To estimate the population-based incidence of first and multiple basal cell carcinomas (BCCs) throughout Europe.Design: The registry practices of 4 population-based cancer registries that routinely register BCC incidence were evaluated for inclusion of first and subsequent histologically confirmed BCCs. Where multiple BCCs were not routinely registered, comparisons with hospital databases were made.Data Sources: Cancer registry databases from Finland, Malta, the Netherlands (Eindhoven), and Scotland were inspected for registry of first and multiple BCCs in recent years. Cross-checks with hospital and pathology databases were made to check for completeness.Results: Age-standardized first BCC incidence rates varied between 77 (Malta) and 158 (Eindhoven) per 100 000 person-years. Generally, rates were higher in males than in females, and incidences increased steeply with increasing age. There were approximately 30% more patients with a BCC and 40% to 100% more BCC tumors diagnosed in a given calendar year than were routinely reported for patients with a first primary BCC. The difference between the number of first primary BCCs and the total number of BCCs in a calendar year was generally slightly higher for males than for females and increased substantially with increasing age. Conclusion:Currently, routinely reported first BCC incidence rates of the included countries should be multiplied by a factor of 1.3 for an estimate of total number of patients diagnosed as having a BCC in a given year.

SummaryBackground Limited data are available on how often basal cell carcinomas (BCCs) are clinically diagnosed without histological confirmation and how they are treated. Objectives Within the framework of the EPIDERM project, an audit was conducted in four European countries to study the occurrence of clinically diagnosed BCCs without histological confirmation and to investigate how these are treated. Methods In the Netherlands, Scotland, Finland and Malta studies were performed within different timeframes. Patients with one or more BCC(s) were selected and the number of clinically diagnosed BCCs without histological confirmation and their treatment was investigated by (manually) reviewing the (electronic) patient records and checking the (hospital) pathology databases to find evidence of histological confirmation. Results In the Netherlands, 1089 patients with a first histologically confirmed BCC developed 1974 BCCs of which 1833 (92AE9%) were histologically confirmed and 141 (7AE1%) were not. A 4-month retrospective study conducted in Scotland selected 294 patients with 344 BCCs; 306 (89AE0%) were histologically confirmed and 38 (11AE0%) were not. A 3-month prospective study performed at the same centre in Scotland identified 44 patients who developed 58 BCCs; 44 (75AE9%) of these were histologically confirmed and 14 (24AE1%) were not. In Finland, there were 701 patients who developed 977 BCCs, of which 807 (82AE6%) were histologically and 170 (17AE4%) nonhistologically confirmed. In Malta, there were 420 patients with 477 BCCs. Only three (0AE7%) of them were clinically diagnosed without histological confirmation. In the Netherlands and Finland, clinically diagnosed BCCs without histological confirmation were most often treated with cryotherapy, whereas in Scotland 5% imiquimod cream was the preferred treatment modality. Conclusions Although the frequency of clinically diagnosed BCCs without histological confirmation differed between the four European regions (range 0AE7-24AE1%), this confirms that the burden of BCC in Europe is underestimated when based on data from pathology and ⁄or cancer registries.

Liebe Regine, I am grateful to you for your focus on the foundation matrix. You have kept it alive in Group Analysis (Scholz, 2003(Scholz, , 2011(Scholz, , 2014. I want to ground my response in my own understanding of the foundation matrix, then underline your proposal of 'protected and open spaces' (Scholz, 2022).My view of the foundation matrix is influenced by my being a medical doctor. To me, it is the physiological matrix. It is the map of the expected world, drawn to the scale of our human bodies. We communicate in large part through spoken language and gesture, which are breath and movement, even if meanings are not always shared. We expect a world where there are children and adults and they are not the same-and of men and women. We expect an immediate social world navigable by walking, manipulable through hand and finger movements. These views are not complete, as we all know. They lead to exclusions and inclusions, and produce the anxiety of being placed outside the norm, and the quiet confidence of being included without even realizing it. And even that wordanxiety-relates to our foundation matrix. We can make sense of the rising heart rate, shakiness, dry mouth, and so on, in a relatively shared way.

Having in mind those gripped by ambivalence over whether to start, or stay on, the Qualifying Course in Group Analysis, we consider the training as one in ambivalence. We see ambivalence as an asset, not a hindrance. Forsaking familiar notions of ambivalence as weak and anxious, the task is to move towards a confident ambivalence. Using the ambivalent etymology of the word ‘threshold’ as an analytic lens, we use threshold not in the sense of a wooden solid boundary to be overcome, but rather as a threshing room. This article is co-written by two people different in terms of race, gender, sexuality, socio-economic background, age and experience. We argue that understanding the relationship between difference and ambivalence is crucial. This is not only because difference matters in itself. This article argues that ambivalence finds separate expressions through these differences, which act as a symbolic site. Our experience as Manchester trainees proves that threshing of the wheat from the chaff cannot happen on seemingly rigid boundaries. Rather, it happens in thresholds. In all this, examining the way ambivalence functions through power, privilege and position, we return to the ambivalent question: Do you want group analysis? And does it want you?