Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services Observational studies of the skin cancer surveillance role of trained nurses have considerable variability but provide evidence that, after appropriate training, nurses can demonstrate high recognition rates for suspicious skin lesions. MDT working 3 The benefits of the model of MDT working have been emphasised in all of the series of guidances on cancer services published by the DH and NICE. The model has been designed to meet the needs of skin cancer patients and those providing service to them. The psychosocial benefits of the services that a CNS can provide are discussed in the chapter on ‘Patient-centred care’ and the Improving outcomes guidance series, as are the benefits of the roles of members of the extended team. Clinical guidelines produced by expert bodies in the UK support multidisciplinary care as the model of care for patients with skin cancer. UK guidelines for plastic surgery services strongly support multidisciplinary management of patients with skin lesions and recommend appropriate training and accreditation for all clinicians who perform skin surgery. Audit evidence from the UK suggests that, to date, progress has been slow in setting up effective skin cancer MDTs that meet the standards set out in the Manual of Cancer Services Standards. One retrospective analysis of multidisciplinary melanoma care found it to be cost-effective. Evidence from three expert opinion articles that describe the experiences of dedicated multidisciplinary melanoma centres suggests that a multidisciplinary approach can offer further services in patient education, psychosocial support and rehabilitation. This approach is reported to increase staff enthusiasm and promote better coordination and communication via nurse coordinators, and also to improve cost efficiency. One multidisciplinary melanoma unit reported that specialist centres that treat high numbers of patients with melanoma encourage adherence to evidence-based guidance and the maintenance of standards for technically demanding surgical procedures. 70 National Institute for Health and Clinical Excellence
One retrospective study compared pathology reports from routine pathology services with a pathology review at a multidisciplinary pigmented lesion clinic. Diagnoses were revised by the multidisciplinary clinic in 11% of all reports, and review of surgical margins led to a change in surgical margin status for 12% of patients. The study concluded that review by experienced pathologists within MDTs provides internally consistent diagnoses and valuable second opinions. Improving Outcomes for People with Skin Tumours including Melanoma Organisation of skin cancer services Published studies are supportive of multidisciplinary care in the treatment of special patient groups (see chapter on ‘Management of special groups’) and palliative care (see chapter on ‘Patient-centred care’). D. Measurement Structure 3 • A published local list of all doctors and nurses who are members of the LSMDT and SSMDT, including approved doctors working in the community. Details of their relevant expertise and training should be available at cancer network level. • Named lead clinician for each team (LSMDT and SSMDT), agreed with the cancer network skin cancer lead clinician, and with appropriate sessional commitment. • Evidence that each team has access to a CNS. • Network-wide protocols for referral of patients to each level of the service and for patient management. • Local commissioning organisations (PCTs/LHBs) providing evidence that all GPwSIs employed to carry out skin cancer work as part of the skin cancer LSMDT/SSMDT comply with the DH/BAD/RCGP guidelines and have weekly parallel clinic sessions in a hospital department with an appropriate specialist who is a member of the skin cancer LSMDT/SSMDT. • A record of all patient information leaflets, to include information on pigmented lesions, precancerous skin lesions, BCC and any treatments offered, such as cryotherapy and PDT. These should contain photographs of skin cancers to help in self-examination. Guidance on cancer services: skin tumours including melanoma 71
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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
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- referral - review of patient care
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early detection have been published
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The epidemiology of skin cancers an
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The incidence of MM increases with
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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: One systematic review (of the abili
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
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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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