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The stoma care nurse (SCN) assesses peristomal skin during each patient intervention. Living in a diverse multicultural society, the SCN needs to consider dark skin tones and how these are documented. This article looks at how the literature on peristomal skin assessment and available tools discuss skin colour, and compare this with the tissue viability literature. Stoma care and peristomal skin literature features very little about skin colour. Registered nurses are often unaware of the differences when assessing light skin tones versus dark skin tones. The article discusses how to assess for, identify and document problems around peristomal skin with patients who have dark skin tones. The differences in skin breakdown between light skin tones and dark skin tones are highlighted. There needs to be further research and development of tools to assist clinicians in identification and documentation relating to skin tone, thus providing consistency in assessment. [ABSTRACT FROM AUTHOR]

Pavement burns are more common in locations familiarised with high temperatures and a dry climate zone, but have not previously been reported in temperate climates. We present two cases of patients who suffered pavement burns in the United Kingdom during an unprecedentedly hot day in July 2022. The first case involved a 66-year-old male who suffered partial and full thickness burns requiring excision and skin grafting. The second case involved a 58-year-old female with partial thickness burns also requiring excision and skin grafting. Both patients had pre-existing co-morbidities and their pavement burns were precipitated by heat stroke. Pavement burns represent a mechanism of injury that necessitates increased operative management, length of hospital stay and cost per surface area burned when compared to flame or scald burns (Silver et al., 2015). As a result of global warming, we anticipate extreme heat events, and subsequently pavement burns, to increase in incidence in the United Kingdom. There is opportunity for education of the public and health professionals for prevention. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis, previously and sometimes still referred to as moisture lesions or moisture damage, is a commonly seen contact dermatitis that is a reactive response of the skin to chronic contact to urine and faecal matter. Understanding the etiology is fundamental to creating a skin care plan and successfully prevention. Systemic reviews and studies have shown that the continued variability in management results from a combination of knowledge base, observation, diagnosis, and product selection. This article aims to improve clinicians' understanding of incontinence-associated dermatitis and its management. [ABSTRACT FROM AUTHOR]

Neonatal herpes simplex virus (HSV) infection is a potentially devastating disease. Data on the recurrence of disease while on suppressive therapy are limited. We reviewed cases of neonatal HSV. Prematurity was associated with more recurrence. No systemic or CNS recurrence occurred, but there were frequent recurrences of skin lesions. [ABSTRACT FROM AUTHOR]

Whole-skin DNA methylation variation has been implicated in several diseases, including melanoma, but its genetic basis has not yet been fully characterized. Using bulk skin tissue samples from 414 healthy female UK twins, we performed twin-based heritability and methylation quantitative trait loci (meQTL) analyses for >400,000 DNA methylation sites. We find that the human skin DNA methylome is on average less heritable than previously estimated in blood and other tissues (mean heritability: 10.02%). meQTL analysis identified local genetic effects influencing DNA methylation at 18.8% (76,442) of tested CpG sites, as well as 1,775 CpG sites associated with at least one distal genetic variant. As a functional follow-up, we performed skin expression QTL (eQTL) analyses in a partially overlapping sample of 604 female twins. Colocalization analysis identified over 3,500 shared genetic effects affecting thousands of CpG sites (10,067) and genes (4,475). Mediation analysis of putative colocalized gene-CpG pairs identified 114 genes with evidence for eQTL effects being mediated by DNA methylation in skin, including in genes implicating skin disease such as ALOX12 and CSPG4. We further explored the relevance of skin meQTLs to skin disease and found that skin meQTLs and CpGs under genetic influence were enriched for multiple skin-related genome-wide and epigenome-wide association signals, including for melanoma and psoriasis. Our findings give insights into the regulatory landscape of epigenomic variation in skin., Competing Interests: Declaration of interests DG is an employee of Unilever., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Melanoma incidence has quadrupled since 1970 and melanoma is now the second most common cancer in individuals under 50. Targeted immunotherapies for melanoma now potentially enable long-term remission even in advanced melanoma, but these melanoma survivors require ongoing surveillance, with implications for NHS resources and significant social and psychological consequences for patients. Total skin self-examination (TSSE) can detect recurrence earlier and improve clinical outcomes but is underperformed in the UK. To support survivors, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed to prompt and improve TSSE performance, with subsequent reporting of concerns and submission of skin photos to a Dermatology Nurse Practitioner (DNP). ASICA was delivered as a randomized pilot trial.Methods: This paper reports on process evaluation. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using Microsoft Excel and SPSS. We explored which participants used ASICA, and how frequently, to report any skin concerns. We also determined how the interactions had worked in terms of quality of skin photographs submitted, clinical assessments made by the DNP, and the assessments and decisions made for each concern. Finally, we explored significant events occurring during the trial. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using SPSS. A semi-structured interview was undertaken with the DNP to gain perspective on the range of concerns presented and how they were resolved.Results: Of 121 recruited melanoma patients receiving ASICA for 12 months, 69 participants submitted a total of 123 reports detailing 189 separate skin-related concerns and including 188 skin photographs. Where participants fully complied with follow-up by the DNP, concerns were usually resolved remotely, but 19 (10.1%) were seen at a secondary care clinic and 14 (7.4%) referred to their GP. 49 (25.9%) of concerns were not completely resolved due to partial non-compliance with DNP follow-up.Conclusion: Melanoma patients randomized to the ASICA intervention were able to report skin-related concerns that could be resolved remotely through interaction with a DNP. Feasibility issues highlighted by ASICA will support further development and optimization of this digital tool.Trial Registration: Clinical Trials.gov , NCT03328247 . Registered on 1 November 2017. [ABSTRACT FROM AUTHOR]

Skin pigmentation is a classic example of a polygenic trait that has experienced directional selection in humans. Genome-wide association studies have identified well over a hundred pigmentationassociated loci, and genomic scans in present-day and ancient populations have identified selective sweeps for a small number of light pigmentation-associated alleles in Europeans. It is unclear whether selection has operated on all of the genetic variation associated with skin pigmentation as opposed to just a small number of large-effect variants. Here, we address this question using ancient DNA from 1,158 individuals from West Eurasia covering a period of 40,000 y combined with genome-wide association summary statistics from the UK Biobank. We find a robust signal of directional selection in ancient West Eurasians on 170 skin pigmentation-associated variants ascertained in the UK Biobank. However, we also show that this signal is driven by a limited number of large-effect variants. Consistent with this observation, we find that a polygenic selection test in present-day populations fails to detect selection with the full set of variants. Our data allow us to disentangle the effects of admixture and selection. Most notably, a large-effect variant at SLC24A5 was introduced to Western Europe by migrations of Neolithic farming populations but continued to be under selection post-admixture. This study shows that the response to selection for light skin pigmentation in West Eurasia was driven by a relatively small proportion of the variants that are associated with present-day phenotypic variation. [ABSTRACT FROM AUTHOR]

