Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
Organisation of skin
cancer services
Introduction
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Currently there are large variations in the way in which skin cancer
patients are seen and treated. Evidence from local audits shows that
in some areas significant numbers of patients with precancerous skin
lesions and BCCs, and smaller numbers of patients with SCC and MM,
are managed entirely in primary care, often with no contact with the
local hospital MDT and no audit of their outcomes. The
recommendations in this guidance should help ensure that all patients
in England and Wales who have any type of skin cancer are treated
to the same standards and that the treatment outcomes are audited.
Diagnosing and recommending appropriate management for skin
lesions requires specialist skills as emphasised by the NHS
Modernisation Agency. 18 This is important to ensure timely
management of skin cancer and the avoidance of unnecessary skin
surgery. The NHS Modernisation Agency specifically recommends that
‘The diagnostic and management phases of the treatment of skin
lesions should ideally be considered separately.’ In the light of this,
this guidance proposes that the diagnosis and treatment planning of
all suspicious pigmented lesions, all skin lesions that may be MM,
SCC or high risk BCCs, and any other skin lesion that may be a skin
cancer but where the diagnosis is unclear, should be carried out only
by specialists (normally dermatologists) who are suitably trained and
who are part of the hospital MDT network (see section on ‘Cancer
networks’).
Different degrees of specialisation are required to treat the various
types and stages of skin cancer. Unlike other cancers, the majority of
precancerous lesions and BCCs carry no risk of death and have a low
risk of recurrence. The treatment and follow-up of patients with these
lesions may be carried out by trained doctors and nurses with
relatively straightforward outpatient or day care. Such care may be
provided in a community setting by appropriately trained doctors and
specialist nurses working within a formal, audited and professionally
led framework. Patients with lesions that are more difficult to treat
may have their treatment carried out within the local dermatology
18 NHS Modernisation Agency. Action on plastic surgery programme. Available from:
www.modern.nhs.uk
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National Institute for Health and Clinical Excellence