Electronic consent (eConsent) and procedure-specific consent forms have been highlighted as methods of improving the consent process. In this two-cycle audit, we assessed the quality of consent documentation pre- and post-implementation of eConsent.

We reviewed paper (first cycle) and eConsent (second cycle) forms for discussion of benefits, risks and alternatives for septorhinoplasty and functional endoscopic sinus surgery. A survey which included the System Usability Scale was distributed to clinicians.

Post-implementation of eConsent, there was a statistically significant increase in the number of risks documented in septorhinoplasty (p-value < 0.001) though this was not the same for functional endoscopic sinus surgery. Feedback was generally positive with a System Usability Scale score of 85.3 indicating high usability.

The implementation of eConsent with procedure-specific consent forms in our centre was well received with significant improvements in septorhinoplasty documentation and more modest improvements in FESS.

High-risk cutaneous squamous cell carcinoma represents 3–5 per cent of all cutaneous squamous cell carcinomas but causes most disease-specific deaths. Head and neck tumours are often high risk. Recent phase-3 trials have challenged surgery plus or minus radiotherapy as standards of care. This review updates definitions and evidence on emerging treatments.

Narrative review.

High-risk cutaneous squamous cell carcinoma is defined by size greater than 2 cm, deep invasion, poor differentiation, perineural/lymphovascular invasion, nodal spread or immunosuppression. Surgery remains central, with adjuvant radiotherapy improving locoregional control. The KEYNOTE-630 trial of adjuvant pembrolizumab showed a non-significant recurrence-free survival gain (hazard ratio 0.76), with benefit in elderly and extracapsular extension subgroups. The C-POST trial established adjuvant cemiplimab as the first systemic therapy significantly improving disease-free survival (hazard ratio 0.32; 24-month disease-free survival 87 per cent vs 64 per cent). Emerging strategies include neoadjuvant programmed cell-death protein 1 blockade, circulating tumour DNA-guided monitoring and combinations.

Cemiplimab redefines the post-operative standard; pembrolizumab awaits confirmation. Future directions include earlier immunotherapy, biomarker validation and access expansion.

Surgical treatment of auricular concha, the helix root and the external auditory canal tumours, and their reconstruction, is a challenge because of the complexity of this anatomic region and the significant functional and aesthetic requirements of these treatments. The purpose of this study is to describe our experience with the retroauricular revolving door island flap technique.

This was a retrospective descriptive study (series of nine clinical cases) conducted between 2020 and 2023 of revolving door island flap reconstruction of auricular conchal and external auditory canal defects caused by tumour removal.

In all the cases, tumour-free margins and total reconstruction of the defect were achieved through the revolving door island flap intervention, with optimal aesthetic and functional results.

Revolving door island flap reconstruction is a viable surgical option for the reconstruction of auricular conchal and external auditory canal defects because of its versatility, reproducibility, low post-operative morbidity and optimal results.