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Misinformation on diseases and treatments is a worldwide threat and can lead to worse outcomes for patients with skin cancer. The aim of this study was to qualitatively assess the content of online misinformation related to skin cancer. Searches were performed via PubMed and Google using the terms 'skin cancer' OR 'melanoma' OR 'non-melanoma skin cancer' OR 'SCC' OR 'BCC' AND 'misinformation' OR 'disinformation' OR 'conspiracy theories'. The most common themes of misinformation related to skin cancer included assertions of the 'dangers' of using sunscreen and alternative sunscreen practices; promotion of tanning and Melanotan (an unlicensed and untested form of a-melanocyte-stimulating hormone) as safe practices; claims that risk of skin cancer are limited to people who are older or have fair skin; and assertions of alternative 'causes' and alternative 'cures' for skin cancer. Sunscreen was particularly vilified as being an ineffective prophylactic measure and a cause of skin cancer. Dermatologists should be aware of misinformation available online relating to skin cancer, and refute and rebut misleading health information.

Background: Conventional testing methods for dermatophytes are time-consuming, and resource limitations in our institution have prompted curtailed access to these diagnostics.Objectives: Evaluation of our hospital's dermatological mycology diagnostic services and similar services nationally. Methods:This was a retrospective observational study on skin, hair and nail mycology samples in our institution comparing twenty five-year periods (2011-2015 and 2016-2021), including analysis of dermatology clinic data and correspondence related to fungal infection. A survey of national public hospitals' laboratories was conducted to evaluate their mycology testing capabilities. Results:The total 5 year test count prior to curtailment was 4851 specimens comprising 90% (n = 4344) from general practice and 6% (n = 290) from dermatology clinics. For the 5 years post curtailment, 64.5% (582/903) of specimens were from dermatology clinics. Dermatology clinic data demonstrated doubling of attendances (for all conditions) and of correspondence related to fungal infection. During this time also, national dermatological antifungal purchasing increased 11%. Ten of 28 Irish public hospital laboratories reported the provision of in-house dermatological mycology testing, and none had routine availability of susceptibility or molecular testing of dermatophytes. Conclusion:This study is the first to report an appraisal of dermatological fungal diagnostic services in Ireland. Insufficient testing capacity implies that patients are either being treated for fungal infection without appropriate diagnostic confirmation, or being left untreated because of the lack of access to diagnostics. The introduction of molecular detection methods and susceptibility systems would enhance testing capabilities and reduce the requirement for the external referral.

