A review of Mohs micrographic surgery for skin cancer. Part 3: Squamous cell carcinoma.

This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for cost-effectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta-analyses. We categorized the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with perineural invasion, and cost-effectiveness. Although there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomized controlled trials (RCT) were identified. The evidence from comparitor studies suggests that MMS has a lower recurrence rate than that of other treatments for cSCC, including standard excision. Many studies identified were single-armed, but did demonstrate a low to very low recurrence rate of cSCC following MMS. A single recent study suggests MMS for intermediate cSCC is highly cost-effective compared with wide local excision when all-in costs are considered. Since the overall quality of included studies was mixed and highly heterogeneous, further methodologically robust studies with comparator arms or comprehensive long-term registry data would be valuable. It would be ideal to employ a definitive multicentre RCT but given the evidence to date and multiple advantages to MMS, the lack of clinical equipoise makes this difficult to justify. Comparison with current modalities would likely not be ethical/achievable on a like-for-like basis given MMS provides 100% margin assessment, enables histological clearance prior to reconstruction, and minimizes the removal of uninvolved tissue.

Health beliefs about bottled water: a qualitative study.

BACKGROUND: There has been a consistent rise in bottled water consumption over the last decade. Little is known about the health beliefs held by the general public about bottled water as this issue is not addressed by the existing quantitative literature. The purpose of this study was to improve understanding of the public's health beliefs concerning bottled mineral water, and the extent to which these beliefs and other views they hold, influence drinking habits. METHODS: A qualitative study using semi-structured interviews, with 23 users of the Munrow Sports Centre on the University of Birmingham campus. RESULTS: Health beliefs about bottled water could be classified as general or specific beliefs. Most participants believed that bottled water conferred general health benefits but were unsure as to the nature of these. In terms of specific health beliefs, the idea that the minerals in bottled water conferred a health benefit was the most commonly cited. There were concerns over links between the plastic bottle itself and cancer. Participants believed that bottled water has a detrimental effect on the environment. Convenience, cost and taste were influential factors when making decisions as to whether to buy bottled water; health beliefs were unimportant motivating factors. CONCLUSION: The majority of participants believed that bottled water has some health benefits. However, these beliefs played a minor role in determining bottled water consumption and are unlikely to be helpful in explaining recent trends in bottled water consumption if generalised to the UK population. The health beliefs elicited were supported by scientific evidence to varying extents. Most participants did not feel that bottled water conferred significant, if any, health benefits over tap water.