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The incidence of cutaneous malignant melanoma has increased considerably in south-east Scotland over recent years. In 1987 the Cancer Research Campaign launched a project to aid the early detection, diagnosis and treatment of malignant melanoma. Edinburgh, chosen as one of seven centres in the U.K. to participate in the study, was provided with funding for a direct access pigmented lesion clinic from 1987 to 1989. The changes in the pattern of cutaneous malignant melanoma before, during and after the publicity campaign have been examined; between 1982 and 1990. The incidence of malignant melanoma doubled from 5.7 to 11.4/100,000 per annum. The percentage of thin tumours (Breslow thicknessor = 1.5 mm) increased steadily and significantly (from 43% in 1982 to 68% in 1990), but the number of thick tumours (Breslow thickness3.0 mm) remained constant over the same period (22 +/- 3.8). The influence of publicity was assessed using a questionnaire. Those who were influenced by publicity were significantly younger and had more thin tumours (Breslowor = 1.5 mm) than those who were uninfluenced by publicity. Five-year survival has significantly increased from 70% in the 1982-84 cohort to 84% in the 1987-89 cohort. The effect of the publicity campaign has been beneficial, but the impact on mortality cannot yet be assessed.

SUMMARY An ultrastructural dopa reaction, with glutaraldehyde-formaldehyde prefixation, was carried out on ten specimens of malignant melanoma showing a wide variation in melanosomal morphology. All tumours, but only a minority of tumour cells, contained reaction product. In all tumours the reaction product was distributed similarly in the Golgi apparatus and Golgi associated endoplasmic reticulum (GERL). However, differences were noted in its deposition in melanosomes. Whereas vacuolar and lamellar profiles sometimes contained reaction product, it was not seen in normal, granular and abortive melanosomes. Tumour cells without melanosomes were also seen to contain reaction product.

The clinical diagnosis of amelanotic melanoma may pose diagnostic difficulties. We report three cases of amelanotic lentigo maligna, two of which developed an invasive component (lentigo maligna melanoma). The clinical appearances in each case mimicked intraepidermal squamous carcinoma.

Atopic dermatitis is a chronic relapsing condition that can have considerable effects on the lives of sufferers. It is apparent that good, valid measures of life quality are necessary for quantifying the patients' perspective of the severity of their disease and the Dermatology Life Quality Index is often employed in clinical research. In a community study of atopic dermatitis we have assessed disability using the Dermatology Life Quality Index and the Patient Generated Index and compared the results from both indices. The results were significantly correlated and reflected the range of disability in patients in the community. Some items of the Dermatology Life Quality Index were not relevant for atopic dermatitis patients in the community and others, including swimming and sleep loss, were often cited in the Patient Generated Index but are not included in the Dermatology Life Quality Index. The Patient Generated Index is a novel, flexible approach to quality of life measurement that may be suitable for reflecting the wide variety of disability that is experienced by dermatological patients.

The persistence of human papillomavirus at cutaneous sites may be due to impaired trafficking of immune effector cells to the epidermis. We investigated whether HPV infection modulates cytokine mRNA expression in skin, thereby influencing local immunity. The mRNA expression of tumour necrosis factor-alpha, interleukin-1 alpha (IL-1 alpha), IL-1 beta, IL-1 receptor antagonist (IL-1ra), IL-4, IL-8, IL-10, IL-12, granulocyte macrophage colony-stimulating factor, transforming growth factor-beta, interferon-gamma and amphiregulin were assayed in cutaneous warts and normal skin by semiquantitative reverse transcriptase-polymerase chain reaction. The expression of the cytokines was heterogeneous in the specimens but, of the 12 mRNA species investigated, only IL-10 mRNA was significantly downregulated in warts compared with normal skin (P = 0.002). IL-1 alpha mRNA expression was significantly upregulated in common warts (P = 0.019) and plantar warts (P = 0.003) compared with normal skin. The expression of IL-1 alpha and IL-1ra mRNAs were significantly correlated in plantar warts (P < 0.05). Warts expressing IL-1 alpha also expressed amphiregulin, and there was a significant correlation between the expression of these two genes (P < 0.05). It is possible that IL-1 alpha expression in cutaneous warts may modulate the growth of papillomavirus-infected keratinocytes, mediated by amphiregulin, thus ensuring viral persistence.

