Seven standards for quality care of skin cancer

The National Institute of Health and Care Excellence (NICE) in the United Kingdom has released a new quality standard for skin cancer that covers the prevention, assessment, diagnosis, and management of malignant melanoma and non-melanoma (Sept. 21, 2016).

The standards feature seven quality statements:

1. Local health promotion activities

2. GPs managing low-risk basal cell

3. Suspected cancer pathway referrals

4. Dermoscopy

5. Skin cancer clinical nurse specialist

6. Sentinel lymph node biopsy

7. Genetic testing

In a press release, professor Gillian Leng, deputy chief executive of NICE, said “melanoma causes more deaths than all other skin cancers combined and we don’t have reliable data for the spread of non-melanoma skin cancers. This quality standard tackles the key areas for improvement in skin cancer care . . . We want to improve the outcome for everyone diagnosed with skin cancer.”

According to NICE, 29% of malignant melanomas were still being referred to secondary care via the standard GP referral in 2013, which depending on the area was between four and six weeks. The new standard states that GPs should refer people with suspected malignant melanoma for an appointment within two weeks. It recommends that GPs who remove low-risk basal cell carcinomas should maintain and audit records of their caseloads.

“There are competent GPs who are trained to perform basal cell carcinoma skin surgery and may do this in GP surgeries or part of a community clinic,” said Dr. Rachael Robinson, GPSI and trust fellow in dermatology, Harrogate District Foundation Trust and member of the quality standard advisory committee. “However there is currently no agreed process in place to support good practice in this area and so this quality statement seeks to address this by recommending those GPs maintain training standards, record activity, and perform audits.”

“The statement on sentinel lymph node biopsy may have a big impact,” added Dr. Robinson. “Whilst it is not available in every hospital and is not always offered to patients even where it is available, it can be a useful tool for accurately staging the melanoma, which can give more information, which may be helpful for some patients. It can enable patients’ entry into clinical trials where there are interesting developments at the moment.”

Quality statement six stressed that healthcare professionals, such as members of local hospital skin cancer multidisciplinary teams or specialist skin cancer multidisciplinary teams, should discuss the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure with people who have stage IB–IIC melanoma with a Breslow thickness of more than 1mm.