Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement.

Sentinel node biopsy (SNB) has been at the forefront of the surgical staging of melanoma patients for the past 15 years. The high accuracy of this prognostic staging procedure is now recognised in all international guidelines for melanoma. However during this period there have been a number of important changes in the management of melanoma, many occurring within the past five years. The outcomes of five recent randomised Phase 3 trials have established the role of adjuvant targeted therapy and immunotherapy in resected Stage 3 and Stage 4 disease and have potentially changed the role of SNB. Two landmark international prospective studies have examined the benefit of performing a completion lymph node dissection (CLND) following the detection of microscopicallyinvolved sentinel nodes. Finally, the marked increase in the incidence of melanoma and the role of SNB in potentially guiding therapy has resulted in a significant increase in the pathological workload of the dermatopathology services. To address these issues a multi-disciplinary consensus meeting involving many melanoma experts from the UK was convened in May 2018. Three main areas were considered: oncology, surgery and pathology. This report is a summary of the conclusions reached, which were agreed by the clinicians attending the meeting and then externally peer reviewed. The recommendations summarised in this Consensus Statement.

The pain of surgery: pain experienced by surgeons while operating.

INTRODUCTION: The operating theatre can be a dreaded experience not only for the patient but also occasionally for the surgeon. We sought to investigate the prevalence of pain experienced by surgeons while operating. METHODS: One hundred and thirty anonymous questionnaires were sent to surgical consultants in the Britain. RESULTS: The response rate was 60% and 63 experienced pain while operating. The back and neck were the most common areas of pain (36 & 30 consultants respectively), followed by the hand (24 consultants). Nearly 80% described pains on a regular basis. Table height was the most common cause of pain (35%), followed by the use of microscopes (27%) and standing (22%). Nearly 43% of the consultants will take a break from surgery because of their symptoms, and 4 took sick leave in direct relation to pain experienced as a result of operating. However only 27% took measures to reduce their symptoms and 65% never sought any help or advice and only one consultant informed the occupational health department. CONCLUSION: Many surgeons will experience pain while operating due to positioning or the instruments they use, however there are no guidelines from occupational health departments or training courses to help minimise these symptoms.

Differences in cephalometric reference values between five centres: relevance to the Eurocleft Study.

Cephalometric data from five different geographical areas (Oslo, Manchester, London, Nijmegen, and Michigan) were compared. The angles SNA, SNB, and ANB were taken from published tables in the form of mean, standard deviation (SD) and number in the sample, divided up by age and sex. Angles SNA and SNB were significantly different among centres on univariate analysis. The Oslo data showed 23 instances in which they differed significantly from the other data, London 16, Manchester 11, Nijmegen 11, and Michigan 7. Multivariate analysis using Penrose distances were Oslo (2.04), Manchester (1.39), London (0.93), Nijmegen (0.80), and Michigan (0.66). The sums of the Mahalanobis distances were Nijmegen (3.60), Oslo (3.10), London (2.80), Manchester (2.25), and Michigan (1.49). As these results probably reflect racial and genetic differences, these must be taken into account when international comparisons are being made, as in the Eurocleft study.

Phenolic household disinfectants--further precautions required.

Phenolic disinfectants (e.g. Meytol, Dettol, etc.) are widely used for domestic purposes. Instructions on the bottles are clearly given with regards to the dilutions that should be used. In domestic cleaning, these instructions are often ignored and higher concentrations are used with the thinking that 'the more I pour, the cleaner it gets!'. Furthermore, cleaning equipment is sometimes stored without prior rinsing with fresh water. As water evaporates much faster than phenol, the solution on stored mops/ brushes, etc. becomes progressively more and more concentrated and can cause chemical burns when these utensils are handled at a later time. We therefore suggest that two further instructions should be added to the usual instructions on bottles of household phenolic disinfectants, namely: 'wear gloves when performing domestic cleaning' and 'wash all cleaning equipment with plenty of fresh water after use'. We support this by a case report of a 65-year-old man who sustained full-thickness, painless chemical burns to his right hand after handling a moist mop which had been used for cleaning a carpet with a phenolic household disinfectant solution 2 days earlier.

Hand ischaemia following radial artery cannulation.

Digital ischaemia following radial arterial cannulation is uncommon. It is usually the result of thrombotic occlusion of a dominant radial artery. However, factors other than arterial thrombosis per se may operate in the critically ill patient to produce digital ischaemia. The following case presentation includes a review of possible mechanisms of digital ischaemia following radial artery cannulation and discusses the therapeutic options available.

Experience of a chemical burn due to 3,5-dichloro 2,4,6-trifluoropyridine.

An example is reported of a burn caused by cutaneous exposure to 3,5-dichloro 2,4,6-trifluoropyridine (DCTFP) involving 25 per cent of the body surface. A striking feature was the development of the appearance of the burn over the first 72h postinjury. Healing was nevertheless spontaneous. The management of the injury is discussed.