Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services If two or more SSMDTs are established in one cancer network, there should be strong links between them. These SSMDTs should establish common clinical protocols across the network as a whole, and for the audit of all aspects of their work. Each team should appoint a lead clinician who will take an active role in the coordination of skin cancer services provided by the network as a whole. If patients attend the SSMDT they should be seen in a combined or parallel clinic staffed by the core members of the SSMDT (see ‘The role of the SSMDT’). The history, histology and radiology of those patients who attend the SSMDT should also be presented at the review meeting. 3 Patients with lymphoma and other rare skin cancers (see chapter on ‘Management of special groups’) should be dealt with by only one SSMDT in the network. All cases should be reviewed by the dermatopathologist designated by the network to have an interest in, and lead responsibility for, cutaneous lymphoma reporting. It is appropriate for the network lead dermatopathologist in lymphoma reporting to attend the clinics as necessary. The lead dermatopathologist in lymphoma reporting is likely to be, but is not necessarily, the SSMDT lead dermatopathologist. The NICE guidance on Improving outcomes in haematological cancers 25 permits considerable flexibility for the type and number of lymphoma/leukaemia MDTs. Multidisciplinary primary cutaneous lymphoma clinics have developed in several networks and have been highly successful. In particular this model facilitates patient examination and clinicopathological correlation, which is often essential for the accurate diagnosis of cutaneous lymphoma. These multidisciplinary clinics can be encouraged to continue and develop, depending on appropriate geography and case numbers. With appropriate core membership these could achieve MDT status, but should formally feed back summaries to the SSMDT. The role of the SSMDT The SSMDT will also act as the LSMDT for their local catchment population. They should, in addition, review other specific groups of patients (Table 4); these will be referred in from other LSMDTs according to network protocols. 25 National Institute for Clinical Excellence (2003) Improving outcomes in haematological cancers. London: National Institute for Clinical Excellence. Available from: www.nice.org.uk 56 National Institute for Health and Clinical Excellence
SSMDT meetings should be at least fortnightly. The key roles of the SSMDT over and above that of an LSMDT are to: • Provide a rapid diagnostic and treatment service (ideally at the same clinical session) for patients referred from LSMDTs. Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services • Provide specialist investigations and treatments not available to LSMDTs. • Undertake research including entering patients into NCRN- and WCTN-approved clinical trials. Wherever possible patients should be considered for clinical trials (e.g. adjuvant therapies or surgical treatments). Where trials are adopted for surgical procedures on lymph nodes, these patients should be referred and coordinated by the SSMDT. • Collect data for network-wide audit (Table 3). • Play a lead role in Mohs surgery activity within the cancer network. 3 • Play a lead role in training and teaching health professionals about skin cancer. The SSMDT should have access to ITU or high-dependency facilities for major surgical cases (for example, widespread tumours affecting the head and neck). It should maintain close contact with other professionals who may be involved in supporting patients or carrying out the management strategy decided by the team, so that rapid access to their services can be provided when required. All cases referred to the SSMDT should receive formal diagnostic histopathological review. There may be a few exceptions; for example, cases referred with extensive BCC for surgical reconstruction. All cases requiring a tertiary histopathological opinion should be supported by the SSMDT on a commissioning basis. Patients reviewed by the SSMDT should be seen by and referred from the LSMDT in most instances, unless the SSMDT is also the LSMDT. However, in order to avoid undue delays some patients may be referred directly from doctors working in the community. Guidance on cancer services: skin tumours including melanoma 57
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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 ...............
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 and 28: Two-week wait data Urgent skin canc
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: • lymphoedema therapists • phar
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
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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
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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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Improving outcomes for people with skin tumours including melanoma

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