Introduction: The replenishment of skin lipids depleted in the dry skin state is a desirable therapeutic target to restore skin moisturization; however, there is limited evidence demonstrating the success of this approach through the use of topical emollients. The purpose of this study was to provide evidence of the benefits of a cream and equivalent lotion containing skin lipids in a multi-vesicular emulsion for the management of dry skin. The hypothesis was that the test cream and test lotion could sustain skin moisturization for longer than traditional emollients by sustainably delivering skin lipids. Methods: A double-blind intra-subject vehicle-controlled single open-application test on the lower legs in people with dry, atopic dermatitis (atopic eczema)-prone, skin was conducted. There were six treatment sites, three per lower leg in each participant, which were treated with the test cream, the test lotion, three reference creams commonly prescribed in the UK and no treatment as a control. After baseline measurements of skin hydration, 100 μl of the test/reference creams was applied to each of the relevant treatment sites (random site allocation). Following treatment, measurements of skin hydration and scoring of visual dryness was conducted at timed intervals (3, 6, 12 and 24 h post-product application). Results: The test cream and lotion both significantly increased skin hydration and reduced skin dryness for at least 24 h following a single application compared to a no treatment control site. Compared to three reference emollient creams the test cream and test lotion were the only products capable of sustaining clinically meaningful improvements in skin moisturization for 24 h. Conclusion: The sustained moisturization imparted by the test products reduces the need for frequent emollient application, often requiring 3–4 applications per day for traditional emollients, and should reduce the high burden of managing dry skin conditions like atopic dermatitis. [ABSTRACT FROM AUTHOR]

Butternut squash is greatly consumed in United Kingdom and as by‐products of its processing are produced large amounts of skin and seeds. However, little research has been reported on the antioxidant properties and bioactive peptides from butternut squash seeds and skin. This study focused on assessing the potential of these wastes as sources of beneficial and bioactive compounds. The results indicated that the squash skin phenolic extract showed higher values of antioxidant activity and phenolic content compared with the values of phenolic for the seed material (3.20 mg GAE/g, 1.82 mg GAE/g, respectively). Furthermore, both squash seed protein hydrolysate and skin phenolic extract inhibited α‐amylase activity in a dose‐dependent manner (5–20 mg/ml). Hydrolyzed peptides from squash seeds possess antihypertensive ability (which was significantly different from the control group p <.05). Therefore, it can be demonstrated that these squash residues are potentially good sources of bioactive compounds with health benefits. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand how the Leishmania parasite is transmitted to humans • To familiarise yourself with the patient groups who are most at risk of contracting cutaneous leishmaniasis • To recognise how to prevent, diagnose and manage cutaneous leishmaniasis Cutaneous leishmaniasis is endemic in more than 70 countries worldwide. It is a non-fatal disease caused by the Leishmania parasite that is transmitted to humans via bites of infected female sandflies. Cutaneous leishmaniasis causes skin lesions on areas of exposed skin, such as the face and limbs, which often produce scarring and atrophy. If untreated, cutaneous leishmaniasis can develop into mucocutaneous leishmaniasis, which is potentially life-threatening. Furthermore, patients with cutaneous leishmaniasis commonly experience psychosocial issues such as anxiety, distress, stigma and rejection. Cutaneous leishmaniasis is spreading outside of its traditional endemic areas because of the effects of environmental changes such as urbanisation and climate change. In the UK, healthcare professionals may encounter the disease in migrants from endemic areas, members of the armed forces, tourists and expatriates. Therefore, emergency nurses need to be able to assess and support patients who present with symptoms suggestive of cutaneous leishmaniasis. This article provides an overview of the epidemiology, aetiology, pathophysiology, clinical presentation, diagnosis, treatment and prevention of the disease. [ABSTRACT FROM AUTHOR]

• Primary scrotal SCC is rare with 10 cases identified over 10 years at our single center. • There are currently no international or national guidelines on the management of scrotal SCC. Management especially inguinal nodal staging is based on penile cancer guidelines. • Tumor resection and inguinal node staging are required as the majority had invasive disease and around half had inguinal node or distant metastasis at presentation. Squamous cell carcinoma (SCC) of the scrotum is a rare and aggressive cancer. There are no established guidelines on the management of scrotal SCC. To analyze the clinical management and outcomes of scrotal SCC. A retrospective analysis of patients diagnosed with primary scrotal SCC over a 10-year period was performed. The type of surgery, tumor stage and histological subtypes, recurrence rate and metastases, cancer-specific mortality (CSM), and other-cause mortality (OCM) were analyzed. Between 2012 and 2022, a total of 10 men were identified with primary scrotal SCC. The median (interquartile, IQR) age was 65.5 (55–77) years. Wide local excision was performed in 9 patients and 1 patient underwent a total scrotectomy. The pathological T-stage was: pT1, n = 3; pT2, n = 1; pT3, n = 5 (50%); pT4, n = 1. Four patients had pathologically positive inguinal lymph nodes and 2 had distant metastatic disease at presentation. At a median (IQR) follow-up of 10.5 (4–31) months 5 patients died, of which 3 died from scrotal SCC. Scrotal SCC is extremely rare in the UK with only 10 primary cases identified in our center over the past 10 years. Surgical resection of the tumor and appropriate inguinal node staging are required due to a high proportion of cases which metastasize to the inguinal lymph nodes. Scrotal cancer is rare. 10 cases were diagnosed over 10 years at a single center. Around half had disease spread to the groin nodes or distant organs at presentation. Surgical resection was required in all patients. At the time of analysis, half of the patients are alive. Due to the rarity and aggressiveness of the cancer, management should be carried out within a specialist center. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration has recently approved the use of clascoterone for the treatment of acne vulgaris. This article looks at the use and mode of action of this topical anti-androgen, and considers where it will fit in the treatment regime if subsequent UK approval is granted. [ABSTRACT FROM AUTHOR]

