Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Background A. Recommendations It is recommended that the Royal College of Pathologists minimum dataset [30] is implemented in order to enhance the quality of cancer registration. 1 It is recommended that at least two cancer registries should receive additional funding to undertake full registration of skin cancers, including the registration of BCCs. Ideally this should include the registries covering the areas with the highest and lowest incidence of skin cancer. Commissioners should implement the recommendations on skin cancer prevention outlined in the Health Development Agency document titled Cancer prevention: A resource to support local action in delivering The NHS Cancer Plan [14]. B. Anticipated benefits Improved data collection on skin cancer should produce accurate population-based information on cancer incidence, prevalence, service utilisation, mortality and survival rates. These data will enhance the understanding of the epidemiology of skin cancer and the ability to monitor the impact of interventions. Specific benefits are envisaged in the following areas: • Prevention. Population-based incidence data are required to monitor the achievement of targets for preventing cancer. This monitoring will probably be required for the next 10–20 years to see whether the current trend can be reversed. • Early detection. Population-based data are required to monitor the effectiveness of early detection and health promotion programmes. • Improving access to specialist care. Population-based data are required to monitor intervals between referral and treatment of cancer patients. • Improving treatment. Treatment patterns need to be monitored to audit adherence to guidelines, effectiveness of interventions and outcomes. Data from cancer registries can identify the scope for NHS intervention. Information systems will have to be developed to support this process, including a palliative care dataset. 26 National Institute for Health and Clinical Excellence
• Improving the experience of care. Access to specialist palliative care and place of death should be monitored to ensure optimal access and choice of place of death for patients. Implementation of the advice set out in the Health Development Agency document titled Cancer prevention: A resource to support local action in delivering The NHS Cancer Plan [14] should start to change attitudes and behaviour towards UV exposure and enhance earlier detection of skin cancers. C. Resource implications There will be resource implications for the networks from the recommendations concerning the implementation of the Royal College of Pathologists minimum data requirements. This will be considered in the ‘Initial investigation, diagnosis, staging and management’ chapter of the guidance. Cancer registries do not currently have the resources to collect data on all skin cancers. Much of the data collection will be facilitated in the future by developments in electronic data transfer as a result of the National Programme for Information Technology in England [31] and Informing Healthcare in Wales [32]. This will take some time to be fully implemented. In order that two cancer registries may undertake full registration of all skin cancers, the costs are estimated to be between £35,638 and £54,842 for the first year, while staff are trained. The annual recurring costs would be the same; the variation is dependent upon exactly how many additional staff are required. This cost is likely to decrease as registries that are not currently fully automated become so. Improving Outcomes for People with Skin Tumours including Melanoma Background 1 D. Audit and research priorities Commissioners should ask their local cancer registries to undertake a joint audit with local clinicians of the current extent and quality of skin cancer registration in order to gain a better understanding of the relevance of local statistics for service planning. The impact on mortality and survival from skin cancer of implementing this guidance should be evaluated. Further research on the epidemiology of skin cancer is urgently required to improve the targeting of preventive interventions. Guidance on cancer services: skin tumours including melanoma 27
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 and 26: Figure 12. Rates of episodes of inp
Page 27: Two-week wait data Urgent skin canc
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
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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
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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
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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
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Gorlin’s syndrome Two expert revi
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Process • Audit of adherence to p
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• Cutaneous lymphoma is so rare t
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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
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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
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Chemoprophylaxis The use of a drug
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Electrodesiccation A surgical metho
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Immunotherapy Treatment by stimulat
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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
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KS LHB LSMDT MCC MDT MM MRI NCC-C N
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