Background: Cutaneous malignancy forms a major part of the dermatologist’ s workload. Clinical diagnosis is an important factor in facilitating the urgent excision of squamous cell carcinomas (SCC) and malignant melanomas. Objectives: To identify the numbers and types of malignant skin tumours managed in an NHS teaching hospital and to assess the diagnostic accuracy. Methods: Data were collected on every histologically proven malignant skin lesion over a 6-month period. Results: One thousand one hundred and ninety-five malignant skin tumours were identified: 78% were basal cell carcinomas, 14% were SCC, 6% were malignant melanomas and the remaining 2% included Merkel cell tumours, malignant adnexal tumours and lentigo maligna. Eighty-one per cent of the tumours were managed by dermatologists. The correct clinical diagnosis had been made by the secondary care clinician in 84% of cases but an incorrect clinical diagnosis was given in 32% of SCC. Of the 1195 tumours, 916 (77% ) had a primary excision and 92% (843 of 916) of these were completely excised. Conclusions: The majority of skin malignancies (968 of 1195, 81% ) were managed by dermatologists. Where primary excision was attempted, this was complete in 91% (767 of 916) of cases. The correct clinical diagnosis was made in 84% of all tumours, but 32% of SCC were not correctly diagnosed prior to surgery. Background: Cutaneous malignancy forms a major part of the dermatologist ’s workload. Clinical diagnosis is an important factor in facilitating the urgent excision of squamous cell carcinomas (SCC) and malignant melanomas. Objectives: To identify the numbers and types of malignant skin tumors. Managed in an NHS teaching hospital and to assess the diagnostic accuracy. Methods: Data were collected on every histologically proven malignant skin lesion over a 6-month period. Results: One thousand one hundred and ninety-five malignant skin tumors were identified: 78% were Six percent were malignant melanomas and the remaining 2% included Merkel cell tumors, malignant adnexal tumors and lentigo maligna. Eighty-one per cent of the tumors were managed by dermatologists. The correct clinical diagnosis had been made by the secondary care clinician in 84% of cases but an incorrect clinical diagnosis was given in 32% of SCC. Of the 1195 tumors, 916 (77%) had a prim Where primary excision was attempted, this was completed in 91% (767) (81% of the patients were completely excised.) The majority of skin malignancies (968 of 1195, 81%) were managed by dermatologists. of 916) of cases. The correct clinical diagnosis was made in 84% of all tumors, but 32% of SCC were not correctly diagnosed prior to surgery.