To assess the diagnostic accuracy of commonly used signs and symptoms of low-intake dehydration in older care home residents. Prospective diagnostic accuracy study. 56 care homes offering residential, nursing, and/or dementia care to older adults in Norfolk and Suffolk, United Kingdom. 188 consecutively recruited care home residents aged ≥65 years, without cardiac or renal failure and not receiving palliative care. Overall, 66% were female, the mean age was 85.7 years (standard deviation 7.8), and the median Mini-Mental State Examination MMSE score was 23 (interquartile range 18-26). Over 2 hours, participants underwent double-blind assessment of 49 signs and symptoms of dehydration and measurement of serum osmolality from a venous blood sample. Signs and symptoms included skin turgor; mouth, skin, and axillary dryness; capillary refill; sunken eyes; blood pressure on resting and after standing; body temperature; pulse rate; and self-reported feelings of thirst and well-being. Serum osmolality, with current dehydration defined as >300 mOsm/kg, and impending dehydration ≥295 mOsm/kg. For dichotomous tests, we aimed for sensitivity and specificity >70%, and for continuous tests, an area under the curve in receiver operating characteristic plots of >0.7. Although 20% of residents had current low-intake dehydration and a further 28% impending dehydration, none of the commonly used clinical signs and symptoms usefully discriminated between participants with or without low-intake dehydration at either cut-off. This study consolidates evidence that commonly used signs and symptoms of dehydration lack even basic levels of diagnostic accuracy in older adults, implying that many who are dehydrated are not being identified, thus compromising their health and well-being. We suggest that these tests be withdrawn from practice and replaced with a 2-stage screening process that includes serum osmolarity, calculated from sodium, potassium, urea, and glucose levels (assessed routinely using the Khajuria and Krahn equation), followed by serum osmolality measurement for those identified as high risk (calculated serum osmolarity >295 mmol/L). [ABSTRACT FROM AUTHOR]

Because of concerns regarding the prevalence of Campylobacter in chicken meat, member countries in the European Union (EU) undertook a surveillance program to determine Campylobacter levels on chicken carcasses. A sample mass of 25 g principally composed of neck skin was used, although breast skin could also be used if there were insufficient neck skin to meet the required sample mass. The aim was to establish a baseline for Campylobacter contamination of carcasses against which future interventions could be assessed. However, in the United Kingdom researchers wanted to explore whether different ratios of neck to breast skin in samples could affect the results obtained. A comparison of the Campylobacter levels on neck and breast skin samples obtained from the same chilled chicken carcasses was undertaken at four chicken slaughterhouses. The neck skins were significantly more heavily contaminated (P < 0.05) with Campylobacter than was breast skin. Statistical analyses revealed no relationship that would allow a conversion between levels obtained on the two skin types. Ongoing surveillance of Campylobacter for 6 years was funded by United Kingdom poultry processors using samples consisting solely of neck skin, and the results of this surveillance (2011 to 2016) are reported here. Given the higher Campylobacter levels on a sample exclusively consisting of neck skin, this protocol could yield results with which the poultry industry would find it more difficult to achieve the contamination reduction target. The contamination reduction target for the United Kingdom (≤10% of chicken carcasses exceeding neck skin Campylobacter levels of 1,000 CFU/g) was not met by the end of 2015, the date stipulated by the United Kingdom government. Campylobacter levels on chicken neck and breast skin were compared. Neck skin was significantly more contaminated (P < 0.05) than breast skin. No relationship between the two skin types was found for Campylobacter levels. A UK government reduction target for highly contaminated chicken was not achieved. [ABSTRACT FROM AUTHOR]

There is growing appreciation of the important role of commensal microbes in ensuring the normal function and health of their hosts, including determining how hosts respond to pathogens. A range of infectious diseases are threatening amphibians worldwide, and evidence is accumulating that the host-associated bacteria that comprise the microbiome may be key in mediating interactions between amphibian hosts and infectious pathogens. We used 16S rRNA amplicon sequencing to quantify the skin microbial community structure of over 200 individual wild adult European common frogs (Rana temporaria), from ten populations with contrasting history of the lethal disease ranavirosis, caused by emerging viral pathogens belonging to the genus Ranavirus. All populations had similar species richness irrespective of disease history, but populations that have experienced historical outbreaks of ranavirosis have a distinct skin microbiome structure (beta diversity) when compared to sites where no outbreaks of the disease have occurred. At the individual level, neither age, body length, nor sex of the frog could predict the structure of the skin microbiota. Our data potentially support the hypothesis that variation among individuals in skin microbiome structure drive differences in susceptibility to infection and lethal outbreaks of disease. More generally, our results suggest that population-level processes are more important for driving differences in microbiome structure than variation among individuals within populations in key life history traits such as age and body size. [ABSTRACT FROM AUTHOR]

Lyme disease (borreliosis) is a tick-borne bacterial infection caused by the spirochaete Borrelia burgdoferi, transmitted by hard-backed Ixodes ticks. Actual numbers of cases are increasing and it appears that the distribution across the UK is widening; however, it occurs most frequently in area of woodland, with temperate climate. It typically presents in mid to late summer. Lyme disease is a multisystem disease. The nervous system is the second most commonly affected system after the skin. Other systemic manifestations, such as carditis, keratitis, uveitis and inflammatory arthritis, rarely occur in European Lyme disease. In 2018, the National Institute for Health and Care Excellence has updated its guidelines on the diagnosis and management of Lyme disease. Here, we highlight important aspects of this guidance and provide a more detailed review of the clinical spectrum of neuroborreliosis, illustrated by cases we have seen. [ABSTRACT FROM AUTHOR]

A retrospective audit of clinical data of patients was taken who required treatment for the management of moderately to highly exuding wounds. The inclusion criteria for this retrospective audit included patients (n=30) from the Worcestershire Health & Care NHS Trust that have already been treated and that required a wound dressing for the management of moderately to highly exuding wounds. Results and discussion: The results of the "in use" evaluations showed a high use of foam secondary dressings with adjunct treatments to manage exudate. However, 65% of these treatments did not meet the clinical objectives related to exudate management. The assessment of how effectively the patient's treatment regimens managed exudate produced by the various wounds showed that exudate management was rated as "poor" or only "adequate" in the majority of cases. It is noteworthy that a proportion of patients suffered from peri-wound skin conditions, e.g. eczema, maceration and excoriation. Over 95% of patients received peri-wound skin treatments to prevent/treat these conditions. As a consequence, these additional treatments add to the product costs and nursing time required. The use of appropriate wound dressings for the management of moderate to high levels of exudate would have prevented these severe skin conditions and likely significantly reduce treatment costs. Conclusion: This paper shows that 65% of the patients included in this audit failed to meet the clinical objective of exudate management. Adverse event sequelae such as skin maceration/excoriation occurred and, consequently, direct and indirect costs associated with treating these patients increased. Using a more appropriate wound dressing such as superabsorbent polymer demonstrated significantly reduced costs when compared to these audit costs. [ABSTRACT FROM AUTHOR]

