B.E. Monk

Epidermolysis bullosa with squamous cell carcinoma

A 55-year-old Turkish Cypriot man had had a tendency^ to blister, spontaneously or follow ing minor trauma., since the age of four. Blistering had predominantly affected the shins, where the blisters had a tendency to break down and form ulcers which healed only slowly. He had been admitted to the Middlesex Hospital in 1969, 1971, and 1976, and had failed to respond to treatment with systemic steroids, azathioprine, and dapsone. Histology

Erythromelalgia following pergolide administration.

Two patients are described in whom treatment of Parkinsons disease with the ergot derivative pergolide was associated with the development of erythromelalgia. The possible mechanism of pergolide‐induced erythromelalgia is briefly discussed.

Mycosis fungoides and Hodgkin's disease.

Three patients with the typical clinical course and pathology of Mycosis Fungoides (MF) were found also to have Hodgkin’s Disease (HD), nodular sclerosing type. In two cases, HD Was diagnosed 2 years after the diagnosis of MF; in the third case, both diseases were diagnosed simultaneously. Previous claims of MF transforming into second lymphomas are reviewed. The possible significance of our observed association of MF and HD is discussed. Cancer 44: 1408141 3, 1979.

Necrobiosis lipoidica and sarcoidosis

The case is described of a female patient with necrobiosis lipoidica of the legs, and a previous history of acute sarcoidosis. There has been only one previous report of an association between necrobiosis lipoidica and sarcoidosis.1 The relationship between these disorders may be suggested by the known association of sarcoidosis and other granulomatous and necrobiotic disorders.

Familial malignant melanoma

A case is reported of a 28-year-old man with three separate primary cutaneous malignant melanomas. The patient denied any family history of melanoma, but screening of the first degree relatives resulted in the early diagnosis of two malignant melanomas in his brother and the recognition of a strong family history of melanoma.

Neurofibromatosis, generalized pruritus and cholestatic liver dysfunction—report of two cases

Two cases are reported in which neurofibromatosis was associated with generalized pruritus and an unexplained cholestatic pattern of liver dysfunction. Neither generalized pruritus, nor hepatic dysfunction arc recognized features of neurofibromatosis, and the co‐occurrence of this triad of abnormalities has not previously been reported.

Missed malignant melanomas.

radiation damage seems to have been lost, and further studies are needed to establish the viability of the proposed procedures. An experimental study of lethally irradiated salivary glands showed serum amylase changes of similar nature, including evidence of dose dependence and correlation with the degree of cell necrosis.4 In view of these findings I would like to suggest that measurement of serum amylase activity could provide a potentially useful, rapid indicator of tissue damage in the early period after exposure to radiation (within the first 12-48 hours). We, in fact, spelt this out in the closing sentence of our paper. Other simple procedures-for example, the total and differential white cell count-do not show significant changes within this early period. I am fully aware that our study was incomplete and applied only to a particular situation and that further studies are needed to establish the viability of the tests suggested. The question of dose dependence in human subjects and individual variations in response have not been properly investigated. There still remains the problem of making any test of this type logistically acceptable. The dose dependence question could possibly be solved by a multicentre study, which would provide relevant data on groups of patients receiving varying doses of therapeutic radiation and if possible including radioisotopes. Measurements of urinary amylase activities could well be a logistically atractive alternative to serum amylase assays, and a suitable enzyme dipstick should also be taken into consideration for screening purposes. I hope that this letter may stimulate some researchers to further studies in this field.

(24) Familial Jessner's syndrome

(i) S.H., female, aged 44 years. History. This lady has had recurrent lesions on the shoulders, back, and upper arms for 9 years. Individual lesions last for several months and resolve spontaneously. Examination. The lesions are firm, elevated, annular, erythematous plaques without superficial scale (Fig. i). Histology. Skin biopsy shows a dense perivascular dermal infiltrate composed of small lymphocytes.

Malignant melanoma: prolonged survival after cerebral metastasis.

tions; their use can cause disequilibrium between intracellular/extracellular sodium and water concentrations, which in children has caused fits and permanent neurological damage (Morris-Jones et al. 1967). The timing of operation requires cooperation between surgeons and anaesthetists; in this case the major risk of delaying the operation to improve his general medical state was infection of the gangrenous leg. He was formally reassessed twice a day by the medical team; had his temperature increased or other signs of infection been noted, then (or in between) his operation would have been brought forward.

Gamasoidosis: avian mite dermatitis (Dermanyssus gallinae)

The avian mite, Dermanyssus gallinae, is normally a blood‐sucking parasite of a large number of species of wild and domestic birds. It may adopt man as a temporary host, causing pruritus and rash. The main sources of such human attacks are infestations of chickens, pigeons, starlings, partridges, sparrows and canaries. The dermatitis caused by such bites is a well recognized entity amongst poultry workers and pigeon fanciers.