Improving outcomes for people with skin tumours including melanoma

More documents

Recommendations

Info

Improving Outcomes for People with Skin Tumours including Melanoma Management of special groups The majority of cases diagnosed in the UK today present with advanced disease and previously undiagnosed HIV infection. A recent telephone survey of clinical oncology departments in London suggests that there were fewer than 50 cases treated in London during the past 12 months. Local therapies including cryotherapy, radiotherapy and topical treatments are effective for treating patients with early skin lesions. Many patients presenting with KS will respond to HAART and require no other intervention. Unsightly lesions on the face or other exposed areas may be excised or may respond well to short courses of radiotherapy. More extensive limb involvement responds well to wide-field irradiation. When the disease is progressing rapidly in spite of HAART or when there is visceral involvement, systemic treatment with cytotoxic chemotherapy is indicated. Children 6 The National Institute for Health and Clinical Excellence has published service guidance for Improving outcomes in children and young people with cancer. 59 This guidance does not address specifically the occurrence in children or young people of skin cancers that are more commonly seen in adulthood. Although skin cancers are rare in children and young people, the clinical features are identical to those occurring in adults and the recommended treatment is similar to that for skin cancers occurring in adults. However, patients in these groups, and their carers, are likely to have complex physical and psychosocial needs. In addition to high-quality management for their skin cancer they may need additional supportive care tailored to the needs of children and young people with cancer. 59 National Institute for Health and Clinical Excellence (2005) Improving outcomes in children and young people with cancer. Available from: www.nice.org.uk 116 National Institute for Health and Clinical Excellence
A. Recommendations Generic recommendations for patients with uncommon risk factors or rare cancers Specialised services commissioners, together with their cancer network(s), should undertake a needs assessment for these special groups of patients, plan the provision of appropriate specialist care and put in place the necessary commissioning arrangements. Improving Outcomes for People with Skin Tumours including Melanoma Management of special groups Network-wide protocols should be developed that describe the pathways of care for these special groups of skin cancer patients. Commissioners should receive results of audits of the care of these special groups. Commissioning for national specialised pathology services for rare skin tumours should be reviewed by the specialised services commissioners. There should be good liaison between the SSMDT and the haematooncology MDT. Specifically, systemic/nodal lymphomas presenting in the skin should have haemato-oncology MDT review. Likewise, primary cutaneous lymphoma presenting to, for example, haematologists should receive SSMDT review. There should be a close liaison between the SSMDT and the soft tissue sarcoma MDT. It is appropriate for many cutaneous sarcomas to be considered by the SSMDT but some should also be discussed at the sarcoma MDT, especially those that penetrate the superficial fascia or require chemotherapy. 6 Information provision for patients in these special groups should be tailored to their specific needs and contain information on their condition and relevant patient support groups. Links should be made to national support groups, to assure the quality of information (see chapter on ‘Patient-centred care’). Treatment strategies for individual patients should be made and developed in the context of MDT meetings at which all relevant clinical specialists, including a CNS who knows the patient, should be present. All patients with a high risk of developing skin cancer should be counselled effectively by a dermatologist or a CNS about sun protection before they develop any skin lesions, and should have annual checks carried out thereafter. Guidance on cancer services: skin tumours including melanoma 117
Page 1 and 2:
NHS National Institute for Health a
Page 3 and 4:
Contents Improving Outcomes for Peo
Page 5 and 6:
Patient information ...............
Page 7 and 8:
Resource implications .............
Page 9 and 10:
Foreword Improving Outcomes for Peo
Page 11 and 12:
- referral - review of patient care
Page 13 and 14:
early detection have been published
Page 15 and 16:
The epidemiology of skin cancers an
Page 17 and 18:
The incidence of MM increases with
Page 19 and 20:
Figure 5. Mortality from MM, Englan
Page 21 and 22:
Figure 8. Incidence of NMSC, Englan
Page 23 and 24:
Risk factors for skin cancer As ski
Page 25 and 26:
Figure 12. Rates of episodes of inp
Page 27 and 28:
Two-week wait data Urgent skin canc
Page 29 and 30:
• Improving the experience of car
Page 31 and 32:
12. National Institute for Clinical
Page 33 and 34:
Patient-centred care Improving Outc
Page 35 and 36:
This document and the NICE Referral
Page 37 and 38:
A checklist may be used by healthca
Page 39 and 40:
Quality assurance Surveys of patien
Page 41 and 42:
One cross-sectional study found tha
Page 43 and 44:
One RCT conducted with patients wit
Page 45 and 46:
• Every skin cancer MDT having ac
Page 47 and 48:
to estimate a separate cost for ser
Page 49 and 50:
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 and 102: • Adherence to treatment protocol
Page 103 and 104: F. Research priorities • Given th
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: patients with cutaneous lymphoma sh
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
Page 153 and 154: • Royal College of Surgeons of En
Page 155 and 156: Appendix 5.3 Researchers carrying o
Page 157 and 158: Appendix 5.4 Expert advisers to the
Page 159 and 160: Appendix 5.5 Report* commissioned t
Page 161 and 162: Appendix 6 Glossary of terms Improv
Page 163 and 164: Chemoprophylaxis The use of a drug
Page 165 and 166: Electrodesiccation A surgical metho
Page 167 and 168: Immunotherapy Treatment by stimulat
Page 169 and 170:
Morbidity A diseased condition or s
Page 171 and 172:
Prognosis A prediction of the likel
Page 173 and 174:
Systemic therapy Treatment that rea
Page 175 and 176:
KS LHB LSMDT MCC MDT MM MRI NCC-C N
show all

Improving outcomes for people with skin tumours including melanoma

Create successful ePaper yourself

Delete template?

Save as template?