Obective: To assess the patient satisfaction and wound outcomes in both techniques of wound closure Material and Methods: A prospective cohort study including all the patients who underwent elective open colorectal surgery, in a single unit, from May 2015 to May 2017 at Mid Cheshire Hospital Trust Crewe, UK. Patients allocated to Subcuticular-suture or Skin-clips groups randomly depending on surgeons' choice. Data was collected on patient demographics, type of surgery, and methods of skin closure, rate of wound infection, cosmetic satisfaction and overall patient satisfactions. Result: Three hundred and sixty nine patients were recruited and 218 patients completed the study, 134 patients were allocated to Skin Suture (SS) group with median age of 67 (IQR 61, 74). Skin Clips (SC) group had a total of 84 patients with a median age of 69 (IQR 61, 71). 15% of SS group developed wound infection, compared to 20% in SC group (p<0.05). Over all 61% of SS group claimed excellent results compared to 46% in SC group (p<0.05). Conclusion: Patients with non-absorbable subcuticular skin closure compared to skin-clips had low infection rates, better cosmetic and patient satisfaction outcome. [ABSTRACT FROM AUTHOR]

Background: Population-wide screening for melanoma is unlikely to be cost-effective. Nevertheless, targeted surveillance of high-risk individuals may be.Objectives: To estimate the cost-effectiveness of various surveillance strategies in the UK population, stratified by risk using a simple self-assessment tool scoring between 0 and 67.Methods: A decision model comparing alternative surveillance policies from the perspective of the UK National Health Service over 30 years was developed. The strategy with the highest expected net benefit for each risk score was identified, resulting in a compound risk-stratified policy describing the most cost-effective population-wide strategy. The overall expected cost and quality-adjusted life-years (QALYs), the incremental cost-effectiveness ratio, and associated uncertainty were reported.Results: The most cost-effective strategy is for those with a Williams score of 15 to 21 (relative risk [RR] of 0.79-1.60 vs. a mean score of 17 in the United Kingdom) to be offered a one-off full-body skin examination, and for those with a score of 22 or more (RR 1.79+) to be enrolled into a quinquennial monitoring program, rising to annual recall for those with a risk score greater than 43 (RR 20.95+). Expected incremental cost would be £164 million per annum (~0.1% of the National Health Service budget), gaining 15,947 additional QALYs and yielding an incremental cost-effectiveness ratio of £10,199/QALY gained (51.3% probability <£30,000).Conclusions: The risk-stratified policy would be expensive to implement but cost-effective compared with typical UK thresholds (£20,000-£30,000/QALY gained), although decision uncertainty is high. Phased implementation enrolling only higher risk individuals would be substantially less expensive, but with consequent foregone health gain. [ABSTRACT FROM AUTHOR]

Over the last decade, anthropologists have drawn attention to the disconnect between a political imagination that conceptualizes nation-states’ borders as unambiguous and linear, and the realities of borderlanders’ experience where cultural and social space is frequently folded and overlapping. Through their very focus on hybridity and crossborder linkages, however, border ethnographies have unwittingly given even more weight to linear demarcations—all the while insisting that they are abstract and ideological. In mining the border-as-skin somatic metaphor, this article foregrounds nonvisual bodily senses such as tactility in its analysis and suggests that the inclusion of proximate senses in ethnographies of border encounters offers significant analytical advantages. It moves away from the visuality that dominates political cartography, thus allowing for a more sensuous and synesthetic ethnographic work. Additionally, in heeding the recent research on topologies published by geographers and social theorists, the paper hopes to contribute to the emerging mathematical turn. [ABSTRACT FROM AUTHOR]

Though primarily used to improve neurodevelopmental outcomes, suppressive oral acyclovir therapy following neonatal herpes simplex virus disease also decreases cutaneous recurrences. Skin recurrences can still occur, however, and understanding their frequency is helpful in managing patients with this rare disease. [ABSTRACT FROM AUTHOR]

A content analysis of cosmetic advertisements in British and Kenyan women's lifestyle magazines from 1955 to 1975 (colonial time period) and 2000 to 2010 (postcolonial period) was conducted. The findings suggested Eurocentric beauty ideals originated in the colonial period, whereas British magazines set the pattern for skin tone. In the postcolonial period, an increased similarity of ideals was observed with Kenyan models reflecting the Eurocentric ideal in skin tone. Differences in gender portrayals reveal that the light skin ideal may be targeted more toward women than men. Meanwhile, changes in British magazines reveal the skin tone of models becomes slightly darker as skin tone for Kenyan magazine models become lighter. This suggests a homogenization of skin tone as different local cultures move towards what is considered ideal on a global level. [ABSTRACT FROM AUTHOR]

Objective: To investigate wound healing after application of adjunctive topical haemoglobin spray in patients with chronic wounds. Method: Consecutive patients with a diversity of chronic wounds (defined as <40% reduction in wound size within 4 weeks) were treated with standard wound care plus haemoglobin spray and evaluated over a 26-week period. Results were compared with a retrospective cohort of 50 consecutive patients treated with standard wound care alone. Results: We evaluated 50 patients for a 26-week evaluation period, during which 45/50 patients (90%) treated with haemoglobin spray were completely healed compared with 19/50 retrospective control patients (38%) (p<0.001). Mean time to complete wound healing was 6.6 weeks (range: 3-22) in the haemoglobin spray group compared with 11.4 weeks (range: 3-25) in the control group (p=0.01). Cox proportional hazards analysis model adjusting for baseline wound size and months wound present also yielded significant treatment effects. Exudate, slough and pain levels were all reduced to a greater extent versus control group. Conclusion: Haemoglobin spray resulted in a higher number of healed wounds and a faster rate of healing, as well as a positive impact on other wound parameters. These results are in accordance with other published data and supports the adjunctive use of haemoglobin spray in patients with a wide variety of chronic wounds of all sizes and origins. [ABSTRACT FROM AUTHOR]

