Improving outcomes for people with skin tumours including melanoma

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Improving Outcomes for People with Skin Tumours including Melanoma Initial investigation, diagnosis, staging and management Treatments using surgery and carbon dioxide laser techniques should be available at regional centres via SSMDTs, but ILP and ILI would only be required at supraregional centres. Vaccine therapy for advanced MM remains uncertain and its use should only be in the context of a clinical trial. Before non-surgical treatment, a tissue sample for confirmation of the diagnosis should usually be obtained. Histopathology services should be adequately staffed and resourced to cope with the potential increase in skin biopsies resulting from the recommendations in this guidance. Commissioners should note, however, that acknowledged current workforce shortages could delay this implementation. 4 NHS histopathologists in England and Wales must work in laboratories that are seeking or have accreditation with Clinical Pathology Accreditation Ltd. All cancer networks should have easy access to appropriate immunophenotypic, molecular biological and cytogenetic facilities. Some of the latter are very specialised pathology services and may not be provided by pathology laboratories within the LSMDT or SSMDT. Cancer networks should identify one or more clinical oncologists and medical oncologists with responsibility for the radiotherapy and systemic treatment of patients with skin cancer. Radiotherapy departments should have the appropriate equipment including orthovoltage radiotherapy machines for the management of patients with skin cancer. All treatments identified in this chapter for the treatment of skin cancer should be available for use by clinicians in all of the teams, subject to locally agreed standards of competence. 88 National Institute for Health and Clinical Excellence
B. Anticipated benefits Better-quality diagnosis and treatment by trained and audited personnel should result in better outcomes for patients. The benefits of giving patients adequate information, breaking bad news sensitively, and providing support at the crucial time of diagnosis are well documented. These issues are further discussed in the ‘Patient-centred care’ chapter and in the NICE guidance Improving supportive and palliative care for adults with cancer. 53 Improving Outcomes for People with Skin Tumours including Melanoma Initial investigation, diagnosis, staging and management There will be greater accuracy in reporting of MM. Adjuvant therapy will predominantly be performed in the context of clinical trials in order to increase knowledge of the efficacy of treatments. SNB will only be performed in centres with expertise in the context of clinical trials, thereby ensuring that the technique will be properly evaluated. 4 Increased access for Mohs surgery will improve outcomes for some patients. C. Evidence Pathological diagnosis There is evidence from observational studies indicating that not all tissue samples are sent for pathology reporting. There is evidence from observational studies that there are discrepancies between general pathologists and specialist dermatopathologists and specialists in pigmented lesion pathology in the reporting of melanomas and other pigmented skin lesions. Observational studies provide evidence that histopathological examination has high sensitivity and specificity for melanoma. These studies also report difficulty with diagnostic accuracy and consistency for melanocytic lesions that are considered borderline for malignancy. Other lesions that are reported as presenting difficulty for pathological diagnosis include childhood melanoma, atypical naevi and Spitz naevi. 53 National Institute for Clinical Excellence (2004) Improving supportive and palliative care for adults with cancer. Available from: www.nice.org.uk Guidance on cancer services: skin tumours including melanoma 89
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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
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Figure 8. Incidence of NMSC, Englan
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Risk factors for skin cancer As ski
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Figure 12. Rates of episodes of inp
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Two-week wait data Urgent skin canc
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• Improving the experience of car
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12. National Institute for Clinical
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Patient-centred care Improving Outc
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This document and the NICE Referral
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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 and 86: Diclofenac 3% gel (Solaraze) is lic
Page 87 and 88: Histopathology services for skin ca
Page 89: Patients with anogenital Bowen’s
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
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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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