Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Figure 13. Number of episodes of inpatient care for MM, by selected specialties, England 1991–2000 1 Background Age standardised rate (per 100,000) 4000 3500 3000 2500 2000 1500 1000 500 0 • General surgery Plastic surgery • ▲ Dermatology ▲ Oncology ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ • • • ▲ ▲ • • • • • • • • • • • • • • • • • 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 Year ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ Table 1. Proportion of patients treated by dermatologists Year MM (%) NMSC (%) 1993 9.2 16.5 1994 6.8 22.5 1995 7.1 23.6 1996 6.4 25.5 1997 10.0 28.9 1998 14.7 31.7 1999 13.8 31.1 2000 16.3 30.4 Specialist and supraregional specialist services At present there is a paucity of services at regional and supraregional level that specialise in the care of high-risk or special groups, for example transplant patients, those with genetic predisposition to skin cancer, those with rare skin tumours (including cutaneous lymphoma) and young people with skin cancer. 24 National Institute for Health and Clinical Excellence
Two-week wait data Urgent skin cancer referrals made using the 2-week wait criteria in England, which reflect MM and SCC outpatient workloads (but exclude precancerous lesions and BCC), accounted for 12.4% of all 2-week wait referrals during the fourth quarter of 2004/2005 [27]. Skin is the thirdcommonest group of cancers to be referred after breast and lower gastrointestinal cancers. An overview of 52 audit studies of skin cancer referrals under the 2-week rule found that MM and SCC account for 10–12% of the referrals, with the remainder found to be benign lesions [28]. Primary care activity There is a paucity of evidence regarding the current levels of management and/or biopsy of skin tumours in primary care. Following the first stakeholder consultation of this guidance, the results of nine audits from NHS trusts in England (see Evidence Review) were submitted to the NCC-C and gave an indication of the wide range of activity in primary care. A summary of these data is provided below. For all skin tumours, the proportion biopsied in primary care ranged from 1.2% to 17%. Audit data estimated that: • between 1.4% and 13% of MM are biopsied in primary care • between 0.7% and 10% of SCC are biopsied in primary care • between 1.3% and 8.8% of BCC are biopsied in primary care. These proportions should reduce once this guidance is implemented. Improving Outcomes for People with Skin Tumours including Melanoma Background 1 Guidance on cancer services: skin tumours including melanoma 25
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 and 16: The epidemiology of skin cancers an
Page 17 and 18: The incidence of MM increases with
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: Figure 12. Rates of episodes of inp
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
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 and 134:
c) The guidance will also refer to
Page 135 and 136:
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
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
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Appendix 5.4 Expert advisers to the
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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
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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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