Objective. The Patient-Reported Outcomes Measurement Information System (PROMIS)-29 assesses seven health-related quality of life domains plus pain intensity. The objective was to examine PROMIS- 29v2 validity and explore clinical associations in patients with SSc. Methods. English-speaking SSc patients in the Scleroderma Patient-centered Intervention Network Cohort from 26 sites in Canada, the USA and the UK completed the PROMIS-29v2 between July 2014 and November 2015. Enrolling physicians provided medical data. To examine convergent validity, hypotheses on the direction and magnitude of correlations with legacy measures were tested. For clinical associations, t-tests were conducted for dichotomous variables and PROMIS-29v2 domain scores. Effect sizes (ESs) were labelled as small (<0.25), small to moderate (<0.25-0.45), moderate (0.46-0.55), moderate to large (0.56-0.75) and large (>0.75). Results. There were 696 patients (87% female), mean (S.D.) disease duration 11.6 (8.7) years, 57% with limited cutaneous subtype. Validity indices were consistent with seven of nine hypotheses (//r// =0.51-0.87, P<0.001), with minor divergence for two hypotheses. Gastrointestinal involvement was associated with significantly worse outcomes for all eight PROMIS-29v2 domains (moderate or moderate to large ES in six of eight). Presence of joint contractures was associated with significant decrements in seven domains (small or small to moderate ESs). Skin thickening, diffuse cutaneous subtype and presence of overlap syndromes were significantly associated (small or small to moderate ESs) with five or six domains. Conclusion. This study further establishes the validity of the PROMIS-29v2 in SSc and underlines the importance of gastrointestinal symptoms and joint contractures in reduced health-related quality of life. [ABSTRACT FROM AUTHOR]

In women with lightly pigmented skin in particular, facial skin color homogeneity decreases with age, primarily due to chronic exposure to solar ultraviolet radiation (UVR), leading to a decrease in perceived health and attractiveness. Perception of female skin may be influenced by continuous exposure to, and thus familiarity with, age-related changes in visible skin condition in a given society. Men and women of two traditional societies, the Maasai (Tanzania) and the Tsimane' (Bolivia), unfamiliar with lighter colored skin, judged images of British women's facial skin for age, health, and attractiveness. In both samples, images with homogeneous skin color (from the cheeks of younger women) were judged to be younger and healthier and received a stronger preference than corresponding images with heterogeneous skin color (from older women). We suggest that (i) human sensitivity for quality-related information from facial skin color distribution is universal and independent of any known age-dependent variation in skin in a given population and (ii) skin discoloration is universally associated with less positive judgment. [ABSTRACT FROM AUTHOR]

The 2023 Annual Review Issue of The Journal of Pathology, Recent Advances in Pathology, contains 12 invited reviews on topics of current interest in pathology. This year, our subjects include immuno-oncology and computational pathology approaches for diagnostic and research applications in human disease. Reviews on the tissue microenvironment include the effects of apoptotic cell-derived exosomes, how understanding the tumour microenvironment predicts prognosis, and the growing appreciation of the diverse functions of fibroblast subtypes in health and disease. We also include up-to-date reviews of modern aspects of the molecular basis of malignancies, and our final review covers new knowledge of vascular and lymphatic regeneration in cardiac disease. All of the reviews contained in this issue are written by expert groups of authors selected to discuss the recent progress in their particular fields and all articles are freely available online (https://pathsocjournals.onlinelibrary.wiley.com/journal/10969896). © 2023 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd., (© 2023 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.)

Background: People with black skin are much less susceptible to sunburn than white‐skinned individuals, yet there are scarce data on self‐reported incidence of sunburn and sun protection measures in people with deeply‐pigmented skin. Method: An on‐line survey tool was used to collect self‐assessed data about demographic variables, sunburn incidence, and use of sun protection modalities. Results: Two‐thirds of respondents with black skin living in the UK claimed never to have been sunburnt; a much higher proportion than those living in South Africa and Nigeria where 34 and 46%, respectively, reported never experiencing sunburn. Similar results were seen in the reported use of sun protection measures between the countries with two‐thirds of black people living in the UK claiming they never used any form of sun protection compared with about one‐third of Black Africans. Black people living in the UK were more likely to use sunscreen as a form of sun protection, whereas sunscreen was the least popular modality in the two African countries with shade being the most common form of limiting sun exposure. Conclusion: The findings provide some insight into the complexities of skin color perception, incidence of sunburn, and sun protection use among people with deeply‐pigmented skin living in three countries with large differences in the solar UV environment. [ABSTRACT FROM AUTHOR]

Pressure ulcers are complex wounds caused by pressure- and shear-induced trauma to skin and underlying tissues. Pressure-reducing devices, such as dressings, have been shown to successfully reduce pressure ulcer incidence, when used in adjunct to pressure ulcer preventative care. While pressure-reducing devices are available in a range of materials, with differing mechanical properties, understanding of how a material's mechanical properties will influence clinical efficacy remains limited. The aim of this study was to establish a standardized ex vivo model to allow comparison of the cell protection potential of two gel-like pressure-reducing devices with differing mechanical properties (elastic moduli of 77 vs. 35 kPa). The devices also displayed differing energy dissipation under compressive loading, and resisted strain differently under constant load in compressive creep tests. To evaluate biological efficacy we employed a new ex vivo porcine skin model, with a confirmed elastic moduli closely matching that of human skin (113 vs. 119 kPa, respectively). Static loads up to 20 kPa were applied to porcine skin ex vivo with subsequent evaluation of pressure-induced cell death and cytokine release. Pressure application alone increased the percentage of epidermal apoptotic cells from less than 2% to over 40%, and increased cellular secretion of the pro-inflammatory cytokine TNF-alpha. Co-application of a pressure-reducing device significantly reduced both cellular apoptosis and cytokine production, protecting against cellular damage. These data reveal new insight into the relationship between mechanical properties of pressure-reducing devices and their biological effects. After appropriate validation of these results in clinical pressure ulcer prevention with all tissue layers present between the bony prominence and external surface, this ex vivo porcine skin model could be widely employed to optimize design and evaluation of devices aimed at reducing pressure-induced skin damage. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a common problem in patients with faecal and/or urinary incontinence. Urine alters the normal skin flora and increases permeability of the stratum corneum and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. However, IAD can be prevented and healed with timely and appropriate skin cleansing and skin protection. This includes appropriate use of containment devices. This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin’s acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage. [ABSTRACT FROM AUTHOR]

