The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review.

Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC.

Ideal Male Umbilicus: An Observational Study of Surface Anatomy and Introduction to the SHAPE Classification.

BACKGROUND: The umbilicus is crucial to the aesthetic appearance of the abdomen. With abdominoplasty and umbilicoplasty, placement of the umbilicus is essential and often left at the surgeon's discretion. This study aims to investigate the ideal male umbilical shape and location by examining photographs of top male models in 2019. METHODS: In this observational study, we examined 81 photographs of top male models to assess different ratios based on anatomical landmarks and umbilical appearance. RESULTS: The ratio of the distance from the xiphoid to the center of umbilicus (XU) and corresponding distance from center of umbilicus to abdominal crease (UC) had the most reliability (ratio XU/UC, with average measurement: 1.68 ± 0.38), which placed the male navel at a similar position but marginally below the average female umbilicus. Our findings revealed that an oval horizontal is the ideal umbilical shape in males, which differs from what is most aesthetically pleasing in females (oval vertical). In addition, we introduced the SHAPE (Shape, Hood, Adiposity, Protrusion & Position, External piercing) classification for navel appearance to better define the umbilicus and its direct management. CONCLUSIONS: This study establishes that the ideal male umbilicus differs from that of females; it should be placed at the XU/UC ratio of 1.68 ± 0.38 and aim for a horizontal shape with hooding (SHAPE: H II). The SHAPE classification facilitates a logical stepwise approach for the surgeon to refashion the umbilicus. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Giant congenital melanocytic nevi and malignant transformation: a case for early radical intervention.

The purpose of this paper is to highlight the risk of early malignant transformation in infants with giant congenital melanocytic nevi (GN) and demonstrate the potential for earlier intervention with aggressive surgery. We describe the case of a child born with a GN who developed a metastatic melanoma early in life, despite early commencement of resection of the nevus. This is contrasted against a second case of a child in which a more radical management was conducted. Despite early commencement of serial resection of the GN, the first child in this series died of metastatic melanoma prior to complete excision of the nevus. With the second child, radical excision combined with the use of Integra™ and negative pressure wound therapy allowed total removal of the GN within the first 6 months of life.

High Aggressive Herpetiform Squamous Cell Carcinoma.

We describe a highly aggressive squamous cell carcinoma that presents in a dermatome pattern shortly following shingles and review the literature on herpetiform lesions.

The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

"Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.

Pedestrian pathway characteristics and their implications on wheelchair users.

Individuals who use wheelchairs (WCs) frequently navigate over pathways with obstacles (e.g., bumps or curb descents) or terrain that is extremely rough. Surface characteristics such as roughness can have an effect on comfort and variables associated with bodily injury. Understanding these relationships can be helpful to ensure safe and comfortable access to all public and private pathways. This article reviews existing research related to the topics of surface roughness effects on WC user's bodies, surface roughness measurement techniques, and design guidelines and exposure limits that attempt to ensure pathways are safe and passable. These findings are discussed along with opportunities to improve them. Using a broad literature search, it was found that several measurement and analysis techniques exist to characterize surface roughness related to automobile roadways, but they have not been systematically applied to WC use over pedestrian pathways. The roughness measurement approach that appears most relevant and adaptable for sidewalks are rolling profilers. Commercially available devices could be recalibrated or adapted to measure pedestrian pathways. IRI and ride-quality analysis techniques appear most relevant and could also be adapted. Any analysis technique that uses profiles of surfaces should focus on frequencies and wavelengths that are most applicable to WC riders.

Six-year retrospective study of bull-riding injuries in central Queensland.

BACKGROUND: Bull riding is an increasingly popular and growing professional sport in Australia. This is the first national study that investigates bull riding-related injuries. METHOD: A six-year retrospective study of patients admitted to Rockhampton Base Hospital with acute injuries sustained whilst bull riding. Patients were identified from the Rockhampton Hospital international coding system and surgical audit excel databases. Supporting information was found from patient chart review. RESULTS: Thirty-eight patients were admitted during the study. Injuries increased from 2008. The most common injuries were to limbs (52%), chest (15%) and brain (10%). Life- threatening injuries were all caused by a direct kick or trampling by the bull; 5% of patients needed air transfer to Brisbane, and 10% to Rockhampton for their acute care. The only complication was infection of open wounds. The average hospital stay was 2.2 (range= 1-5, SD= 1.1) days and 64% of patients required operative intervention. CONCLUSION: Patients that had been kicked or trampled should be identified as having potentially life-threatening injuries, and transferred for review at an appropriate facility. Due to the high risk of infection all contaminated wounds should be washed out formally and receive antibiotics. Protective equipment should be encouraged among riders.