Atopic eczema affects 2.3% of the U.K. population. We have carried out a community study in a semi-rural area to assess its economic impact. One hundred and fifty-five patients with atopic eczema were identified and expenditure was assessed over a 2-month period. The mean personal cost to the patient was pounds 25.90, while the mean cost to the health service was pounds 16.20. There were 58 lost working days and 17 lost school days. A cohort of 10 severely affected patients attending the Royal Infirmary of Edinburgh were studied; each patient spent, on average, pounds 325 in 2 months, and lead to a mean health service expenditure per patient of pounds 415, in 2 months. If these results were extrapolated to the U.K. population, the annual personal cost to patients with atopic eczema would be pounds 297m, the cost to the health service would be pounds 125m, and the annual cost to society of lost working days would be pounds 43m, making the total expenditure on atopic eczema pounds 465m.

Summary The medical records of 306 British soldiers in whom a clinical diagnosis of cutaneous leishmaniasis had been made following a tour of duty in Belize were analysed. Parasitological confirmation of the diagnosis was established in 187 cases: leishmania were cultured in 117 cases and Leishman-Donovan bodies were identified histologically in a further 70 cases. Leishmania braziliensis braziliensis was identified in 78 cases and Leishmania mexicana mexicana in a further 29 cases. Seventy-one per cent of patients had a single lesion which, in most cases, occurred on the exposed extremities. The mean diameter of the ulcers was 14.4 mm. Treatment with sodium stibogluconate was effective. Two regimens were used, consisting of either 600-800 mg daily given initially for 10 days, or 600 mg b.d. given initially for 14 days. Of those allocated to the lower dose regimen 48.5% were cured after the initial 10-day course, and ultimately the ulcers of 93% of patients healed following more prolonged treatmentat this dose. Of those allocated to the higher dose regimen 63.9% were cured after the initial 14-day course and ultimately the ulcers of all patients healed after more prolonged treatment at this dose. A transient leucopenia and a rise in liver enzymes were noted during treatment, and these changes were dose-dependent. No cases of mucocutaneous leishmaniasis were encountered.

Summary In vitro lymphoproliferative responses of peripheral blood mononuclear cells (PBMC) from patients with cutaneous warts, caused by infection with human papillomavirus type 1 (HPV-1) or type 2 (HPV-2), were assayed during the course of treatment. Purified HPV-1 and HPV-2 were used as antigens, as well as herpes simplex virus (HSV) and concanavalin A (Con A). All patients had normal percentages of subsets within the PBMC population and normal lymphoproliferative responses to Con A, and those with a clinical history of HSV infections had positive lymphoproliferative responses to HSV. Responses to both HPV antigens were poor. Only 10 of 100 assays of PBMC from 26 patients showed a stimulation index greater than 2. Addition of interleukin 2 made little difference in most cases. No correlation of clinical status of warts, i.e. improving, unchanged or resolved, with lymphoproliferation was found. When the PBMC were depleted of plastic-adherent cells and enriched for T cells, some samples which had not shown a lymphoproliferative response to HPV-1 or HPV-2 became positive: this response was abolished when the adherent cells were re-added. Thus it is possible that the adherent cell population from a proportion of patients contains cells which suppress lymphoproliferation, or that an immunoregulatory network is present so that lymphoproliferation does not take place in vitro without prior activation and cloning of T cells.

Summary An open cross-over study was performed to assess the effects of astomizole, cetirizine and loratadine on weal and flare reactions to intradermal histamine, codeine and house dust mite antigen. Percentage inhibition of weal area, flare area and weal volume was greatest for cetirizine, then astemizole and smallest for loratadine. Wealing due to mast-cell degranulation with either codeine or antigen was less Inhibited by all three antihistamines than that due to histamine itself. Time-course studies revealed similarities between wealing provoked by codeine and histamine but different characteristics to that induced by antigen.

A lymphocyte transformation test (LTT) was able to distinguish between nickel-sensitive subjects and non-nickel-sensitive controls. Sixty-one out of 66 (92%) nickel-sensitive subjects had positive stimulation indices in 6- and/or 7-day assays using 5 micrograms/ml of nickel sulphate, whereas none of the 43 controls gave positive results. Stimulation indices were not enhanced by the patch testing of subjects to nickel before performing the LTT. A weak correlation was seen between the results of the LTT and the macroscopic degree of patch-test reactivity. The concentration of nickel sulphate used (5 micrograms/ml) did not have a significant non-specific mitogenic effect.

