Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
Increased concentration of work in the hands of fewer specialists will
improve the expertise of those who see more patients. This is likely
to improve outcomes in all groups of patients, but particularly in
those with more challenging or rarer forms of skin cancer. Staging of
tumours, which is essential for treatment planning, is more likely to
be accurate when clinicians are more specialised.
Management of patients within these structures will facilitate highquality
audit and research.
C. Evidence
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Delay in diagnosis
Observational studies are inconsistent in their findings on the
relationship between delay in presentation and the prognostic factors
of melanoma tumours at diagnosis.
General practitioner
The clinical guidelines issued by NICE (Referral guidelines for
suspected cancer) make recommendations for referral of patients with
suspected cancer from primary care to specialist services. These
guidelines recommend that patients presenting with skin lesions
suggestive of skin cancer, or in whom a biopsy has been confirmed,
should be referred to a team specialising in skin cancer.
Two RCTs demonstrated that provision of training to GPs significantly
improved their ability to diagnose melanoma and NMSC, and to
correctly manage patients accordingly. In one trial the training was
delivered via the Internet.
Two RCTs examined the use of a diagnostic algorithm and a camera
as diagnostic tools for primary care physicians treating patients with
pigmented lesions suspicious of melanoma. One trial demonstrated a
reduction in the proportion of excised lesions that were found by
pathology to be benign, whereas the other trial found no effect.
One RCT found no evidence that giving feedback to GPs improved
their ability to diagnose and manage skin cancer. However, provision
of feedback was associated with an improvement in the likelihood of
their including a clinical diagnosis when submitting a pathology
request form.
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National Institute for Health and Clinical Excellence