Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Organisation of skin
cancer services
the opportunity cost for the consultant. In future, training will have to
be undertaken to the accepted level of an accredited course, examples
of which will be available and will involve accreditation by all relevant
parties including BAD, RCGP, patient groups and primary care society
in dermatology.
It is not possible to estimate how many networks will commission
GPwSI services. It is estimated that for a network with an average
number of PCT/LHBs (8.78 per network), having a service involving
three GPwSIs in each PCT/LHB, about 26 GPwSIs would be required,
with some working part-time.
F. Research priorities
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All aspects of the impact of this proposed model of care should be
evaluated using appropriate research methods.
Teledermatology
Teledermatology refers to the use of digital images, together with
relevant patient information, as a means of aiding referral of patients
with skin problems from primary to secondary care, and it can also be
used as a means of communication between specialists in secondary
care (store and forward teledermatology). Real-time videoconferencing
with patients from remote sites is also possible, and this guidance
refers to this as a possible means of facilitating MDT work.
The evidence for the benefits of store and forward teledermatology as
a means of triaging referral for patients with skin lesions is conflicting,
as is the evidence regarding its cost-effectiveness. There are still many
problems to be overcome before the use of teledermatology can be
recommended as routine, not least the problem of ensuring patient
confidentiality and the use of the Internet. It is most likely to be useful
in aiding referral of patients from rural areas that may not have easy
access to a specialist unit for rapid diagnosis.
The guidance recommends more research into the most effective way
of utilising teledermatology to triage patients with suspicious skin
lesions, looking at all aspects of its use including clinical accuracy,
cost-effectiveness, patient confidentiality and patient acceptability.
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National Institute for Health and Clinical Excellence