Mitomycin C is an alkylating agent, used by intravesical instillation to treat carcinoma of the bladder. Repeated instillations can induce cystitis and an eczematous eruption affecting the palms, soles and face. If these effects are due to delayed hypersensitivity with sensitization to mitomycin C occurring in the bladder wall, it should be possible to demonstrate antigen-presenting cells in the bladder wall and positive patch tests to the drug. Using an immuno-alkaline phosphatase method we have identified CDI+ cells in bladder epithelium and submucosa and have demonstrated Birbeck granules in a few cells. In further support of our hypothesis it was also possible to demonstrate delayed type hypersensitivity in 13 out of 26 patients who had received mitomycin instillations by applying the allergen as a patch test. These results indicate that the eczematous eruption in this group of patients is most likely a hypersensitivity reaction and that it may be mediated transvesically.

Seven patients with a clinical and histologic diagnosis of Sweet's syndrome were tested for the presence of circulating antibodies to neutrophil cytoplasmic antibodies. Six of the seven patients had detectable antibodies to neutrophil cytoplasmic antibodies at a serum dilution of at least 1:20. Antibodies to neutrophil cytoplasmic antibodies were not found in serum from patients with a range of cutaneous diseases, some known to cause clinical or histologic confusion with Sweet's syndrome. The detection of circulating antibodies to the neutrophil cytoplasm may be of possible diagnostic value in Sweet's syndrome.

The influence of atopy on delayed-type hypersensitivity remains unclear. The expression of cytokine mRNA was assessed by reverse transcription-polymerase chain reaction (RT-PCR) in biopsy skin taken 24 h after the application of a 5% NiSO4 patch to five patients with atopic dermatitis and seven non-atopic subjects with previously proven contact allergy to nickel. Control specimens were obtained from untested and vehicle-tested skin from the same individuals. There was a significant increase in the mRNA expression for interferon-gamma (IFN-gamma), interleukin (IL)-2 and IL-4 together after nickel challenge in both patients (analysis of variance P = 0.007) and non-atopic-individuals (P = 0.005). In contrast, IL-10 mRNA increased in the non-atopic group only. These results show that atopic patients and normal subjects have a similar immunological reaction to nickel challenge. Moreover, it is suggested that both Th1- and Th2-type cytokines are involved in the immunopathogenesis of contact dermatitis.

The efficacy of aminosidine was compared with sodium stibogluconate in an open, randomized study of parasitologically-proven cutaneous leishmaniasis in Belize. Aminosidine, 14 mg/kg/d (max. 1 g daily) for 20 d, healed 10 of 17 lesions and sodium stibogluconate, 20 mg/kg/d for 20 d, healed 15 of 17 lesions. Lesions caused by Leishmania braziliensis were relatively unresponsive to aminosidine. Aminosidine was well tolerated and toxicity was not observed. Sodium stibogluconate was not well tolerated and treatment was associated with bone marrow suppression and elevation of serum aminotransferases.

SUMMARY A Study of out-patient dermatological services (NHS and private) in the south-east of Scotland was carried out by medical staff in the Department of Dermatology in Edinburgh during the month of November 1988. The aim was to assess changes in referral patterns and workload compared with the findings of an identical investigation undertaken in November 1981. Of particular interest were the possible effects of recent publicity campaigns aimed at increasing public awareness about skin cancer. The medical complement of the dermatology department had changed minimally since 1981 and the population increase in the south-east of Scotland over the same period was 1·5%. During November 1988 1592 new patients and 2037 review patients were seen. This represented an increase of 29·2% and 28·3%, respectively, since 1981. The most striking changes in diagnostic groups were a 173% rise in new cases presenting with benign tumours (excluding viral warts) and a 106% increase in new patients with malignant tumours. Viral warts and eczema were, as in 1981, the second and third most common diagnostic categories amongst new patients. There was a 98% increase in the number of surgical procedures performed on new patients compared with 1981. We conclude that the substantial increase in numbers of both benign and malignant tumours and the consequent doubling in surgical treatments was due to increased public awareness and concern about skin cancer.

An epidemiological study of atopic eczema (AE), based on a semirural community in Scotland, using sound diagnostic criteria, has yielded prevalence data for all age groups including infants and adults. The overall 1-year period prevalence, age-standardized to the Scottish population, was 2.3%. The 1-year period prevalence was highest in the under 2s (9.8%), and showed a continuous reduction with increasing age. Over the age of 40, AE was found to be relatively rare, with a 1-year period prevalence of 0.2%. Adults over 16 years made up 38% of all patients with AE.

