Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Appendix 6 Dermatofibrosarcoma protuberans A type of tumour that begins as a hard nodule and grows slowly. These tumours are usually found in the dermis (the inner layer of the two main layers of tissue that make up the skin) of the limbs or trunk of the body. They can grow into surrounding tissue but do not spread to other parts of the body. Dermatologist A doctor who specialises in the diagnosis and treatment of skin disorders. Dermatology The specialist treatment of skin disorders. Dermatopathologist A pathologist with special training and expertise in the diagnosing of skin diseases. Dermatopathology The study of the pathology of the skin. A6 Dermatoscope A tool like a hand-held microscope used by doctors to view a mole or suspicious spot on living skin. Dermatoscopy Skin scoping or observing the skin directly using a special microscope, usually performed on a mole or suspicious spot on living skin. Dermis The lower or inner layer of the two main layers of tissue that make up the skin. Diagnostic radiographer The role of the diagnostic radiographer is to work closely with other specialists, to provide safe and accurate imaging examinations, to give patients information and support and to discuss possible side effects and care. Dietitian The healthcare professional responsible for the planning and managing of the patient’s diet in hospital and providing dietary advice for a wide range of medical conditions. Ear, nose and throat (ENT) Diagnosis and treatment of diseases of the ear, nose and throat. 162 National Institute for Health and Clinical Excellence
Electrodesiccation A surgical method of drying out tissue by touching it with a needlelike electrode that passes electric current into the tissue. Epidemiology The study of populations in order to determine the frequency and distribution of disease and to measure risks. Improving Outcomes for People with Skin Tumours including Melanoma Appendix 6 Excision Removal by surgery. Gorlin’s syndrome An inherited condition that can increase an individual’s chance of developing basal cell carcinoma. Also called basal cell nevus syndrome. High-risk basal cell carcinoma Those that have a high recurrence rate after treatment. There are several factors that may have an effect on recurrence rate including histological sub-type, other histological features, site, and other patient and tumour features. Histological sub-type Morphoeic – linear groups of cancer cells with surrounding scarring; clinically this causes a thickened and hardened skin Infiltrating – like morphoeic but with less scarring Micronodular – very small groups of cancer cell Basosquamous carcinoma – a skin cancer with both basal and squamous elements A6 Histological features Perineural invasion Invasion below dermis Sites Nose and paranasal folds Periocular Ears Scalp and temples Lips Other factors Size > 2 cm Immunosuppression Genetic disorders such as Gorlin’s syndrome Previously treated lesion Guidance on cancer services: skin tumours including melanoma 163
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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
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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 and 162: Appendix 6 Glossary of terms Improv
Page 163: Chemoprophylaxis The use of a drug
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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