Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Initial investigation,
diagnosis, staging and
management
Management of precancerous lesions
The cost implications of training GPwSIs have been considered in the
‘Clinicians working in the community’ section. The British
Dermatological Nursing Group recommends courses for nurses who
wish to undertake further training to become specialists in
dermatology and in skin cancer. They are either first degree or
masters level modules; examples include minor surgery, managing
patients with pigmented skin lesions and phototherapy. Some courses
are available as distance-learning modules. Costs for specialist
modules range between £350 and £791 per module (mean £570). For
existing staff these costs would be part of annual CPD.
Management of skin cancers – Mohs
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The recommendation that will have a significant cost impact in this
section relates to the training of Mohs surgeons. Currently
dermatologists, or other consultants, can train with an expert in the
technique for 3 months in the UK. There is no charge for this training
at present. Three months’ salary for a consultant undergoing the
training, including oncosts, for 2005/06 is around £24,570. There is
also a 12-month Fellowship Program in Mohs surgery in the United
States. The consultant’s employment costs would be around £98,280
for 12 months. Other training options are available in Lisbon.
In order for there to be one Mohs specialist per network, the
estimated employment cost will be between £24,570 and £98,280 per
network currently without such expertise. Additional funds would be
needed for locum cover while the consultant is training. However,
this would not be an immediate cost as there are limited numbers of
trainee placements available each year. In addition to the direct cost,
there is an opportunity cost for the consultant delivering the training.
The introduction of Mohs surgery also has significant cost and staffing
implications for histopathology services. As well as laboratory
facilities, this includes staffing at both biomedical scientist and
consultant histopathologist levels. These must be taken into account
in the commissioning of a new Mohs surgery service. Detailed
costings for the Mohs service, with histopathology, have not been
included in the guidance as they are variable depending on the local
model of Mohs surgery introduced.
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National Institute for Health and Clinical Excellence