Minerva

doi:10.1136/bmj.333.7558.104

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What induces malignant melanomas in people without sun damage? US scientists report that fair skinned people who inherit variants of MC1R, which encodes a pigment receptor, have a higher risk of developing melanomas with mutations in the BRAF gene, an oncogene associated with melanomas that occur with little chronic damage to the skin. They think there's a link between the two genetic variants, but the mechanism is still unknown (www.sciencexpress.org/29June2006/Page1/10.1126/science. 1127515).

A 79 year old man with recurrent haemoptysis was admitted to the medical ward. Investigations of his chest and upper gastrointestinal tract were normal. He was referred to the ear, nose, and throat department to rule out other local causes of bleeding. On examination, he had several lingual varices on the ventral surface of his tongue. The varices were cauterised and he was given a blood transfusion. His postoperative recovery was uneventful and his haemoglobin was around 100 g/litre on discharge. Lingual varices are unusual and can easily be missed on clinical examination; they can cause subtle and potentially dangerous bleeding.

Abdul Nasir (dranasir@goolemail.com), senior house officer, D Gupta, trust surgeon, G McBride, consultant, Department of Ear, Nose, and Throat Surgery, Altnagelvin Area Hospital, Londonderry, …