Mohs micrographic surgery (MMS) is recognized as the goldstandard treatment for high-risk nonmelanoma skin cancers (NMSC) of the head and neck. Given the rising incidence of skin cancer, the past two decades have seen a rapid increase in the number of centres providing this service in the U.K. However, data on the safety, complication rates and patient acceptance of MMS in the U.K. are lacking. Over a 3-month period (September to November 2012) eight regional MMS centres collected data that included tumour site, number of stages to clearance, method of reconstruction and intra-and postoperative complications. In addition to collecting basic demographic and medical information, patients were also asked to rate, on a 10-point Likert scale, (i) their perceived anxiety levels preoperatively, (ii) how well they tolerated the surgery on the day, and (iii) when followed up, their overall acceptance of having undergone MMS under local anaesthesia (LA). Data on 565 patients were analysed. There were 278 women and 287 men, with a median age of 67 years (range 28-93 years). The majority of lesions treated were NMSC (98%). The average number of stages to tumour clearance was 1Á3 (range 1-5). Overall, 60% of patients were clear of tumour within one stage and 34% in two stages, with 6% requiring three or more stages. On average, patients were able to leave the department a little over 4 h after commencing treatment. In total, 88% of all reconstructions (including large flaps and interpolated flaps) were performed on the day by the Mohs surgeon. No major peri-or postoperative complications occurred. Although trouble-

This study shows that the majority of patients with positive reactions to sodium metabisulfite are also positive to sodium sulphite. Routinely patch testing with sodium sulfite is probably unnecessary, as most patients with positive reactions will also react to sodium metabisulfite. Clinicians should consider advising patients to avoid sodium sulfite and other sulfites when a positive allergic reaction to sodium metabisulfite occurs.

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Calciphylaxis is a rare and potentially life-threatening condition. It is thought to result from arterial calcification causing complete vascular occlusion and subsequent cutaneous infarction. Most often, it is a complication of end-stage renal failure or hyperparathyroidism; without either of these associated conditions, it is extremely rare. We report a case of calciphylaxis in a 58-year-old white British man, who had received long-term oral prednisolone for asthma control, with prophylactic calcium supplementation. There was no history of renal failure, and the patient's parathyroid function was normal. He was found to be heterozygous for the Factor V Leiden mutation. The acute presentation was seemingly precipitated by an episode of trauma and subsequent compression bandaging. The patient responded promptly to intravenous sodium thiosulfate. To our knowledge, this is the first case with no history of renal failure and normal parathyroid function, precipitated by compression bandaging and with an associated Factor V Leiden mutation.