Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Cancer service guidance supports the implementation of The NHS Cancer Plan for England, 1 and the NHS Plan for Wales Improving Health in Wales. 2 The service guidance programme was initiated in 1995 to follow on from the Calman–Hine Report, A Policy Framework for Commissioning Cancer Services. 3 The focus of the cancer service guidance is to guide the commissioning of services and is therefore different from clinical practice guidelines. Health services in England and Wales have organisational arrangements in place for securing improvements in cancer services and those responsible for their operation should take this guidance into account when planning, commissioning and organising services for cancer patients. The recommendations in the guidance concentrate on aspects of services that are likely to have significant impact on health outcomes. Both the objectives and resource implications of implementing the recommendations are considered. This guidance can be used to identify gaps in local provision and to check the appropriateness of existing services. References 1. Department of Health (2001) The NHS Cancer Plan. Available from: www.dh.gov.uk 2. National Assembly for Wales (2001) Improving Health in Wales: A Plan for the NHS and its Partners. Available from: www.wales.gov.uk/healthplanonline/health_plan/content/nhsplan-e.pdf 3. A Policy Framework for Commissioning Cancer Services: A Report by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales (1995). Available from: www.dh.gov.uk National Institute for Health and Clinical Excellence MidCity Place 71 High Holborn London WC1V 6NA Web: www.nice.org.uk ISBN: 1-84629-125-9 Copies of this document can be obtained from the NHS Response Line by telephoning 0870 1555 455 and quoting reference N0957. Information for the public is also available from the NHS Response Line (reference number N0958). A CD-ROM with all documentation, including the research evidence on which the guidance is based, is available from the NHS Response Line (reference N0959). Published by the National Institute for Health and Clinical Excellence February 2006 © National Institute for Health and Clinical Excellence, February 2006.All rights reserved.This material may be freely reproduced for educational and not-for-profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.
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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
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The written and photographic inform
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Genetic predisposition to MM may al
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patients with cutaneous lymphoma sh
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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
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
Page 173 and 174: Systemic therapy Treatment that rea
Page 175: KS LHB LSMDT MCC MDT MM MRI NCC-C N
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