Keratinocytes expressed major histocompatibility complex class II antigens during the development of irritant contact dermatitis, and during the induction of contact hypersensitivity, as well as in established allergic contact dermatitis. A battery of anti-class II monoclonal antibodies, some of which are specific for class II subregion products (DP, DQ, DR), was used in an immunohistochemical study of the sequential changes in the allergic challenge reactions to dinitrochlorobenzene (DNCB) and nickel, the irritant response to anthralin, and the induction of sensitization to DNCB. The induction of keratinocyte class II expression paralleled the influx of Leu-3a+ T cells into the skin and had occurred by 24 or 48 h in each type of reaction. Differential expression of class II subregion products on keratinocytes was noted: DR was the most frequently expressed molecule, followed by DP and DQ, although in the irritant response, DP expression was not observed. The importance of these observations can be decided only by functional studies.

SUMMARY Serial biopsies during the first 24 hours after dinitrochlorobenzene (DNCB) challenge in fifteen sensitized patients have shown that DNCB associates with Langerhans cells within 1 hour of application, and has reached the dermis around the appendages by 6 hours.

Ultrastructural studies were carried out on the invasive nodule of forty malignant melanomas. The findings support the concept that the fine structure of lentigo maligna melanoma is often characteristic, and differs from that of superficial spreading and nodular melanoma. The melanosomes in lentigo maligna melanoma are usually ellipsoidal and resemble those of normal melanocytes, whereas the melanosomes in superficial spreading and nodular melanoma are most often spheroidal and abnormal in appearance. Superficial spreading and nodular melanomas cannot be distinguished reliably by their ultrastructure. Melanosomal appearances could not be related to the presence of a pre-existing naevus or the depth of invasion of the tumour nodule.

Summary Twenty-two patients with a history of an adverse reaction to a paste bandage were investigated by patch testing. Thirteen patients showed reactions to some components of the bandages; the paraben preservatives were the most frequent sensitizers. Testing with the International Contact Dermatitis Research Group standard series was a satisfactory screening procedure.

SUMMARY One hundred and twenty renal transplant recipients were investigated. Fifty-eight (48%) were found to have warts, 13(11%) keratoses and six (5%) to have, or recently to have had cancers. The longer the time of immunosuppression, the greater the prevalence of warts; of those patients who had had their transplant for at least 5 years, 87% had warts. Those with a graft survival time of 10 years or more are at special risk of warts, keratoses and malignancy. Five (10%) of 50 women had genital warts, four of whom had internal lesions (vaginal, cervical or anal) and one developed a carcinoma of the vulva. These findings indicate the advisability of colposcopy for all female renal transplant recipients, a high risk group. Eighty-eight specimens from 42 patients were examined by DNA restriction enzyme analysis and cross hybridization for the presence and type of human papillomavirus (HPV). HPV DNA was detected in 66% of the warts examined, HPV2 and HPV4 occurring most often and HPV1 and HPV3 only infrequently. In sequential specimens from common hand warts of one individual, an HPV was found which could not be precisely identified but was related to HPV4. HPV16 was detected in a vaginal wart from one patient and an HPV6-related virus in a vulval wart of another. HPV DNA of an unknown type was demonstrated in one of 11 keratoses examined. With the probes used to examine the few samples of skin cancers available, HPV 16 was found in a squamous cell carcinoma of the vulva, and faint bands from an unidentified type of HPV were detected in two squamous cell carcinomata from a patient's hand. One woman had plaque lesions morphologically and histologically resembling those found in epidermodysplasia verruciformis (EV). HPV5 was identified in these lesions. This is only the third reported case of HPV5, previously thought to be unique to EV, in a renal transplant recipient.

SUMMARY Fish handlers frequently suffer from hand warts. The clinical form and HPV type in these lesions were studied. Eleven individuals (10 fishmongers and one fisherman) with multiple hand warts were examined clinically and samples from their warts examined by Southern blot and reverse blot analysis. Clinically, with one exception, the warts were of the common type. HPV DNA was detected in all but one individual. HPV4 was found in one sample, HPV1 related virus in three, a virus hybridizing with both HPV27 and HPV2 in five (four individuals) and HPV7 in seven (six individuals). More than one type was detected in four individuals. HPV7 infection was related to the greater length of time spent in handling fish. These findings indicate that HPV7 is not, as was previously thought, found exclusively in those handling butcher meat and suggest that environmental conditions may be a factor in the clinical manifestation of HPV7 infection. The exact nature of a virus designated HPV2/27 and the significance of its presence in these fish handlers remains uncertain.

