Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Appendix 6 Basal cell carcinoma A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. Benign Not cancerous; not malignant. Biopsy Removal of a sample of tissue or cells from the body to assist in the diagnosis of a disease. Bowen’s disease A skin disease marked by scaly or thickened patches on the skin. The patches often occur on sun-exposed areas of the skin and in older white men. These patches may become malignant. Also sometimes called precancerous dermatosis, precancerous dermatitis or carcinoma in situ. Brachytherapy Radiotherapy delivered by a temporary or permanent implant of radioactive material into a tissue or organ. A6 Breslow thickness A measuring scale of thickness for malignant melanomas, measured from the top layer of skin to the bottom of the tumour. The deeper the melanoma has grown, the more likely it is that some cells may have spread through the blood stream or lymphatic system. Cancer Growth of altered body cells that keep on growing, which is able to spread from where it started to another part of the body. Cancer Networks The organisational model for cancer services to implement the NHS Cancer Plan, bringing together health service commissioners and providers, the voluntary sector and local authorities. There are currently 34 Cancer Networks in England covering between 600,000 and 3 million population (two-thirds serve a population of between 1 and 2 million people). Carcinoma Cancer of the skin tissue that covers all the body organs. Most cancers are carcinomas. Cautery The application of a hot instrument, an electrical current, a caustic substance or other substance to kill certain types of small tumours or to seal off blood vessels to stop bleeding. 160 National Institute for Health and Clinical Excellence
Chemoprophylaxis The use of a drug or chemical to prevent future occurrences of a disease. Chemotherapy The use of drugs that kill cancer cells, or prevent or slow their growth. Improving Outcomes for People with Skin Tumours including Melanoma Appendix 6 Clinical oncologist A doctor who specialises in the treatment of cancer patients, particularly through the use of radiotherapy, but may also use chemotherapy. Clinical oncology The specialist treatment of cancer patients, particularly through the use of radiotherapy, but may also be through the use of chemotherapy. Cohort studies Research studies in which groups of patients with a particular condition or specific characteristic are compared with matched groups who do not have it. Computed tomography (CT) An X-ray imaging technique. Cryosurgery A procedure performed with an instrument that freezes and destroys abnormal tissue. A6 Cryotherapy A treatment that uses a cold temperature to remove cells or tissue by freezing. Curettage Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. Cutaneous T-cell lymphoma A disease in which certain cells of the lymph system (called T lymphocytes) become cancerous and affect the skin. Cytopathologist A doctor who specialises in the study of disease changes within individual cells or cell types. Cytotoxic Cell-killing. Guidance on cancer services: skin tumours including melanoma 161
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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
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curettage (as recommended in BAD gu
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Diclofenac 3% gel (Solaraze) is lic
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Histopathology services for skin ca
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Patients with anogenital Bowen’s
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B. Anticipated benefits Better-qual
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One RCT compared teledermatology wi
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One systematic review based upon 12
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Expert review evidence suggests tha
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Immunotherapy An RCT comparing allo
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• Adherence to treatment protocol
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F. Research priorities • Given th
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For patients with low-risk BCC or S
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Follow-up for patients after treatm
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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 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: Appendix 6 Glossary of terms Improv
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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Improving outcomes for people with skin tumours including melanoma

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