Case study 1 Xeroderma Pigmentosum: In this disease the DNA repair mechanism is defective. Sun damage induces skin cancer – mostly melanomas and squamous cell carcinoma. Extreme suns protection and early radical treatment for malignancies would be indicated but most sufferers die before puberty. This 7-year-old presented at our on the first day of a new clinic we opened on 15th October 2108 in a village far from the tarmac road. His grandmother brought him, telling us it was the first time they had had access to medical care. The boy was cheerful but had lost the sight of one eye. This is a case we had to refer and fortunately we have developed a good relationship with the oncology unit for children in Lilongwe, funded by a major USA pharmaceutical company and they accepted the boy for in-patient care. The prognosis was not good but chemotherapy with Cisplatin/5FU in an attempt to shrink the carcinoma for possible surgery initially brought some improvement. He was allowed to go home to his village before the next stage of treatment but it was all too late and he died a couple of days later. A condition like this should never be left untreated as this was for years and develop to this extent.