this is a patient i have at the moment. i plan on operating as soon as the consultant anaesthetist sees his way clear to dope her. this is not too unusual in south africa. it shows a tendency to wait a long time before seeking help. this next photo will show something that south african doctors will immediately recognise, but may need a note to explain to our international audience. roughly in the middle of the mass are two small parallell scars. these are markings made by a sangoma. they are meant to be therapeutic. as you can see they were not. i have already posted about that (here and here) so i will not labour the point any more.
but, if there is any sage advice from surgeons out there for when i do attack this lady with my blade, i'm open to any suggestions. after all, two heads are better than one (except of course in the case above)