It is estimated that around one in 500 people in the UK are living with a stoma, with approximately 21 000 operations that result in stoma formation being performed each year (Colostomy Association, 2016). These people face a unique set of challenges in maintaining the integrity of their peristomal skin. This article explores the normal structure and function of skin and how the care and management of a stoma presents challenges for maintaining peristomal skin health. Particular focus is paid to the incidence of skin problems for those living with a stoma, whether it is temporary or permanent, and the factors that contribute to skin breakdown in this population. Wider factors such as the central role of the clinical nurse specialist and the impact of product usage on positive outcomes and health economics are also considered. [ABSTRACT FROM AUTHOR]

This article examines the strange case of Hannah West, a 'very fair female of the white race of mankind' who had patches of black skin upon her body. A closer glance at William Charles Wells's 1818 posthumous publication of her case, Account of A female of the white race of mankind, part of whose skin resembles that of a Negro, exposes the process through which Wells crafted an incipient theory of natural selection that was based upon the belief that innate racial differences between blacks and whites were a result of generational adaptations to specific disease environments. Finally, this article demonstrates how Wells maintained Hannah West's whiteness, despite the potential for her skin to disrupt commonly held associations between skin colour and race. Rather than casting her as a racially transformative figure, Wells used her case to not only reify but also reaffirm the distinctiveness of black and white bodies. [ABSTRACT FROM AUTHOR]

This article outlines my journey from tissue viability specialist nurse in the community to tissue viability specialist nurse in offender health and the challenges I have encountered along the way. Since coming into this post, I have concentrated on pressure ulcer risk assessment, leg ulcer management, documentation and staff training. The patients I have been involved with have a variety of wounds that can be quite complex in nature. Intravenous drug use is an ongoing problem and, as a consequence, some of our patients have complicated leg ulcers. Although the service is still developing, progress has been made and we are now looking to expand the team. [ABSTRACT FROM AUTHOR]

Objective evaluation of cutaneous wounds through use of noninvasive devices has important implications for diagnosis, monitoring treatment efficacy, progression and may lead to development of improved theranostic treatment strategies. However, there is a lack of validation in the use of certain devices in wound repair, where objective measurements taken by noninvasive devices have been corroborated by immunohistochemical analysis. Thus, data from three acute wound-healing studies in healthy volunteers using three noninvasive objective devices were further evaluated by immunohistochemistry. One hundred ten participants had 5-mm diameter skin biopsies to their arms. Spectrophotometric intracutaneous analysis (SIAscopy), full-field laser perfusion imaging, and three-dimensional imaging provided quantitative measurements of melanin, hemoglobin, collagen, blood flow, and wound size; all of which were validated by immunohistochemistry. Full-field laser perfusion imaging showed blood flow increased to D7 and decreased by 40% to D14. SIAscopy showed that hemoglobin increased to D7 and reduced to D14. CD31 analysis corroborated this by showing a 76% increase in blood vessel density to D7 and a reduction by 14% to D14. Three-dimensional imaging showed that wound surface area reduced by 50% from day 7 to day 14. Alpha-smooth muscle Actin (Alpha-SMA) staining supported these trends by showing increased levels by 72% from D0 to D14 (corresponding to wound contraction). Collagen, measured by SIAscopy, decreased to D7 and increased to D14, which was validated by collagen III analysis. Additionally, collagen I increased by 14% from D0 to D14. SIAscopy measurements for melanin showed an increase at D7 and a slight reduction to D14, while melanogenesis increased by 46.7% from D0 to D14. These findings show the utility of noninvasive objective devices in the quantitative evaluation of woundhealing parameters in human skin as corroborated by immunohistochemistry. This may contribute to the development of prognostic parameters for assessment of response to wound therapy. [ABSTRACT FROM AUTHOR]

This article describes a recent training workshop to educate children's nurses on injection technique best practice for diabetes, in particular, lipohypertrophy. The workshop was organised by the Forum for Injection Technique UK, the University of York, Leeds Children's Diabetes Team and Becton Dickinson Signature Solutions, and attended by delegates from Leeds Children's Hospital and the Children and Young Peoples Diabetes Network for Yorkshire and the Humber. The article discusses the causes of lipohypertrophy and the effect it can have on patient's glycaemic levels. There is an emphasis on the importance of regularly inspecting children and young people with diabetes for lipohypertrophy -- a common complication of diabetes injection -- and promotes the motto 'suspect, detect and protect'. The article also provides practical information for children's nurses on how to examine for lipohypertrophic lesions and guidance on how they can be prevented by adhering to correct injection technique. [ABSTRACT FROM AUTHOR]

Tea consumption has been shown to protect against skin carcinogenesis in laboratory-based studies; however, epidemiological evidence is limited and inconsistent. This prospective study examined the association between black tea consumption and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Usual black tea consumption was estimated from food frequency questionnaires completed in 1992, 1994, and 1996 by 1,325 Australian adults. All histologically confirmed skin cancers diagnosed in participants from 1997 to 2007 were recorded. Relative risks (RRs) and 95% confidence intervals (CIs) were assessed using generalized linear models with Poisson and negative binomial distributions and adjusted for confounding factors including skin phenotype and sun exposure. Compared with never drinking black tea, drinking ≥4 cups/day was not associated with BCC (RR = 1.03, 95% CI: 0.70–1.53;P-trend = 0.74) or SCC (RR = 1.25, 95% CI: 0.71–2.19;P-trend = 0.29) in person-based analyses. Stratification by previous history of skin cancer as well as tumor-based analyses also showed no significant associations between black tea intake and incidence of BCC or SCC tumors. Our results do not support the hypothesis that high black tea consumption reduces risk of skin cancer, including in people with a previous history of skin cancer. [ABSTRACT FROM PUBLISHER]

Surgical site infection (SSI) is a common healthcare-associated infection (HCAI) and complicates up to 10-15% of operations, with considerable healthcare resources expended in the process. In addition to the use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and peri-operative blood glucose control to reduce SSIs, there is new research and outcomes that should be considered for inclusion in guidelines. The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and peri-operative oxygen supplementation to prevent SSIs remains doubtful. However, the use of 2% chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic surgical dressings do show promise. Antimicrobial sutures, in independent meta-analyses, reduced the risk of SSI after most classes of surgery, whereas wound guards did not. The incidence of SSI is not falling and is proportionally rising as the most common HCAI. Some innovations should be included into care bundles, but more research is required for others, together with improved compliance with care bundles. [ABSTRACT FROM AUTHOR]

