Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Management of special
groups
All patients in high-risk groups with precancerous skin lesions (e.g.
multiple warty lesions and/or AK) should be referred early to a
dermatologist for assessment, active treatment and follow-up.
Once patients at high risk start to develop skin lesions they should be
offered at least 6-monthly follow-up.
Genetic predisposition
Patients with evidence of genetic predisposition and their families
should be offered referral to the clinical genetics services or a
specialist dermatology service. The criteria for referral for families with
MM are:
• three or more family members with MM, or
• two first-degree relatives with MM, or
• two relatives with MM, one of whom had multiple primaries.
6
Patients with familial MM, Gorlin’s syndrome or XP should be
reviewed by SSMDTs and be managed by dermatologists and surgeons
who have expertise in these conditions.
Patients with Gorlin’s syndrome should not be treated with
radiotherapy.
Transplant patients
Transplant patients who have precancerous skin lesions or who have
developed a skin cancer should be seen in a dedicated ‘transplant
patient skin clinic’, either in the transplant centre or in a hospital
closer to the patient’s home, according to the choice of the patient.
Close links should be established between the transplant centre, local
physician and dermatologist for the management of transplant patients
postoperatively.
Dermatologists managing transplant recipients with multiple and/or
recurrent skin cancers need to liaise with the transplant team
regarding reduction of immunosuppression and the use of systemic
retinoids in order to reduce the risk of invasive disease.
118
National Institute for Health and Clinical Excellence