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 ...

Nasal polyps are common, affecting one to four per cent of the population. Their cause, however, remains unknown and it is possible that it is not the same in all patients. They have a clear association with asthma, aspirin sensitivity and cystic fibrosis. Histologically they demonstrate large quantities of extracellular fluid, mast cell degranulation and an infiltrate of inflammatory cells, usually eosinophils. While this appearance would suggest an allergic pathology there is little conclusive evidence to support this in most patients. There is, however, some preliminary evidence to suggest that a local allergic process could be the cause. While allergic fungal sinusitis is a well defined clinical entity with recognized diagnostic criteria the ubiquitous nature of fungal spores makes the role of fungal infection in patients with nasal polyps difficult to determine and currently this remains unclear. Surgical treatment of nasal polyps has declined in recent years as the benefits of medical treatment have become increasingly recognized. There is good evidence to support the use of corticosteroids both as a primary and post-operative treatment in the majority of patients. Other medical treatments require further evaluation before they could be considered a viable alternative to steroids. Assessment of the literature regarding surgical intervention is difficult and there is little evidence on which to base a surgical treatment philosophy. The authors believe that an endoscopic approach using a microdebrider facilitates accurate removal of polyps with preservation of normal anatomy.

We describe the technique of implant-site split-skin grafting for the bone-anchored hearing aid (BAHA). Twenty-five patients have undergone this procedure (20 adults and five children) since 1993 with a minimum follow-up of 1 year. Fifteen adults were operated upon as single stage surgery, all other cases (including all children) were performed in two stages. In four patients (16%) significant early graft inflammation was encountered which settled with outpatient treatment. In one the abutment had to be temporarily removed to allow the graft to settle. All patients now have a stable graft site. This surgical technique is straightforward and a separate graft donor site is avoided. It would appear this technique results in a stable BAHA graft site with low associated morbidity.

Informed consent is becoming an increasingly important issue in patient care. Inherent in this is the ability to accurately inform patients of the risks and complications involved in surgery. Nasal septal surgery is commonly performed by otolaryngologists and although often considered routine has a number of recognized complications that can have a significant effect on life quality. We carried out a review of the literature over the last 25 years and reviewed studies quoting rates of complications after septoplasty and submucous resection (SMR) using strictly applied criteria for study inclusion. There was a paucity of prospective data, especially for the cosmetic effects of septal surgery. Rates of septal perforation were two to eight per cent for SMR and 1.6-5.4 per cent for septoplasty. The incidence of cosmetic deformity was low for both procedures zero to one per cent. More well-designed studies are required to augment the current evidence base. While this does not replace the need for surgeons to audit their own results it provides evidence-based information to assist in the process of informed consent.