Improving outcomes for people with skin tumours including melanoma

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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 4 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. 100 National Institute for Health and Clinical Excellence
F. Research priorities • Given the enormous service burden associated with treatment of skin tumours, there is a lack of good-quality research on the efficacy of the treatment modalities used. Improving Outcomes for People with Skin Tumours including Melanoma Initial investigation, diagnosis, staging and management • Studies with long-term follow-up are needed to examine the benefits of excisional surgery of NMSC compared with those of other treatments available. • Further research on systemic PDT is needed before it can be recommended. 4 Guidance on cancer services: skin tumours including melanoma 101
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NHS National Institute for Health a
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Contents Improving Outcomes for Peo
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Patient information ...............
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Resource implications .............
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Foreword Improving Outcomes for Peo
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- referral - review of patient care
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early detection have been published
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The epidemiology of skin cancers an
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The incidence of MM increases with
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Figure 5. Mortality from MM, Englan
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Figure 8. Incidence of NMSC, Englan
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Risk factors for skin cancer As ski
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Figure 12. Rates of episodes of inp
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Two-week wait data Urgent skin canc
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• Improving the experience of car
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12. National Institute for Clinical
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Patient-centred care Improving Outc
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This document and the NICE Referral
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A checklist may be used by healthca
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Quality assurance Surveys of patien
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One cross-sectional study found tha
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One RCT conducted with patients wit
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• Every skin cancer MDT having ac
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to estimate a separate cost for ser
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department or they may be referred
Page 51 and 52: The 2-week waiting time standard an
Page 53 and 54: The local hospital skin cancer mult
Page 55 and 56: A function of the LSMDT is to audit
Page 57 and 58: • lymphoedema therapists • phar
Page 59 and 60: SSMDT meetings should be at least f
Page 61 and 62: As set out in the section on ‘Arr
Page 63 and 64: • Palliative care specialists. Si
Page 65 and 66: Videoconferencing and teleconferenc
Page 67 and 68: A basic knowledge of skin cancer hi
Page 69 and 70: B. Anticipated benefits At present,
Page 71 and 72: One systematic review (of the abili
Page 73 and 74: One retrospective study compared pa
Page 75 and 76: • Critical incidents where treatm
Page 77 and 78: Network-wide protocols It is not po
Page 79 and 80: Initial investigation, diagnosis, s
Page 81 and 82: Figure 14. Skin lesion - patient pa
Page 83 and 84: curettage (as recommended in BAD gu
Page 85 and 86: Diclofenac 3% gel (Solaraze) is lic
Page 87 and 88: Histopathology services for skin ca
Page 89 and 90: Patients with anogenital Bowen’s
Page 91 and 92: B. Anticipated benefits Better-qual
Page 93 and 94: One RCT compared teledermatology wi
Page 95 and 96: One systematic review based upon 12
Page 97 and 98: Expert review evidence suggests tha
Page 99 and 100: Immunotherapy An RCT comparing allo
Page 101: • Adherence to treatment protocol
Page 105 and 106: For patients with low-risk BCC or S
Page 107 and 108: Follow-up for patients after treatm
Page 109 and 110: C. Evidence Evidence exists that ea
Page 111 and 112: One observational study found that
Page 113 and 114: The written and photographic inform
Page 115 and 116: Genetic predisposition to MM may al
Page 117 and 118: patients with cutaneous lymphoma sh
Page 119 and 120: A. Recommendations Generic recommen
Page 121 and 122: Cutaneous lymphoma All patients sho
Page 123 and 124: Children and young people with skin
Page 125 and 126: Gorlin’s syndrome Two expert revi
Page 127 and 128: Process • Audit of adherence to p
Page 129 and 130: • Cutaneous lymphoma is so rare t
Page 131 and 132: Dermal and subcutaneous tumours Aty
Page 133 and 134: c) The guidance will also refer to
Page 135 and 136: 4.2.2 Healthcare settings and servi
Page 137 and 138: Referral from the Department of Hea
Page 139 and 140: Table A1. Summary of service option
Page 141 and 142: For those cancer networks with part
Page 143 and 144: Appendix 4 How this guidance manual
Page 145 and 146: Appendix 5 People and organisations
Page 147 and 148: Professor Julia Newton-Bishop Mr Ba
Page 149 and 150: • Bristol South and West PCT •
Page 151 and 152: • Healthcare Commission • Help
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• Royal College of Surgeons of En
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Appendix 5.3 Researchers carrying o
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Appendix 5.4 Expert advisers to the
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Appendix 5.5 Report* commissioned t
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Appendix 6 Glossary of terms Improv
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Chemoprophylaxis The use of a drug
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Electrodesiccation A surgical metho
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Immunotherapy Treatment by stimulat
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Morbidity A diseased condition or s
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Prognosis A prediction of the likel
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Systemic therapy Treatment that rea
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KS LHB LSMDT MCC MDT MM MRI NCC-C N
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