in place for 60 s. The skinfold sizes at 10 s and 60 s are recorded and caliper creep is calculated as the difference between these two readings.Dermal thickness on the affected side using high-resolution, high-frequency skin ultrasoundLymphoedema affects the skin and underlying tissues, and previous research has suggested that ultrasound may provide information on the amount of oedema present in these areas (Gniadecka 1996). The thickness of the dermis is likely to be influenced by the level of oedema present, although the validity and reliability of skin ultrasound in the identification and measurement of dermal thickness has not been fully ascertained. Easy accessibility to the method prompted its use in this study, particularly as a step towards developing new outcomes measures in a currently limited field.A 20-MHz ultrasound scanner (Hadsund, Dermascan-C, Cortex Technology APS, Denmark) was used to obtain cross-sectional images of the skin at four sites on the swollen arm: (a) 8cm down from the elbow crease on the inner forearm (forearm); (b) 12cm down from the supra- clavicular joint over the deltoid muscle (deltoid); (c) 4cm out from the posterior axillary crease on the back (poste- rior axilla); (d) 12 cm down from the axillary crease on the side above the waist (flank). Sites were always located to anatomical reference points to ensure the same site was used for subsequent readings. A ring of hydrocolloid dress- ing (Granuflex®) was cut to the size of the scanner head and placed on the skin over each measurement site. This ensured that the image size and distance from the skin was always the same and allowed a standard amount of ultrasound gel to be used within the Granuflex® ring. Dermal thickness was calculated in millimetres by mea- suring the distance on each image between the surface entry/echo line and the border between the lower dermis and subcutaneous layer using specifically designed pro- grammes on Matlab® software.EORTC QLQ C30 quality of life questionnaireAt the time of the study, there were no condition-specific quality of life tools available for lymphoedema. This patient-completed instrument consists of 30 functional, symptom and individual items designed to address a range of quality of life issues relevant to a broad spectrum of cancer patients (Aaronson et al. 1993). Permission to use the instrument was obtained.