Improving outcomes for people with skin tumours including melanoma

More documents

Recommendations

Info

Improving Outcomes for People with Skin Tumours including Melanoma Initial investigation, diagnosis, staging and management Radiotherapy is curative for some cases of advanced inoperable disease. Radiotherapy also has a role in the palliative treatment of patients with large, inoperable and recurrent SCC, or if there are inoperable metastases in lymph nodes or elsewhere. Radiotherapy has a role in adjuvant treatment of extracapsular nodal disease following neck dissection, for example, and not just palliation. • Systemic treatment. There are very few patients with NMSC who need systemic treatment with chemotherapy. A. Recommendations Investigation and diagnosis 4 GPs should receive training as recommended in the NICE Referral guidelines for suspected cancer 44 on the diagnosis of precancerous and cancerous lesions, and should receive feedback through audit on their diagnostic accuracy. GPs should refer certain groups of skin lesions as described in Box 1 and Figure 14 directly to an LSMDT without biopsy. This practice should be subject to audit. All excised skin specimens should be sent for histopathological examination as recommended in the NICE Referral guidelines for suspected cancer. 45 Dermatoscopy should be available in all MDTs, but its use requires training. There should be equity of access so that all tissue samples are reviewed in high-quality histopathology services. Accurate diagnosis in dermatopathology depends on clinicopathological correlation, involving input from both clinician and pathologist. Although this can be achieved in difficult cases by interspecialist discussion or seeing the patient records, in some instances (such as cutaneous lymphoma) it may be essential for the patient to be seen jointly. Accordingly, for good clinical governance, it is recommended that the histopathology reporting of any specimens likely to be considered by a skin cancer MDT should be undertaken in a laboratory having easy access to relevant clinicians, patient records and the attending patient. 44 National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. Available from: www.nice.org.uk/CG027 45 National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. Available from: www.nice.org.uk/CG027 84 National Institute for Health and Clinical Excellence
Histopathology services for skin cancer should be part of a managed pathology network or equivalent model. Histopathology reporting should be provided by histopathologists who participate in EQA. This may be a general histopathology EQA scheme that includes skin or a more specialist skin EQA scheme. When appropriate, the EQA scheme should cover lymphoma. Given the overlap with head and neck cancer services, it should be noted that the head and neck histopathology EQA scheme includes skin cases. Improving Outcomes for People with Skin Tumours including Melanoma Initial investigation, diagnosis, staging and management All histopathology reports relating to skin cancer should conform to the Royal College of Pathologists minimum datasets 46 on cancer in order to provide adequate and appropriate information on prognosis, planning individual patient treatment, supporting epidemiology and research, and to evaluate clinical services and support clinical governance. SNB samples for skin cancer should be examined and reported by specialists with a registered qualification in histopathology. It is desirable that SNB samples resulting from skin cancer are handled and reported by the same team of pathologists involved in the reporting of skin cancer. The technical processing of SNB samples must conform to recognised national or international protocols (such as that used by the European Organisation for Research and Treatment of Cancer (EORTC) 47 ). 4 All MMs and severely atypical naevi should be double-reported if resources allow the report to be generated within 2 weeks. The acknowledged current shortfall of an NHS histopathology workforce in some centres could delay this quality recommendation. Although it is ideal that all melanocytic lesions are double-reported to avoid missing MM, it is likely to be many years before the NHS histopathology workforce could achieve this. Given an adequate histopathology workforce in the medium to long term, it is desirable that eventually all skin cancers are doublereported to achieve consistency and accuracy in diagnosis. It is also recognised that alternative models to double-reporting of MM exist, such as consensus meetings outwith the MDT. These are equally acceptable so long as all potential MDT cases are discussed and the meetings formally minuted with regard to attendance and diagnosis. 48 46 Royal College of Pathologists. Standards and datasets for reporting cancers. Available from: www.rcpath.org 47 www.eortc.be 48 Department of Health (2004) Manual for cancer services. Available from: www.dh.gov.uk Guidance on cancer services: skin tumours including melanoma 85
Page 1 and 2:
NHS National Institute for Health a
Page 3 and 4:
Contents Improving Outcomes for Peo
Page 5 and 6:
Patient information ...............
Page 7 and 8:
Resource implications .............
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: Diclofenac 3% gel (Solaraze) is lic
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
show all

Improving outcomes for people with skin tumours including melanoma

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?