma (SCC) of the skin, including scrotal carcinoma. This case report highlights the importance of reviewing histology with a second biopsy if clinical manifestations change, and secondly to obtain a thorough occupational history in oddly- presenting lesions.

Warthin tumour of the buccal mucosa.

We report a case of Warthin tumour that arose in the buccal mucosa in a 57-year-old woman. It was treated by excision biopsy. This acts as a reminder particularly to junior clinicians that Warthin tumour may arise outside the parotid.