Purpose. To investigate the range of collimation errors in x-ray rooms and to calculate their possible effects on the radiation dose for anteroposterior pelvic examinations. Methods. A collimator test tool was suspended at 3 heights (14, 21, and 28 cm) above the table Bucky in 9 x-ray rooms. Heights corresponded to the typical patient thickness (mean, ± 2 SD) of 67 patients undergoing anteroposterior pelvic radiography. The x-ray beam was visually collimated to the inner boundary of the test tool and exposed to radiation. Differences between the visualized field size and the resultant x-ray field size (corrected for magnification) indicated a collimation error. Next, using a pelvic phantom, minimum textbook collimation was set and then changed and verified to simulate a range of possible collimation errors. Phantom examinations used a standard anteroposterior technique with exposure termination using outer automatic exposure control chambers. Dose area product (DAP) was recorded. Results. All but 1 of the 9 x-ray machines had a smaller irradiated area than was visually set. Errors ranged from a 16% reduction in irradiated field size to a slight overirradiation by 0.4%. Assuming that these errors could be larger in other institutions, additional errors with a range of 27% to 18% were simulated. Increases in field size by 1 cm (superiorly/inferiorly) increased the DAP by 5%. Laterally, a 1-cm increase caused a 4% rise in DAP. Increases of 1 cm in both planes raised DAP by 4%. Discussion. Within a single clinical department, minimal collimation errors were demonstrated. Further evidence from multiple centers would be beneficial; however, such low incidences might reflect strict legislative requirements governing the use of ionizing radiation. Understanding the magnitude of any error is important, but it is also important to ascertain an error’s influence on the effective radiation dose for any given examination. Conclusion. Overall, collimation errors were minimal and favored underirradiation. Small collimation errors can affect DAP and are more dose significant in the superior/inferior plane. [ABSTRACT FROM AUTHOR]

Wound care clinicians need to maintain the integrity of the periwound skin while ensuring the best wound healing environment. In cases where incontinence or high levels of exudate are present, there is a higher risk of damage to the surrounding skin. The author assess the new finoderm range of skin protection products, which are designed to minimise any potential trauma to periwound skin from damage from exudate or the mechanical impact of adhesive dressings. [ABSTRACT FROM AUTHOR]

Objectives. Juvenile localized scleroderma (JLS) is a rare condition that is often difficult to assess and for which a variety of monitoring tools have been described. We aimed to describe how monitoring tools are used and perceived by clinicians in the UK, to ascertain treatments used for JLS and to provide a description of transition arrangements to adult care.Methods. An e-survey of UK paediatric rheumatologists and dermatologists managing children and young people (CYP) with JLS was distributed using the national organisations representing these clinician groups. We asked respondents for their views and experience using 15 JLS monitoring tools, about transition services and about treatments used.Results. Thirty-five dermatologists and 13 paediatric rheumatologists responded. Paediatric rheumatologists managed more CYP with JLS than dermatologists (median 16–20 and 3, respectively). Transition arrangements were reported by 43% of dermatologists and 91% of paediatric rheumatologists. Medical photography was the most frequently regularly used monitoring tool (73% respondents). The modified Rodnan skin score was the skin score used most commonly: 33% of paediatric rheumatologists and 3% of dermatologists reported using this tool frequently. Topical treatments and ultraviolet light were used by 49–80% of dermatologists and 0–8% paediatric rheumatologists. Biologic drugs and CYC were used by 0–3% of dermatologists and 31–46% of paediatric rheumatologists.Conclusion. How monitoring tools are accessed, used and perceived by paediatric rheumatologists and dermatologists in the UK varies between and within clinician groups, as do treatment prescribing patterns and transition arrangements. These differences will impact on the feasibility of conducting multicentre clinical trials and on standardising clinical care. [ABSTRACT FROM PUBLISHER]

Skin reactions are a common side effect of radiotherapy. Radiotherapy damages basal cells and skin reactions occur when the basal layer is unable to produce enough new cells to compensate for the loss of damaged cells at the skin’s surface. Skin reactions progress from erythema, through dry desquamation to moist desquamation. As yet, there are no nationally recognised guidelines for the management of radiotherapy-induced skin reactions. As a result, there is widespread variation in practice throughout the UK. Hydrocolloid and hydrogel dressings have been used to treat moist desquamation. However, this article describes the successful clinical experience with an alternative dressing, Mepilex Lite®. The clinical evidence presented also raises the question of whether Mepilex Lite can be used prophylactically as an alternative to aqueous cream on grade 1 (erythema) reactions. Further evidence on this indication for Mepilex Lite will be published in a BJN supplement in November 2014. [ABSTRACT FROM AUTHOR]

This article considers the anatomy and physiology of the skin,wound healing, excoriation, maceration, peristomal skin and the importance of periwound protection. The results of a 54-patient study of the use of barrier film forming skin protection in periwound skin are presented and a 10-patient healthy volunteer experimental evaluation. The results confirm the effectiveness of barrier protection in healthy skin in an experimental evaluation and a 54-patient study requiring periwound protection. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) is considered to be an effective wound treatment, yet research has highlighted a clear need for its improvement, particularly in reducing pain. This is important not only for patient well-being and treatment satisfaction but also for the healing process. In parts 1 and 2, wound care clinicians were invited to share their views on patients' experiences of NPWT. Part 3, presented here, explores the views of patients who have had NPWT, through use of a questionnaire survey and interview (n = 50). Findings show that the majority of patients felt that NPWT had a positive impact on their wound (94%) and that their overall experience was positive (88%). However, respondents identified a number of challenges associated with NPWT, such as reduced mobility, noise issues, and sleep disturbance. Respondents also identified a number of areas for improvement with NPWT, including greater training for nurses, practical alterations to the equipment,and methods of minimising pain and skin damage during NPWT. Taken together with the findings from part one and two, this study highlights several key considerations for future research and clinical practice with NPWT. [ABSTRACT FROM AUTHOR]

