This study examines the prevalence of sun-related damage to the skin in a caucasian population in north-west England. The importance of constitutional factors (complexion, skin type and age) as well as environmental and occupational exposures for the development of actinic keratosis (AK) and skin cancers was assessed in people over 40 years of age attending outpatient clinics (non-dermatology) at four centres in north-west England (Mersey region). Nine hundred and sixty-eight volunteers (531 men and 437 women) were recruited. The overall prevalence of AK was 15.4% in men and 5.9% in women. The prevalence was strongly related to age in both sexes, being 34.1% and 18.2%, respectively, in men and women aged 70 years and above, and was most strongly related to two objective signs of sun exposure, namely degree of solar elastosis and presence of solar lentigines. The prevalence of AK was higher in subjects with red hair and freckles, particularly women. There was no evidence of an increased prevalence of AK in relation to any occupation. There was a high prevalence of seborrhoeic keratosis and viral warts in both sexes, which was age-related in the case of seborrhoeic keratosis. Ten cases of basal cell carcinoma, eight cases of Bowen's disease and one case of malignant melanoma were identified. This study shows that the sun exposure received in 'normal' life in England is sufficient to cause potentially malignant skin damage in a significant proportion of the population.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence.Recommendations• Royal College of Pathologists minimum datasets for NMSC should be adhered to in order to improve patient care and help work-force planning in pathology departments. (G)• Tumour depth is of critical importance in identifying high-risk cutaneous squamous cell carcinoma (cSCC), and should be reported in all cases. (R)• Appropriate imaging to determine the extent of primary NMSC is indicated when peri-neural involvement or bony invasion is suspected. (R)• In the clinically N0 neck, radiological imaging is not beneficial, and a policy of watchful waiting and patient education can be adopted. (R)• Patients with high-risk NMSC should be treated by members of a skin cancer multidisciplinary team (MDT) in secondary care. (G)• Non-infiltrative basal cell carcinoma (BCC) <2 cm in size should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in sites where reconstructive options are limited, when reconstruction should be delayed. (R)• Where there is a high risk of recurrence, delayed reconstruction or Mohs micrographic surgery should be used. (R)• Surgical excision of low-risk cSCC with a margin of 4 mm or greater is the treatment of choice. (R)• High-risk cSCC should be excised with a margin of 6 mm or greater. (R).• Mohs micrographic surgery has a role in some high-risk cSCC cases following MDT discussion. (R)• Delayed reconstruction should be used in high-risk cSCC. (G)• Intra-operative conventional frozen section in cSCC is not recommended. (G)• Radiotherapy (RT) is an effective therapy for primary BCC and cSCC. (R)• Re-excision should be carried out for incompletely excised high-risk BCC or where there is deep margin involvement. (R)• Incompletely excised high-risk cSCC should be re-excised. (R)• Further surgery should involve confirmed marginal clearance before reconstruction. (R)• P+ N0 disease: Resection should include involved parotid tissue, combined with levels I–III neck dissection, to include the external jugular node. (R)• P+ N+ disease: Resection should include level V if that level is clinically or radiologically involved. (R)• Adjuvant RT should include level V if not dissected. (R)• P0 N+ disease: Anterior neck disease should be managed with levels I–IV neck dissection to include the external jugular node. (R)• P0 N+ posterior echelon nodal disease (i.e. occipital or post-auricular) should undergo dissection of levels II–V, with sparing of level I. (R)• Consider treatment of the ipsilateral parotid if the primary site is the anterior scalp, temple or forehead. (R)• All patients should receive education in self-examination and skin cancer prevention measures. (G)• Patients who have had a single completely excised BCC or low-risk cSCC can be discharged ...

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The term 'angry back syndrome' (ABS) was coined by Mitchell in 1975. It was stated that a strong positive patch test reaction could create an 'angry back' which becomes hyper-reactive to other patch test challenges. The present study investigated whether the ABS is a generalized state of hyper-reactivity of skin, whether it is a localized hyper-reactivity of skin, i.e. only in the close proximity to a strong patch test reaction, whether it is an individual specific phenomenon and if ABS is a reproducible phenomenon. The studies failed to demonstrate any generalized or localized change in the reactivity of the skin. This left the possibility that ABS might be a rare, and individual-specific phenomenon. However, even in the subjects who had previously been diagnosed as having ABS we failed to reproduce the angry back.

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