Background Evidence based consensus guidelines for venous thromboembolism (VTE) prevention are broadly accepted to be effective and safe for more than three decades (Clagett GP et al, 1992). However VTE continues to be associated with a major global burden of disease with 3.9 million cases of HAT during one year among 1.1 billion citizens of high income countries (Jha AK et al, 2013). Therefore prevention is the key to reduce death and disability resulting from VTE (Kahn S et al, Gould MK et al & Falck-Yitter Y et al, 2012). Ireland like many other countries has yet to implement a mandatory risk assessment tool and thromboprophylaxis (TP) policy nationally. Aims The aim of this study was to calculate the proportion of inpatients who had a VTE risk assessment performed and received appropriate TP in a large tertiary referral hospital. This information will be vital for baseline data for implementation of a new national policy for prevention of HAT. Methods This audit was performed at Cork University Hospital on 4 pre specified days between November 2014 to February 2015. All adult inpatients (Medical and Surgical) excluding maternity and psychiatric were included. Patients on therapeutic anticoagulation were also excluded. The patients' medical chart and drug prescription chart were reviewed to determine whether or not a VTE risk assessment was documented for each patient and if they had received appropriate TP. If no risk assessment had been performed, trained researchers applied the National Institute for health and Care Excellence (NICE) guidelines 92 (Jan 2010) for VTE risk assessment and prevention. Following the risk assessment patients were divided into three categories, high risk of VTE with low risk of bleeding; high risk of VTE with significant risk of bleeding and low risk of VTE. From this the proportion of patients in each group that received appropriate TP were calculated. Results A total of 1019 patients were enrolled the majority were medical patients 63.5% (n=648). The mean age of patients was 69 years. Females accounted for 52% of patients. Average length of hospitalisation for each patient at the time of the audit was 6 days (range 1-664 days). Overall, a formal TP risk assessment was documented in only 24% (n=244) of all charts reviewed however TP was prescribed in 43.2% (n=441) of patients. See table.Table 1.High Risk of VTE low risk of bleedingHigh risk of VTE significant risk of bleedingLow risk of VTENo. of pts80.3% (n=819)16.6% (n=170)2.9% (n=30)VTE risk assessment documented21.9% (n=180)28.2% (n=55)30% (n=9)Received TP46.3% (n=380)28.8% (n=49)40% (n=12) Within the high risk category patients, 64.3% (n=526) medical. TP was only administered to 46.3% (n=380) of patients in the high risk category. This was almost evenly distributed between surgical 50.1% (n=147) and medical 43.4% (n=233) patients. Conclusion This audit was done as the initial step to develop a national policy to prevent HAT. As suspected, this audit highlights that a large proportion of hospitalised patients, both surgical and medical, continue to be at high risk for VTE despite the availability of preventative measures. There is clear illustration of under prescription of safe, effective and recommended means of VTE prevention. The current overall figure of less than 50% prescription of VTE thromboprophylaxis in high risk patients is a major patient safety concern. There are numerous recognised international guidelines for prevention of VTE, and an efficient method to implement these guidelines needs to be developed. Beyond developing national guidelines for TP, we need a co-ordinated approach to implement and monitor compliance with guidelines. Once the preliminary results of this audit were available to us in March 2015, urgent measures were taken to reduce the identified risk such as the establishment of a Hospital Thrombosis Group which developed a user friendly VTE risk assessment tool and TP policy. The VTE risk assessment tool was incorporated into the patients drug prescription chart and included a pre printed prescription for TP. It is now mandatory for the all patients to have a VTE risk assessment tool and TP prescribed if appropriate within 24hrs of admission. This was successfully piloted for four weeks in the acute medical assessment unit and is now incorporated into each patients drug chart throughout the hospital. This audit will be replicated in 6 months from introduction of this initiative, with an aim of >90% compliance. Disclosures No relevant conflicts of interest to declare.

The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing in the White population. Despite a favourable prognosis in the majority, it remains a cause of morbidity and mortality, especially in immunosuppressed and elderly individuals. Large cSCCs can be challenging for surgical clearance, recurrence and metastatic disease, despite guidelines for the management and staging of cSCC. We sought to identify high-risk features of those who develop metastatic disease. Our centre typically manages 300 cSCCs annually, but only cSCCs discussed at our two multidisciplinary team (MDT) meetings (head and neck and skin cancer) at our level 4 hospital over a 3-year period (2019–2021) were included in a retrospective observational study. A total of 124 patients with high-risk cSCC (due to patient or tumour factors) were included. Male sex predominated. Sixteen cases had metastatic disease. Median age at diagnosis was 80 years in the total MDT group and 86.5 years in the metastasis group. Of 16 patients with metastases, eight had complete primary excisions. Five cases had incomplete primary excision (peripheral or deep margins involved), and three cases had a narrow margin of < 1 mm. Primary tumour size was similar in both the MDT and metastasis groups (median size 17 vs. 20 mm). Head and neck sites predominated in both (88%). In the metastatic group, one had chronic lymphocytic leukaemia, but no other patients with immunosuppression were identified, and the majority (81%) suffered with multimorbidity (≥ 2 chronic illnesses). Nine patients with metastatic cSCC received radiotherapy, two systemic chemotherapies, five neck dissections and one immunotherapy. Most patients presenting with metastatic cSCC at our centre were > 85 years old, a group sometimes known as ‘the oldest old’, and many had multimorbidity. This, coupled with tumour location, poses challenges for healthcare professionals in managing the initial cSCC aggressively and implementing a reasonable follow-up and surveillance schedule. In comparing both groups, advanced age was the predominant difference, with twice as many aged > 85 years in the metastasis group vs. the MDT group. Immunosenescence is a process of immune dysfunction that occurs with age and includes remodelling of lymphoid organs, leading to changes in the immune function of the elderly and relates to the development of malignant tumours. It is estimated that 5 million people in the UK will be in this age group by 2050 (www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health–wellbeing/rb_feb13_understanding_the_oldest_old_improving_later_life.pdf). There is a need to continue to consider this dynamic group (those aged > 85 years) and those with multimorbidity when strategies for the projected management of cSCC are being considered.