Crude bacterial α -amylase and ethylenediaminetetraacetic acid act on the interfibrillar matrix of the fiber to weaken the fibril—fibril interaction and allow the constituent fibrils to disperse in dilute acetic acid. The morphology, range of diameter, amino acid composition, carbohydrate content, and stability of the polymeric collagen fibrils thus obtained is identical to that of native fibrils.

A new treatment for venous lakes (Bean and Walsh, 1956) has been devised using an infrared coagulator. The solid light guide with its sapphire cap enables the ectatic vessels to be compressed prior to coagulation, minimising the energy required to destroy the vessels. We have successfully treated 10 lesions with a pulse duration of 1.125 seconds.

A double-blind crossover oral challenge with placebo (lactose) or the equivalent of 400 μg elemental nickel (as nickel sulphate), was performed on 10 nickel-sensitive volunteers with hand dermatitis. Nickel or the placebo was given on two consecutive days; the clinical effect was observed 3 days later and this routine was repeated the following week with the other preparation. Three patients produced a cutaneous reaction after nickel alone, two after placebo only, two reacted to both and three to neither. The above protocol was repeated with 10 different nickel-sensitive subjects using the equivalent of 2–5 mg of elemental nickel or placebo; serum nickel was estimated before and three days after each oral challenge, using electrothermal atomic absorption spectrometry. Three patients reacted to nickel by itself, three to placebo alone, three to both preparations and one showed no response to either. The serum nickel was slightly raised in three patients prior to challenge, but was subsequently normal in each. An elevation in serum nickel occurred in all specimens taken after nickel ingestion, the rise usually being two to three times the resting value. Serum nickel was normal in three nickel-sensitive patients with an active hand dermatitis. These studies indicate that hand dermatitis in nickel-sensitive patients, cannot be precipitated by the oral doses we have administered.

SUMMARY Plasma 5-S-cysteinyldopa (5-S-CD) concentrations measured in healthy volunteers in Edinburgh, Scotland (latitude 56 N) showed only minor changes during the day. However, when measurements were performed over a 12-month period a significant rise in 5-S-CD concentration was found. Skin pigmentation and hair colour were not related to plasma 5-S-CD levels. Patients with psoriasis treated with ultraviolet-B or photochemotherapy (PUVA) developed an almost two fold increase in their plasma 5-S-CD level within the first five treatments, before pigmentation developed, subsequent increments of up to four times the pretreatment level being found in the PUVA group. Dithranol treatment caused an increase in plasma 5-S-CD in some psoriatic patients, suggesting a possible association between skin erythema and elevated 5-S-CD levels. The value of plasma 5-S-CD in the follow-up of patients with malignant melanoma does not seem to be invalidated by unavoidable exposure of the subjects to sunlight in a temperate climate such as that of South East Scotland.

Skin disorders were reported in 33% of catering staff and 35% of women cleaners who returned a questionnaire, and were employed in a large hospital. Hand dermatitis occurred in 15% of the caterers and 12% of the cleaners. In the majority, the dermatitis was irritant in origin and related to their wet work occupations. Cleaners had a high prevalence of jewellery dermatitis. Limited patch testing revealed a majority positive to nickel, but a third were negative, indicating that jewellery reactions often but not invariably predict nickel sensitivity. Few subjects were atopic, but some psoriatic patients with hand problems were encountered. Most workers were able to carry on in their occupations despite having hand dermatitis.

SUMMARY We present details of nine patients who developed morphoea after radiotherapy. In every patient morphoea began within the irradiated area and in four spread beyond it. We believe the irradiation triggered the morphoea despite the absence of any clear-cut relationship to dosage or severity of the acute reaction. Dermatologists and radiation oncologists should be aware that this condition may lead to the mistaken diagnosis of a local tumour recurrence.

