• All patients with more than one of: chronic otalgia, bloody otorrhoea, bleeding, mass, facial swelling or palsy should be biopsied. (R)

• Magnetic resonance and computed tomography imaging should be performed. (R)

• Patients should undergo audiological assessment. (R)

• Carotid angiography is recommended in select patients. (G)

• The modified Pittsburg T-staging system is recommended. (G)

• The minimum operation for cancer involving the temporal bone is a lateral temporal bone resection. (R)

• Facial nerve rehabilitation should be initiated at primary surgery. (G)

• Anterolateral thigh free flap is the workhorse flap for lateral skull base defect reconstruction. (G)

• For patients undergoing surgery for squamous cell carcinoma, at least a superficial parotidectomy and selective neck dissection should be carried out. (R)

• Royal College of Pathologists minimum datasets for NMSC should be adhered to in order to improve patient care and help work-force planning in pathology departments. (G)

• Tumour depth is of critical importance in identifying high-risk cutaneous squamous cell carcinoma (cSCC), and should be reported in all cases. (R)

• Appropriate imaging to determine the extent of primary NMSC is indicated when peri-neural involvement or bony invasion is suspected. (R)

• In the clinically N0 neck, radiological imaging is not beneficial, and a policy of watchful waiting and patient education can be adopted. (R)

• Patients with high-risk NMSC should be treated by members of a skin cancer multidisciplinary team (MDT) in secondary care. (G)

• Non-infiltrative basal cell carcinoma (BCC) <2 cm in size should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in sites where reconstructive options are limited, when reconstruction should be delayed. (R)

• Where there is a high risk of recurrence, delayed reconstruction or Mohs micrographic surgery should be used. (R)

• Surgical excision of low-risk cSCC with a margin of 4 mm or greater is the treatment of choice. (R)

• High-risk cSCC should be excised with a margin of 6 mm or greater. (R).

• Mohs micrographic surgery has a role in some high-risk cSCC cases following MDT discussion. (R)

• Delayed reconstruction should be used in high-risk cSCC. (G)

• Intra-operative conventional frozen section in cSCC is not recommended. (G)

• Radiotherapy (RT) is an effective therapy for primary BCC and cSCC. (R)

• Re-excision should be carried out for incompletely excised high-risk BCC or where there is deep margin involvement. (R)

• Incompletely excised high-risk cSCC should be re-excised. (R)

• Further surgery should involve confirmed marginal clearance before reconstruction. (R)

• P+ N0 disease: Resection should include involved parotid tissue, combined with levels I–III neck dissection, to include the external jugular node. (R)

• P+ N+ disease: Resection should include level V if that level is clinically or radiologically involved. (R)

• Adjuvant RT should include level V if not dissected. (R)

• P0 N+ disease: Anterior neck disease should be managed with levels I–IV neck dissection to include the external jugular node. (R)

• P0 N+ posterior echelon nodal disease (i.e. occipital or post-auricular) should undergo dissection of levels II–V, with sparing of level I. (R)

• Consider treatment of the ipsilateral parotid if the primary site is the anterior scalp, temple or forehead. (R)

• All patients should receive education in self-examination and skin cancer prevention measures. (G)

• Patients who have had a single completely excised BCC or low-risk cSCC can be discharged after a single post-operative visit. (G)

• Patients with an excised high-risk cSCC should be reviewed three to six monthly for two years, with further annual review depending upon clinical risk. (G)

• Those with recurrent or multiple BCCs should be offered annual review. (G)

• At-risk individuals should be warned about the correlation between ultraviolet radiation (UVR) exposure and skin cancer, and should be given advice on UVR protection. (R)

• Dermatoscopy can aid in the diagnosis of cutaneous melanoma. (R)

• Histological examination after biopsy is essential to confirm the diagnosis and the tumour thickness. (G)

• Excisional biopsy is method of choice. (G)

• Staging investigations can be performed for both regional and distant disease. (R)

• Scanning (computed tomography (CT) and/or magnetic resonance imaging) is recommended for patients with high-risk melanoma. (G)

• Patients with signs or symptoms of disease relapse should be investigated by imaging. (R)

• Imaging of the brain should be performed in patients who have stage IV disease. (G)

• Patients with melanoma of unknown primary should be thoroughly examined and investigated for a potential primary source. (R)

• Primary cutaneous invasive melanoma should be excised with a surgical margin of at least 1 cm. (G)

• The maximum recommended excision margin is 3 cm. (R)

• The actual margin of excision depends upon the depth of the melanoma and its anatomical site. (G)

• Ultrasound-guided fine needle aspiration (FNA) or core biopsy of suspected lymphadenopathy is more accurate than ‘blind’ biopsy. (R)

• Open biopsy should only be performed if FNA or core biopsy is inadequate or equivocal. (R)

• Prior to lymph node dissection, staging by CT scan should be carried out. (R)

• If parotid disease is present without neck involvement, both parotidectomy and neck dissection should ideally be performed. (R)

• There is no role for elective lymph node dissection. (R)

• Sentinel lymph node biopsy (SLNB) can be considered in stage IB and above by specialist skin cancer multidisciplinary teams. (G)

• Patients should be made aware that SLNB is a staging procedure, and should understand that it has, as yet, no proven therapeutic value. (R)

• All patients with cutaneous melanoma should have their original tumour checked for BRAF gene status, and their subsequent targeted biological therapy based on this. (R)

• Patients who develop brain metastases should be considered for stereotactic radio-surgery. (R)