Improving outcomes for people with skin tumours including melanoma
Improving outcomes for people with skin tumours including melanoma
Improving outcomes for people with skin tumours including melanoma
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<strong>Improving</strong> Outcomes <strong>for</strong><br />
People <strong>with</strong> Skin Tumours<br />
<strong>including</strong> Melanoma<br />
Follow-up<br />
Follow-up<br />
Introduction<br />
This chapter deals <strong>with</strong> follow-up of the majority of patients <strong>with</strong> <strong>skin</strong><br />
cancer who do not fall into the groups cited in the ‘Management of<br />
special groups’ chapter who may have more intensive follow-up<br />
needs.<br />
5<br />
This chapter does not deal <strong>with</strong> follow-up of patients <strong>with</strong><br />
precancerous lesions, because once the diagnosis and education have<br />
been given to the patient, no further follow-up is indicated. Following<br />
consultation, some patients <strong>with</strong> multiple lesions and those <strong>with</strong><br />
continually developing lesions may need longer-term follow-up, and<br />
this should be at the discretion of the doctor in charge of the<br />
management of the patient. Follow-up of these patients may not<br />
necessarily have to be made in a local hospital, and arrangements will<br />
depend on local circumstances and patient choice.<br />
Although a large proportion of patients report that they value followup,<br />
it does cause anxiety in many, and some patients find that<br />
attending <strong>for</strong> follow-up makes it difficult <strong>for</strong> them to return to ‘normal<br />
life’. These patients may prefer not to attend but currently feel that<br />
they do not have this choice. Options and decisions regarding followup<br />
should be agreed jointly <strong>with</strong> the patient.<br />
The importance of follow-up varies across <strong>skin</strong> cancer types,<br />
depending on the risk of recurrence, the efficacy of intervention in<br />
recurrent disease, the risk of development of metachronous (new<br />
primary) disease and the methods <strong>for</strong> detecting this. Follow-up by<br />
doctors or nurses is only of benefit if it leads to detection of recurrent<br />
or new disease at a point in time when intervention is more likely to<br />
be effective than when patients present, having become aware of the<br />
problem themselves. In <strong>skin</strong> cancers <strong>with</strong> a low risk of mortality or<br />
recurrence (e.g. low-risk BCCs), long-term follow-up is not costeffective.<br />
The net benefit <strong>for</strong> patients in terms of reassurance is poorly<br />
understood.<br />
102<br />
National Institute <strong>for</strong> Health and Clinical Excellence
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