Improving outcomes for people with skin tumours including melanoma

One systematic review (of the ability of primary care physicians and
dermatologists to diagnose melanoma, and to make correct decisions
on biopsy and referral) included 32 primary studies, from a variety of
countries. The review concluded that the data from primary studies
were inadequate to show differences between dermatologists and GPs
in these diagnostic and decision-making outcomes.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
One systematic review of 14 US primary studies found that
dermatologists performed significantly better than non-dermatologist
doctors in the diagnosis of images of benign and malignant skin
lesions.
In the patient survey commissioned for this guidance there was
evidence that diagnosis had been delayed for a number of patients by
GPs who failed to recognise the severity of the lesions or who
removed lesions inadequately. The patients wanted to see improved
education in skin cancer for GPs as one way of improving services.
Three observational studies found that GPs were more likely to
perform incomplete excisions of melanoma tumours. One study also
found that some GPs do not routinely obtain histological examination
of skin lesions that they believe to be benign. Audits have shown that,
when GPwSIs work to an agreed protocol dealing only with low-risk
lesions, the incomplete excision rate is comparable to hospital
specialty rates.
3
One retrospective study examined outcomes for patients with
melanoma by the type of clinician performing initial treatment. This
study found that, when adjusted for prognostic factors, patients
treated by GPs had poorer overall survival, disease-free survival and
recurrence-free interval than patients treated by dermatologists.
However, these differences were not statistically significant.
In an expert paper submitted by the British Association of
Dermatologists (BAD) there was support for the training of GPwSIs by
consultant dermatologists in diagnostic skills for benign and malignant
skin tumours. It also recommended maintaining close links with the
local dermatology and histopathology departments.
Nurses
Guidelines produced by the British Association of Plastic Surgeons
and the NHS Modernisation Agency recommend that more nurse
specialist posts should be created and supported by adequate funding.
Guidance on cancer services: skin tumours including melanoma
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