Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Follow-up
The Cancer Services Collaborative Project in England 54 has shown that
the perceived need for lifetime follow-up of cancer patients in
hospital clinics can be challenged by a review of the evidence. With
appropriate education and training, patients can be discharged to
active self-follow-up, releasing significant capacity in outpatient clinics
for the management of new patients.
Patients with precancerous and cancerous lesions of the skin are
extremely numerous and the vast majority will not die of their
disease. Although the risk of metachronous disease for patients
presenting with cancer is high, for most patients follow-up will make
no difference to survival, although later presentation may result in
more extensive treatment and related morbidity. It is therefore
essential that only those patients who will benefit be recalled for
doctor- or nurse-based follow-up. This will include patients with:
• advanced-stage disease at presentation
• disease for which the management is difficult
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• a high risk of developing recurrent disease
• a high risk of developing metachronous tumours
• failure to respond to the initial treatment
• lesions at sites that are difficult to examine.
Reducing the number of patients attending for formal follow-up will
improve the capacity to provide high-quality treatment to the everincreasing
numbers of new patients and patients re-presenting with
metachronous lesions. Moreover, as the skin is visible to patients and
carers, most can be trained to identify new lesions.
A. Recommendations
Cancer networks should develop locally agreed protocols for followup
of each skin cancer type, taking into account national guidelines,
the risks of local recurrence, metastatic spread and new primary
lesions.
54 www.aswcs.nhs.uk/aswcs/csc/default.htm
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National Institute for Health and Clinical Excellence