Lower 25-hydroxyvitamin D2/D3 levels at melanoma diagnosis are associated with thicker primaries and poorer survival. We postulated that this might relate to the deleterious effect of systemic inflammation as 25-hydroxyvitamin D2/D3 levels are inversely associated with levels of C-reactive protein. 2182 participants in the Leeds Melanoma Cohort (median follow up 7.98 years) provided data on drug exposure, co-morbidities and a serum 25-hydroxyvitamin D2/D3 level at recruitment. Factors reported to modify systemic inflammation (low vitamin D levels, high body mass index (BMI), use of aspirin or non-steroidal anti-inflammatory drugs or smoking were tested as predictors of microscopic ulceration (in which primary tumours are inflamed) and melanoma specific survival (MSS). Ulceration was independently associated with lower 25-hydroxyvitamin D2/D3 levels (OR=0.94 per 10nmol/L, 95% CI 0.88–1.00, p=0.05) and smoking at diagnosis (OR=1.47, 95% CI 1.00–2.15, p= 0.04). In analyses adjusted for age and sex, a protective effect was seen of 25-hydroxyvitamin D2/D3 levels at diagnosis on melanoma death (OR=0.89 per 10nmol/L, 95% CI 0.83–0.95, p<0.001) and smoking increased the risk of death (OR=1.13 per 10 years, 95% CI 1.05–1.22, p=0.001). In multivariable analyses (adjusted for tumour thickness) the associations with death from melanoma were low 25-hydroxyvitamin D2/D3 level at recruitment (<20 nmol/L vs. 20–60 nmol/L, HR=1.52, 95% CI 0.97–2.40, p=0.07) and smoking duration at diagnosis (HR=1.11, 95% CI 1.03–1.20, p=0.009). The study shows evidence that lower vitamin D levels and smoking are associated with ulceration of primary melanomas and poorer MSS. Further analyses are necessary to understand any biological mechanisms that underlie these findings.

Background: Personal protective equipment (PPE) is defined as equipment that protects the wearer's body against health/safety risks at work. Gloves cause many dermatoses. Non-glove PPE constitutes a wide array of garments. Dermatoses resulting from these have hitherto not been documented.Objectives: To determine the incidence and types of non-glove PPE-related dermatoses.Patients/Methods: We analysed incident case reports from dermatologists of non-glove PPErelated dermatoses to a UK-wide surveillance scheme (EPIDERM) between 1993 and 2013.Results: The dermatoses associated with non-glove PPE accounted for 0.84% of all occupational skin disease. Of all PPE-related cases, 194 (9.2%) were attributable to non-glove PPE. Of these, 132 (68.0%) occurred in men, and the median age (both male and female) was 42 years (range 18-82 years). The non-glove PPE-related dermatoses were diagnosed as: allergic contact dermatitis (47.4%), irritant contact dermatitis (16.0%), friction (11.3%), occlusion (11.3%), unspecified dermatitis (8.8%), acne (3.1%), infections (1.5), and contact urticaria (0.52%). The industries most associated with non-glove PPE-related dermatoses were manufacturing (18.6%), public administration and defence (17.0%), health and social work (15.5%), and transport, storage, and communication (9.8%).Conclusions: Clothing, footwear, facemasks and headgear need to be recognized as causes of dermatoses occurring at body sites less commonly associated with occupational skin disease.

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Methylisothiazolinone is particularly relevant at present as strategies to control the outbreak are yet to be enforced and there is no current evidence of the outbreak abating.