Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Initial investigation,
diagnosis, staging and
management
All cases referred to the SSMDT should have a specialist
histopathology review.
An appropriately resourced national system for histopathology tertiary
review should be established. Currently, several thousand complex
and/or rare skin cancer cases per year require tertiary opinions from
a small number of informally recognised national expert specialist
dermatopathologists. Even with the formation of larger pathology
networks, the complexity of these cases indicates that this tertiary
referral practice will continue to be necessary to obtain the correct
diagnosis and thereby maximise the quality of patient treatment and
care. All SSMDT cases falling into this category should have full
access to this tertiary referral facility when supported by the SSMDT.
Commissioners should be aware of the funding implications. These
services, which may cross many network boundaries, should be
commissioned through the specialised services commissioners.
4
MDTs should complete the national cancer datasets for common skin
cancers and for lymphoma. 49,50
Management of precancerous lesions
Where there is any doubt about the diagnosis, the patient should be
referred for a specialist opinion as described in Box 1 and Figure 14.
All excised skin specimens should be sent for histopathological
examinations as recommended in the NICE Referral guidelines for
suspected cancer. 51
Patients with two or more atypical naevi, and giant congenital naevi
where there is a suspicion of malignant transformation, and who
need assessment and education should be referred to a member of
the LSMDT or SSMDT (see chapter on ‘Organisation of skin cancer
services’, Table 2 and Table 4).
Medical photography has a special role to play in surveillance for
patients with atypical naevi. Therefore all departments treating skin
cancer should have access to high-quality medical photography and
storage of digital images.
Any doctor or nurse who knowingly treats patients with precancerous
lesions should have received locally approved training in available
treatments.
49 Royal College of Pathologists. Standards and minimum datasets for reporting cancers.
www.rcpath.org
50 www.icservices.nhs.uk/cancer/pages/dataset/default.asp
51 National Institute for Health and Clinical Excellence. Referral guidelines for suspected
cancer. Available from: www.nice.org.uk/CG027
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National Institute for Health and Clinical Excellence