Improving outcomes for people with skin tumours including melanoma

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1 Improving Outcomes for People with Skin Tumours including Melanoma Background The estimate of 60,000 new cases of skin cancers in England and Wales each year [16] is therefore likely to be a significant underestimate and does not include BCCs. One of the few studies published in the UK suggests that the true annual incidence could be over 125,000 new cases of NMSC annually in England and Wales. This would mean that a district general hospital (DGH) serving a population of 250,000 would treat about 625 new cases per year and a typical general practice, serving a population of 10,000, would see about 25 new NMSC cases each year. Despite these limitations, cancer registry data can be used to look at trends in incidence, mortality and survival, and variations in these by sex, age and region of the country. Malignant melanoma MM, although far less common (around 10% of skin cancers) than NMSC [16], is the major cause of death from skin cancer [16] and is more likely to be accurately reported and diagnosed than NMSC. MMs most commonly develop on intermittently exposed sites, on the back in males and the lower leg in females. In 2001 there were 6432 new cases of MM registered in England and Wales [20]. MMs are more common in women than in men. The age-standardised incidence of MM has been steadily increasing over the past three decades in both males and females with rates of 11.7 (females) and 10.1 (males) per 100,000 population by 2001 (Figure 1) [17]. Figure 1. Age standardised incidence of MM, England and Wales, 1971–2001 14 Incidence per 100,000 population 12 10 8 6 4 2 0 1971 1973 1975 1977 1979 1981 1983 1985 1987 Year 1989 1991 1993 1995 1997 1999 Males Females 2001 14 National Institute for Health and Clinical Excellence
The incidence of MM increases with age in both men and women, rising steadily in both sexes from age 15 years onwards. It is the third most common tumour in the 15–39 age group [16]. The median age of diagnosis of MM in men is 62 years and in women 60 years [16]. In Figure 2 the changes in age-specific incidence rates between 1981 and 2001 are shown. The incidence rate has increased in each age group age 15 and older over the last two decades. Improving Outcomes for People with Skin Tumours including Melanoma Background Figure 2. Incidence of MM, all persons England and Wales, 1981–2001 Incidence rate per 100,000 40 35 30 25 20 15 10 5 0 0-4 5-9 ◆ ✛ 1981 1986 1991 1996 2001 ■ ▲ • • ◆ ◆ ◆ ◆ ◆ ▲■ ■ ■ ■ ■ ▲ ▲ • • • ▲ ▲• ✛ ✛ 10-14 15-19 ◆ ◆ • • ▲ ■ ■ ▲ ■ • ▲ ■ ▲ ■ ■ ■ • • ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ▲■ • ▲ ▲ ■ ◆ ▲ ■ • • ▲ ▲ ■ ■ ▲ • • • ▲ ▲ ■ ◆ ◆ ✛ ✛ ✛ ✛ 20-24 ✛ 25-29 ✛ ✛ 30-34 ✛ ✛ 35-39 40-44 ✛ 45-49 Age (years) ✛ ✛ 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ There are approximately 1500 deaths from MM in England and Wales each year [16]. MM is a significant cause of cancer mortality in the 15–39 age group and the number of potential years of life lost is greater than for some other cancers. ✛ ✛ ✛ • • ✛ 1 The age-specific mortality rates for MM of the skin are higher in men than in women in the older age groups, and the increase in mortality with age mirrors the increase in incidence. The 2001 provisional figures indicated that the peak mortality at ages 85 years and older would reach 20 in men and 15 in women per 100,000 population [17] (Figure 3). Guidance on cancer services: skin tumours including melanoma 15
Page 1 and 2: NHS National Institute for Health a
Page 3 and 4: Contents Improving Outcomes for Peo
Page 5 and 6: Patient information ...............
Page 7 and 8: Resource implications .............
Page 9 and 10: Foreword Improving Outcomes for Peo
Page 11 and 12: - referral - review of patient care
Page 13 and 14: early detection have been published
Page 15: The epidemiology of skin cancers an
Page 19 and 20: Figure 5. Mortality from MM, Englan
Page 21 and 22: Figure 8. Incidence of NMSC, Englan
Page 23 and 24: Risk factors for skin cancer As ski
Page 25 and 26: Figure 12. Rates of episodes of inp
Page 27 and 28: Two-week wait data Urgent skin canc
Page 29 and 30: • Improving the experience of car
Page 31 and 32: 12. National Institute for Clinical
Page 33 and 34: Patient-centred care Improving Outc
Page 35 and 36: This document and the NICE Referral
Page 37 and 38: A checklist may be used by healthca
Page 39 and 40: Quality assurance Surveys of patien
Page 41 and 42: One cross-sectional study found tha
Page 43 and 44: One RCT conducted with patients wit
Page 45 and 46: • Every skin cancer MDT having ac
Page 47 and 48: to estimate a separate cost for ser
Page 49 and 50: department or they may be referred
Page 51 and 52: The 2-week waiting time standard an
Page 53 and 54: The local hospital skin cancer mult
Page 55 and 56: A function of the LSMDT is to audit
Page 57 and 58: • lymphoedema therapists • phar
Page 59 and 60: SSMDT meetings should be at least f
Page 61 and 62: As set out in the section on ‘Arr
Page 63 and 64: • Palliative care specialists. Si
Page 65 and 66: Videoconferencing and teleconferenc
Page 67 and 68:
A basic knowledge of skin cancer hi
Page 69 and 70:
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
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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
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Cutaneous lymphoma All patients sho
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Children and young people with skin
Page 125 and 126:
Gorlin’s syndrome Two expert revi
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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
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c) The guidance will also refer to
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4.2.2 Healthcare settings and servi
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Referral from the Department of Hea
Page 139 and 140:
Table A1. Summary of service option
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For those cancer networks with part
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Appendix 4 How this guidance manual
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Appendix 5 People and organisations
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Professor Julia Newton-Bishop Mr Ba
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• Bristol South and West PCT •
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• Healthcare Commission • Help
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• Royal College of Surgeons of En
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Appendix 5.3 Researchers carrying o
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Appendix 5.4 Expert advisers to the
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Appendix 5.5 Report* commissioned t
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Appendix 6 Glossary of terms Improv
Page 163 and 164:
Chemoprophylaxis The use of a drug
Page 165 and 166:
Electrodesiccation A surgical metho
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Immunotherapy Treatment by stimulat
Page 169 and 170:
Morbidity A diseased condition or s
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Prognosis A prediction of the likel
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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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