Improving outcomes for people with skin tumours including melanoma

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3 Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services • Histopathologists. Ideally there should be at least two specialist dermatopathologists or histopathologists with a special interest in dermatopathology. This is to provide flexibility and adequate cover during leave periods. There should be a designated lead in the area and ideally a deputy lead. The lead and deputy lead engaged in reviewing and reporting SSMDT skin cancer cases should each attend over 50% of SSMDTs. Other histopathologists reviewing and reporting SSMDT work should be able to demonstrate some MDT activity. All specialist histopathologists reviewing and reporting common and rare skin cancers should be able to demonstrate experience, competency and skills sufficient to fulfil the task, or undertake appropriate training to acquire the skills. The level of competence and skills for this activity is broadly that of the RCPath Diploma in Dermatopathology and American Board Certification in Dermatopathology. These qualifications are not, however, regarded as mandatory. All specialist histopathologists engaged in this work should participate in some CPD relevant to common and rare skin cancers and participate in an appropriate EQA scheme. Ideally this should be a national specialist EQA scheme in dermatopathology, when available. Those reporting primary cutaneous lymphoma must participate in an EQA scheme including this group of diseases. It is also desirable that the CPD is facilitated by membership of appropriate national societies (such as the British Society for Dermatopathology and/or the UK Cutaneous Lymphoma Group). Each cancer or pathology network could hold a panel of histopathologists suitable for SSMDT participation based on these criteria. Histopathologists restricting their activity in the SSMDT centre to work at the LSMDT level should be able to demonstrate the same activity as defined previously. It is acknowledged that because of workforce shortages in histopathology there could be an implementation delay of these goals in some centres. • Radiologists. Cross-sectional imaging is important for staging new cases and managing advanced cases. Sessional time must be identified to allow the radiologists to prepare for and attend the MDT meeting. • Clinical oncologists. A designated clinical oncologist should be identified as a member of the SSMDT and should be present in both the clinic and MDT review meeting. • Medical oncologist. A designated medical oncologist should be identified as a member of the SSMDT and should be present in both the clinic and MDT review meeting. 60 National Institute for Health and Clinical Excellence
• Palliative care specialists. Since the management of complex invasive skin cancers (particularly metastatic MM) is often palliative, a palliative care specialist (either a doctor or a nurse) should be included in the core team. Patients with specialist palliative care needs should also be referred to the appropriate community palliative care services. Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services • Team coordinator/secretary. A team coordinator/secretary should provide clerical support, record meetings and ensure that all documentation required to inform MDT discussion is available at each meeting. • For each of the specialties described above there should be a nominated lead and deputy. Members of the extended SSMDT The core members and those in the list below form the extended multidisciplinary team that meets at least once a year to decide and discuss local issues of service delivery and quality. The trust cancer services managers should attend such meetings. 3 The extended SSMDT may include: • trained counsellors with experience in cancer • psychologists • liaison psychiatrists • pharmacists • cosmetic camouflage service advisers • clinical geneticist/genetic counsellors • lymphoedema therapists • occupational therapists • prosthetics and orthotics staff • physiotherapists • radiographers • speech and language therapists. Guidance on cancer services: skin tumours including melanoma 61
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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 ...............
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Resource implications .............
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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 and 58: • lymphoedema therapists • phar
Page 59 and 60: SSMDT meetings should be at least f
Page 61: As set out in the section on ‘Arr
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
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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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