Background and Methods Cutaneous squamous cell carcinoma (cSCC) is the commonest skin cancer with metastatic potential, however, reported rates of metastasis varies greatly. All cases of primary cSCC on the Isle of Wight between 2005 and 2014 were identified and retrospectively followed for recurrence and/or metastasis. Primary outcome was to identify the rate of metastasis/recurrence from cSCC. Secondary outcomes included associated risk factors for metastasis/recurrence, death from cSCC, and time from diagnosis of primary cSCC to event. Results A total of 1122 patients with 1495 tumors were identified within the study period. A total of 18 metastasized and 40 recurred, an overall incidence of 1.2% and 2.7%, respectively. Eight patients died from their disease. Conclusions Risk of metastasis from cSCC in the UK general population is likely to be in the order of 1.2%. Where metastasis occurs this is often within 2 years. Recurrence rates are higher following curette and cautery. Discussion If treated adequately both recurrence and metastasis from cSCC is a rare event. Not all cSCC cases need follow‐up instead time should be spent educating patients around signs of recurrence/metastasis then discharged, relieving burden on secondary care. Multi‐disciplinary teaming meetings are expensive and should be limited to complex cases.

Aims Diabetes is an independent risk factor for severe SARS-CoV-2 infections. The goal of this study is to elucidate risk factors predictive of more severe outcomes in these individuals by comparing clinical characteristics of those requiring inpatient admission to those who remain outpatient. Methods A retrospective review identified 832 patients — 631 inpatients and 201 outpatients—with diabetes and a positive SARS-CoV-2 test between March 1 and June 15, 2020. Comparisons between the outpatient and inpatient cohorts was conducted to identify risk factors associated with severity of disease determined by admission rate and mortality. Previous DPP-4 inhibitor use and disease outcomes were analyzed. Results Risk factors for increased admission included older age (OR 1.04 (95% CI 1.01 – 1.06), p = 0.003) presence of chronic kidney disease (OR 2.32 (1.26 – 4.28), p = 0.007), and a higher A1C at time of admission (OR 1.25 (1.12 – 1.39), p <0.001). Lower admission rates were seen in those with commercial insurance. Increased mortality was seen in individuals with older age (OR 1.09 (1.07 – 1.11), p <0.001), BMI (OR 1.04 (1.01- 1.07), p = 0.003), and A1C at time of diagnosis of COVID (OR 1.12 (1.01 – 1.24), p = 0.028) and patients requiring hospitalization. Lower mortality was seen in those with hyperlipidemia. DPP-4 inhibitor use prior to COVID-19 infection was not associated with decreased hospitalization rate. Conclusions/Interpretation This retrospective review offers the first analysis of outpatient predictors for admission rate and mortality of COVID-19 illness in patients with diabetes.

We describe a case of cutaneous diphtheria in the UK, presenting as lower leg ulcers in a returning traveller, and discuss the epidemiology, significance and public health implications of this disease and the therapeutic options available. A 65-year-old woman presented with a 6-week history of multiple ulcers appearing on her legs following a holiday in Kenya. Culture of biopsy tissue grew Corynebacterium diphtheriae. A cascade of therapeutic and public health interventions followed, many of which were terminated once the isolate was confirmed as nontoxigenic. Cutaneous diphtheria is a rare, notifiable disease in the UK, but is common in tropical countries, and is most often seen in the West as a traveller's disease. Corynebacteria are common skin commensals, and without appropriate clinical details, laboratories may not recognize C. diphtheriae/Corynebacterium ulcerans. This is likely to have led to under-reporting and under-recognition of the condition.

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