Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Management of special groups The SSMDT should have access to bone marrow aspirate and trephine biopsies for complete staging of all patients with B- and NK-cell lymphomas and for patients with CTCL variants and late stages of mycosis fungoides (stage IIb or above). The World Health Organization (WHO)–EORTC primary cutaneous lymphoma classification should be used to classify primary cutaneous lymphomas. Chemotherapy should be reserved for patients with advanced disease as it may have a detrimental effect on those with early disease. Skin sarcomas Skin cancer MDTs should liaise with sarcoma MDTs in the management of patients with cutaneous sarcomas. As stated in the section on SSMDTs, it is essential for all cutaneous sarcomas to receive specialist histopathology review. 61 Sarcomas needing SSMDT review include all those involving the dermis and subcutaneous fat above the superficial fascia. It is appropriate for small/superficial cutaneous sarcomas to be dealt with by the SSMDT. 6 It is essential that there is close liaison between the SSMDT and sarcoma MDTs. This is particularly important for patients whose sarcomas are large or penetrate the superficial fascia or are of a histological type requiring chemotherapy (e.g. rhabdomyosarcoma, Ewing’s sarcoma). Patients with KS should be referred to experts in the management of this tumour. Children and young people All children and young people diagnosed with skin cancer should be managed within the context of an MDT, which will include a dermatologist expert in skin malignancies and have access to specialist children and young people cancer support services and inpatient facilities at network level (see NICE service guidance Improving outcomes in children and young people with cancer 62 ). 61 National Institute for Health and Clinical Excellence (Publication due March 2006) Improving outcomes in people with sarcoma. Available from: www.nice.org.uk 62 National Institute for Health and Clinical Excellence (2005) Improving outcomes in children and young people with cancer. Available from: www.nice.org.uk 120 National Institute for Health and Clinical Excellence
Children and young people with skin cancer should be given the opportunity of entering into NCRI-approved clinical trials, as recommended in the NICE service guidance Improving outcomes in children and young people with cancer. 63 B. Anticipated benefits Improving Outcomes for People with Skin Tumours including Melanoma Management of special groups A structured and coordinated approach to these groups of patients with special needs will allow issues such as prevention, surveillance, access to services, quality of life and comorbidities to be better managed. Appropriate treatment for these patients can be expected to improve both short- and long-term outcomes. Patients and carers who are offered full information about all potential treatment options and their anticipated effects can contribute better to participative decision-making. Where children and young people meet the eligibility criteria for NCRI-approved clinical trials, their participation will add to the evidence base. Involving specialists from a range of disciplines at an early stage allows all aspects of the patient’s condition and situation to be considered in decision-making. 6 C. Evidence Genetic predisposition A meta-analysis has shown that the risk of developing a melanoma is much higher in people with more than 100 common naevi or five atypical naevi. A consensus statement from the Melanoma Genetics Consortium reports that while less than 1–2% of melanoma cases are thought to be attributable to genetic mutations, people with one or more affected first-degree relatives have an increased risk of developing a melanoma and those with multiple affected family members have a much greater risk. There is evidence that suggests that, of the melanoma types, superficial spreading melanoma shows the highest familial risk, and two case control studies have found an increased risk of melanoma associated with the presence of numerous atypical naevi. 63 National Institute for Health and Clinical Excellence (2005) Improving outcomes in children and young people with cancer. Available from: www.nice.org.uk Guidance on cancer services: skin tumours including melanoma 121
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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
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The 2-week waiting time standard an
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The local hospital skin cancer mult
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A function of the LSMDT is to audit
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• lymphoedema therapists • phar
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SSMDT meetings should be at least f
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As set out in the section on ‘Arr
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• Palliative care specialists. Si
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Videoconferencing and teleconferenc
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A basic knowledge of skin cancer hi
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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 and 118: patients with cutaneous lymphoma sh
Page 119 and 120: A. Recommendations Generic recommen
Page 121: Cutaneous lymphoma All patients sho
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
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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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Improving outcomes for people with skin tumours including melanoma

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