Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Appendix 2 b) This document is the scope. It defines exactly what this piece of service guidance will (and will not) examine, and what the developers will consider. The scope is based on the referral from the Department of Health and Welsh Assembly Government (see page 131). c) The areas that will be addressed by the guideline are described in the following sections. 4.1 Population A2 4.1.1 Groups that will be covered a) Adults with malignant tumours of the skin (basal cell carcinoma, squamous cell carcinoma, malignant melanoma and other rare primary tumours). b) Adults with primary cutaneous lymphomas. c) Adults with skin tumours arising in immuno-compromised patients. d) Children and young people in their late teens and early twenties presenting with skin tumours typical of the adult group, whose management does not generally require specialist paediatric oncology services. e) Adults and children with precancerous skin lesions such as actinic keratoses, Bowen’s and lentigo maligna, including the specific needs of people with genetic disorders. 4.1.2 Groups that will not be covered a) Adults and children with benign skin tumours. b) Adults and children with cutaneous metastases from tumours at other primary sites. 4.2 Healthcare setting and services 4.2.1 Healthcare settings and services that will be covered a) Primary care, including diagnosis, treatment and follow-up. b) Secondary care, including the role of skin cancer networks and multidisciplinary teams. c) Tertiary care in cancer centres, specialist dermatology centres and specialist plastic surgery units. 132 National Institute for Health and Clinical Excellence
4.2.2 Healthcare settings and services that will not be covered a) Primary prevention and education. 4.3 Key areas of clinical management Improving Outcomes for People with Skin Tumours including Melanoma Appendix 2 The following key areas of clinical management will be included, because they have direct implications for service delivery. a) Services for Diagnosis and Staging (excluding those being addressed as part of the updated referral guidelines) including: • General practitioners and other members of the primary care team • Dermatology departments A2 • Plastic surgery units • Pathology departments • Radiology and nuclear medicine departments • Telemedicine In addition, the guidance will address the important issue of data collection and registration of skin tumours. b) Treatment services, to include treatment in the following settings. • Primary care – surgery, cryotherapy, topical chemotherapy. • Dermatology centres – surgery, Mohs surgery, cryotherapy, photodynamic therapy, topical chemotherapy, laser therapy and immunotherapy. • Plastic surgery units, including oculoplastic surgery. • Cancer centres – radiotherapy, chemotherapy and immunotherapy. • Other specialised units such as maxillofacial surgery, ENT, and genetics. c) Multi-professional working and service integration across sectors. d) Follow-up. Guidance on cancer services: skin tumours including melanoma 133
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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,
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One systematic review (of the abili
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One retrospective study compared pa
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• Critical incidents where treatm
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Network-wide protocols It is not po
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Initial investigation, diagnosis, s
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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 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: c) The guidance will also refer to
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
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