Improving outcomes for people with skin tumours including melanoma

department or they may be referred to a variety of other specialists
appropriate for their needs. Although few patients with MM and SCC
are currently treated in the community (1.4–13% for MM and 0.7–10%
for SCC), delay, misdiagnosis or mismanagement could have a serious
effect on their chances of survival (see Evidence Review). Therefore
these patients need to be managed by a hospital-based MDT.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
Precancerous lesions of the skin are common. Prevalence studies
have demonstrated that approximately 23% of the population aged 60
years and older have actinic keratosis (AK). Most patients with
precancerous skin lesions can be managed by their GP or by a
clinician working in the community (see ‘Clinicians working in the
community’). However, where there is doubt about the diagnosis the
patient should be referred to the hospital dermatology department.
Some treatments for well-defined groups of patients may be carried
out in the community by a variety of clinicians, including GPs with a
special interest (GPwSI) in skin cancer. A recent audit of GPwSIs in
dermatology has shown that many PCTs/LHBs are not following the
guidelines for GPwSI working agreed and published by the Royal
College of General Practitioners (RCGP), BAD and DH. 19,20 It is
essential that these guidelines are adhered to by GPwSIs who wish to
see and treat patients with skin cancer, in order to ensure a high
quality of care for these patients.
3
This guidance is proposing a structured approach to the organisation
of the management of patients with skin cancers, with firm
recommendations on which types of skin lesions can be diagnosed
and treated in the community, local hospitals and specialist centres.
The proposed structure should standardise care regardless of where
the patient is treated and should minimise the risks to patients,
because all clinicians who treat patients with skin cancers will be
working to the same protocols and have their outcomes audited. It
will encourage some treatments for patients with precancerous skin
lesions and low-risk BCCs to be carried out in the community but
ensure that patients with MM, SCC and high-risk BCC have their care
managed by a hospital-based MDT with specialist skills.
19 British Association of Dermatology (2002) Service provision guidelines: GPs with a special
interest in dermatology. British Association of Dermatologists’ position statement. Available
from: www.bad.org.uk/healthcare/service/statement.asp
20 Department of Health (2003) Guidelines for the appointment of GPs with special interests
in the delivery of clinical services: dermatology. Available from: www.dh.gov.uk
Guidance on cancer services: skin tumours including melanoma
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