Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Contents Dermatoscopy ........................................................................................90 Teledermatology ....................................................................................90 Imaging techniques ...............................................................................91 Surgical therapies ..................................................................................92 Lymph node clearance ..........................................................................93 Topical therapy ......................................................................................95 Systemic therapy ....................................................................................96 Interferon alfa ........................................................................................96 Immunotherapy .....................................................................................97 In-transit melanoma ..............................................................................97 Palliative and supportive care ..............................................................97 Measurement ...................................................................................98 Resource implications ................................................................99 Investigation and diagnosis ..................................................................99 Management of precancerous lesions ................................................100 Management of skin cancers – Mohs .................................................100 Research priorities .....................................................................101 5. Follow-up ............................................................................102 Introduction ...................................................................................102 Recommendations ......................................................................104 Basal cell carcinoma and squamous cell carcinoma .........................105 Melanoma .............................................................................................106 Anticipated benefits ...................................................................106 Evidence ...........................................................................................107 Basal cell carcinoma ............................................................................107 Squamous cell carcinoma ...................................................................108 Melanoma .............................................................................................108 Educating patients for self-examination .............................................109 Measurement .................................................................................110 4 National Institute for Health and Clinical Excellence
Resource implications ..............................................................110 BCC and SCC .......................................................................................111 Melanoma .............................................................................................111 Improving Outcomes for People with Skin Tumours including Melanoma Contents Research priorities .....................................................................111 6. Management of special groups ..........................112 Introduction ...................................................................................112 Genetic predisposition ........................................................................112 Organ transplant patients ....................................................................113 Skin lymphomas ..................................................................................114 Skin sarcomas ......................................................................................115 Kaposi’s sarcoma .................................................................................115 Children ................................................................................................116 Recommendations ......................................................................117 Generic recommendations for patients with uncommon risk factors or rare cancers .............................................117 Genetic predisposition ........................................................................118 Transplant patients ..............................................................................118 Cutaneous lymphoma .........................................................................119 Skin sarcomas ......................................................................................120 Children and young people ................................................................120 Anticipated benefits ...................................................................121 Evidence ...........................................................................................121 Genetic predisposition ........................................................................121 Lymphoma ...........................................................................................122 Kaposi’s sarcoma .................................................................................122 Gorlin’s syndrome ...............................................................................123 Transplant patients ..............................................................................123 Children ................................................................................................124 Children and adolescents in clinical trials .........................................124 Measurement .................................................................................124 Guidance on cancer services: skin tumours including melanoma 5
Page 1 and 2: NHS National Institute for Health a
Page 3 and 4: Contents Improving Outcomes for Peo
Page 5: Patient information ...............
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 and 58:
• lymphoedema therapists • phar
Page 59 and 60:
SSMDT meetings should be at least f
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
Page 109 and 110:
C. Evidence Evidence exists that ea
Page 111 and 112:
One observational study found that
Page 113 and 114:
The written and photographic inform
Page 115 and 116:
Genetic predisposition to MM may al
Page 117 and 118:
patients with cutaneous lymphoma sh
Page 119 and 120:
A. Recommendations Generic recommen
Page 121 and 122:
Cutaneous lymphoma All patients sho
Page 123 and 124:
Children and young people with skin
Page 125 and 126:
Gorlin’s syndrome Two expert revi
Page 127 and 128:
Process • Audit of adherence to p
Page 129 and 130:
• Cutaneous lymphoma is so rare t
Page 131 and 132:
Dermal and subcutaneous tumours Aty
Page 133 and 134:
c) The guidance will also refer to
Page 135 and 136:
4.2.2 Healthcare settings and servi
Page 137 and 138:
Referral from the Department of Hea
Page 139 and 140:
Table A1. Summary of service option
Page 141 and 142:
For those cancer networks with part
Page 143 and 144:
Appendix 4 How this guidance manual
Page 145 and 146:
Appendix 5 People and organisations
Page 147 and 148:
Professor Julia Newton-Bishop Mr Ba
Page 149 and 150:
• Bristol South and West PCT •
Page 151 and 152:
• Healthcare Commission • Help
Page 153 and 154:
• Royal College of Surgeons of En
Page 155 and 156:
Appendix 5.3 Researchers carrying o
Page 157 and 158:
Appendix 5.4 Expert advisers to the
Page 159 and 160:
Appendix 5.5 Report* commissioned t
Page 161 and 162:
Appendix 6 Glossary of terms Improv
Page 163 and 164:
Chemoprophylaxis The use of a drug
Page 165 and 166:
Electrodesiccation A surgical metho
Page 167 and 168:
Immunotherapy Treatment by stimulat
Page 169 and 170:
Morbidity A diseased condition or s
Page 171 and 172:
Prognosis A prediction of the likel
Page 173 and 174:
Systemic therapy Treatment that rea
Page 175 and 176:
KS LHB LSMDT MCC MDT MM MRI NCC-C N
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