Mitogen- and antigen-driven T-cell proliferation is dependent upon the presence of MHC II+ accessory cells. The ability of plastic-adherent blood cells and epidermal cells to act as accessory cells was assessed using a modified 6-day lymphocyte transformation test (LTT). Accessory cells from both the blood and epidermis of patients contact-sensitized to nickel were able to mediate antigen- (nickel sulphate) and mitogen-(concanavalin A) induced proliferation of purified autologous T cells. The requirements for MHC II molecules in accessory cell function were assessed by the addition of monoclonal antibodies to the LTT Antibodies against HLA-DR markedly inhibited the antigen-specific response. In contrast, an antibody against HLA-DP only weakly inhibited cell proliferation and an antibody against HLA-DQ had no effect. These studies confirmed the importance of HLA-DR molecules in antigen-induced cell proliferation. Further work is needed to clarify the role of HLA-DP and HLA-DQ.

Summary A questionnaire was sent to all consultant dermatologists in The Netherlands, Belgium and Scotland regarding their management of suspected melanomas. The 343 evaluable responses showed that 29·7% of the dermatologists regularly prefer to ‘wait and see’ or carry out incisional biopsies in the early management of suspected melanoma, especially if the risk is thought low. The main arguments advanced by the proponents of incision were doubts about whether incisional biopsy provokes metastatic spread, and the belief that a pathologist can make reliable diagnosis on a partial specimen of the tumour. These arguments are questioned and excision biopsy, provided it is feasible without being disfiguring, is strongly recommended in the initial treatment of a suspected melanoma.

SUMMARY Lichen myxoedematosus was diagnosed in a 44-year-old woman in 1957. Despite the persistence of an abnormal serum protein, the skin lesions cleared by 1965. The protein abnormality disappeared several years later.

Summary The scalp psoriasis of 13 out of 20 out-patients and of 9 out of 10 in-patients improved with a 6% salicyclic acid gel. Out-patients found the treatment acceptable but in-patients preferred a traditional treatment with salicylic acid made up in soft paraffin. Absorption of salicylic acid from the gel was negligible.

Fluorescent-labelled polymeric collagen fibrils have been prepared which contain three fluorescein residues in the telopeptide regions and four fluorescein residues in the helical region of each tropocollagen unit within the polymer. This material has been used as a substrate for the study of enzymes present in the synovial fluid of inflamed rheumatoid joints which are capable of degrading polymeric collagen fibrils. Two enzyme systems were observed, one inhibited by EDTA and having the properties of the known synovial collagenase, the other having the properties of a neutral protease. The neutral protease was found to be present in sonicates of the polymorphonuclear leucocytes in the synovial fluids of inflamed joints. This enzyme attacked the telopeptides of fluorescein-labelled polymeric collagen fibrils and was similar to trypsin in removing two residues of fluorescein-labelled peptides per tropocollagen molecule within the polymeric collagen fibrils but did not depolymerise the polymeric collagen fibrils.

We have carried out a case control study on 200 patients presenting in the past 3 years with primary cutaneous malignant melanoma and 200 age- and sex-matched controls. Total body melanocytic naevus counts were performed on all 400 subjects by four trained dermatologists. Analysis was by stratum matched logistic regression, with stratum matching for age, sex and city of treatment. Each variable was adjusted for the other risk factors found in the study, such as hair and eye colour, skin type, amount of UV exposure and episodes of acute sunburn. Substantially increased risk of malignant melanoma was found for persons with large numbers of normal benign melanocytic naevi, with any moles larger than 7 mm in diameter, and also with irregular edges and colour variation in moles—the so-called dysplastic naevi. The number of moles present on the same anatomical areas as the tumour (arms, legs, trunk, face, head and neck, and palms and soles) was a stronger predictor of melanoma incidence than was the total number of body moles. The relationship of histology and Breslow thickness of melanoma to site, sex, age and number of naevi will also be presented. Our results show that a very high-risk group for melanoma can now be identified and these patients should be advised about avoiding excessive sun exposure and the early recognition of cutaneous melanoma.

Venous lakes are formed from dilated venules lined with endothelium, and occur most commonly on the lips and ears. They are quite common after middle age. Treatment is usually sought for cosmetic reasons or because of bleeding after minor trauma. Such lesions have been destroyed with cautery, cryosurgery and more recently, with an argon laser. We have treated 10 lesions with an infrared coagulator (MBB AT Model IRK 151) using a pulse duration of 1·125 s. Each treatment has been successful and has given excellent cosmetic results. This method has two advantages over others. Firstly, the solid light guide enables the operator to compress the lesion prior to coagulation: it becomes a thin fiat structure emptied of blood, and less energy is required to destroy it. Secondly, the coagulator has an electronic timer which enables exactly the same energy to be applied on each occasion, making this procedure reproducible even by an inexperienced operator. The technique and clinical results are described and illustrated.