The study involves 95 subjects within a UK Primary Care Organisation and was undertaken in two arms. The objective was to determine the clinical outcomes and clinical acceptability of a newly available range of no-sting barrier film and no-sting barrier cream products offering significant financial benefits. The importance of undertaking this study is underpinned by evidence in the literature relating to the use of no-sting barrier preparations within clinical practice. The first part of the study (arm 1) involved extensive evaluation of either the film or cream barrier in 36 patients and was compared to existing standardised barrier protection care within the organisation. The results indicated that the new product range met all the criteria for formulary inclusion and following this the barrier range was further evaluated in arm 2, 33 patients with barrier cream and 26 patients with barrier film. The entire study was conducted over a 3-month period with patient treatment lasting a minimum of 2 days to a maximum 4-week period adhering to the agreed evaluation protocol as approved by clinical governance. In arm 1 ( n = 36), the clinical expectation of the product was met in 32 cases relating to ease of use, conformability, no-sting, quick drying, ease of absorption, compatibility with devices, frequency of application, prevention and management including visual skin improvement resulting in a recommendation for formulary listing in 31 of 36 cases. In arm 2 ( n = 59), barrier film and barrier cream performance was consistently rated same as, better than or much better than the existing barrier used. A formulary listing recommendation was made in 51 of 59 cases. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. However, structured knowledge to mitigate a patient's specific risk of developing adverse events are limited. Nevertheless, there is an exponential growth of clinical studies combining conventional therapies such as radiation therapy (RT) with ICIs. Cutaneous reactions are among the most common adverse events after monotherapy with either ICIs or RT. So far, little is known about interindividual differences for the risk of developing severe tissue toxicity after the combination of RT with ICIs, and the underlying biological mechanisms are ill defined. We used experimental models of RT-induced skin injury to analyze skin toxicity after simultaneous application of ICIs. We compared different RT regimens such as fractionated or stereotactic RT with varying dose intensity. Strikingly, we found that simultaneous application of RT and ICIs did not significantly aggravate acute skin injury in two different mouse strains. Detailed examination of long-term tissue damage of the skin revealed similar signs of epidermal hyperplasia, dermal fibrosis, and adnexal atrophy. In summary, we here present the first experimental study demonstrating the excellent safety profiles of concurrent treatment with RT and ICIs. These findings will help to interpret the development of adverse events of the skin after radioimmunotherapy and guide the design of new clinical trials and clinical decision-making in individual cases. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland., (© 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.)

Aims and objectives To explore the practice of nurses who prescribe medication for patients with skin conditions. Background Nurses have lead roles in dermatology services. In the United Kingdom, nurses in primary care frequently prescribe medicines for skin conditions, but there are concerns about role preparation and access to continuing professional development. The prescribing practices of nurse independent supplementary prescribers who care for patients with skin conditions are under-researched. Design Cross-sectional survey. Methods An online questionnaire was used to survey 186 nurses who prescribed for skin conditions from May-July 2010. Data were analysed using descriptive statistics and nonparametric tests. Results The majority worked in primary care (78%) and general practice (111, 59·7%). Twenty (10·8%) had specialist modules (at diploma, degree or master's level), 104 (55·9%) had dermatology training (e.g. study days), 44 (23·7%) had no training, and a further 18 (9·6%) did not respond. Oral antibiotics, topical antifungal and antibacterial drugs were frequently prescribed. Nurses with specialist dermatology training used their qualification in a greater number of ways, prescribed the broadest range of products and prescribed more items per week. Over 70% reporting on continuing professional development had been able to access it. Conclusions A large number of nurses in primary care prescribe medicines for skin conditions and are involved in medicines management activities. Lack of specialist dermatology training is a concern and associated with lower prescribing-related activities. Access to dermatology training and continuing professional development are required to support nurse development in this area of practice and maximise benefits. Relevance to clinical practice Nurse prescribers' involvement in medicines management activities has important implications in terms of improving access to services, efficiency and cost savings. To maximise their contribution, improved provision of specialist dermatology training is required. This will be of interest to education providers and service planners in the UK and countries around the world. [ABSTRACT FROM AUTHOR]

Summary: Surgical excision remains the gold standard for the management of cutaneous squamous cell cancers (SCC) and national guidelines for operative radial margins predict 95% oncological clearance with a margin of 4 mm for low-risk and 6 mm for high-risk tumours. We retrospectively analysed all cutaneous SCC excisions performed across 4 regional Plastic surgical units in England over a consecutive 24-month period and collected data on tumour characteristics, operative and histological margins and completeness of excision. We identified 633 eligible SCC excisions of which 265 (42%) were over 2 cm in diameter with 37 recurrent tumours (5.8%). The mean radial operative margin was 6.5 mm across all tumours and 8.4 mm for tumours greater than 2 cm. The mean histological tumour diameter was 21 mm. The overall incomplete excision rate was 7.6% (7.9% for tumours >2 cm). Ninety-four percent (45/48) of incomplete excisions involved the deep margin and only 3 out of 633 excisions (0.47%) were incomplete at a radial margin only. No differences were observed in tumour size or excision margin between incompletely and completely excised tumours. Incomplete excisions were most common on the ear, nose and cheek. In summary our analysis demonstrates that despite adherence to recommended surgical margins for cutaneous SCCs the incomplete excision rate remains higher than expected. We believe that this is because most incomplete excisions are incomplete at the deep margin and question the utility of performing increasingly wide excisions, and, the generalisability of the evidence upon which recommendations for radial margins are based. [ABSTRACT FROM AUTHOR]

The long-chain n-3 PUFA, EPA, is believed to be important for skin health, including roles in the modulation of inflammation and protection from photodamage. FFQ and blood levels are used as non-invasive proxies for assessing skin PUFA levels, but studies examining how well these proxies reflect target organ content are lacking. In seventy-eight healthy women (mean age 42·8, range 21–60 years) residing in Greater Manchester, we performed a quantitative analysis of long-chain n-3 PUFA nutrition estimated from a self-reported FFQ (n 75) and correlated this with n-3 PUFA concentrations in erythrocytes (n 72) and dermis (n 39). Linear associations between the three n-3 PUFA measurements were assessed by Spearman correlation coefficients and agreement between these measurements was estimated. Average total dietary content of the principal long-chain n-3 PUFA EPA and DHA was 171 (sd 168) and 236 (sd 248) mg/d, respectively. EPA showed significant correlations between FFQ assessments and both erythrocyte (r 0·57, P< 0·0001) and dermal (r 0·33, P= 0·05) levels, as well as between erythrocytes and dermis (r 0·45, P= 0·008). FFQ intake of DHA and the sum of n-3 PUFA also correlated well with erythrocyte concentrations (r 0·50, P< 0·0001; r 0·27, P= 0·03). Agreement between ranked thirds of dietary intake, blood and dermis approached 50 % for EPA and DHA, though gross misclassification was lower for EPA. Thus, FFQ estimates and circulating levels of the dietary long-chain n-3 PUFA, EPA, may be utilised as well-correlated measures of its dermal bioavailability. [ABSTRACT FROM PUBLISHER]