Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
Depending on local circumstance, community skin cancer clinics could
be based in GPs’ surgeries, community hospitals or diagnostic and
treatment centres where these exist. Patients could be referred to these
clinics by local GPs or members of the LSMDT/SSMDT. For instance,
when a diagnosis of low-risk BCC is made in a dermatology clinic, the
patient may prefer the surgery to be carried out in the community if
the specialist agrees this to be appropriate. Patients could be seen by
these teams for treatment and follow-up when appropriate, according
to agreed protocols and patient choice (see Box 1 and Figure 14 for
details of the patient pathway for different types of skin lesions).
3
Any doctor or specialist nurse who wishes to treat patients with skin
cancer should have specialist training in skin cancer work, be a
member of the LSMDT and undergo ongoing education (see section
on ‘Structure and clinical governance’). In the absence of a national
body to determine the surgical training within the remit of skin cancer,
this should be determined by the network site-specific group for skin
cancer and be consistent with the NICE Referral guidelines for
suspected cancer. 29 All doctors participating in the MDT should have a
letter of appointment from the MDT lead clinician. Ideally all doctors
treating patients with skin cancer should have attended a recognised
skin surgical course. They should also work at least one session per
week as a clinical assistant, hospital practitioner, associate specialist or
staff-grade doctor in the local hospital department. This should be in a
parallel clinic with an appropriate hospital specialist, normally a
dermatologist, who is a member of the LSMDT/SSMDT. This applies to
GPwSIs as well, as specified in the joint recommendations by the DH,
RCGP and BAD. 30,31 This is considered essential to maintain skills and
promote dialogue with the specialist.
29 National Institute for Health and Clinical Excellence. Referral guidelines for suspected
cancer. Available from: www.nice.org.uk/CG027
30 Department of Health, Royal College of General Practitioners (2003) Guidelines for the
appointment of general practitioners with special interests in the delivery of clinical
services: dermatology. Available from: www.dh.gov.uk
31 British Association of Dermatologists (2002) Service provision guidelines: GPs with a
special interest in dermatology. British Association of Dermatologists’ position statement.
Available from: www.bad.org.uk
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National Institute for Health and Clinical Excellence