Posted 29 September 2016 - 11:39
Posted 29 September 2016 - 11:39
Clinical update
Skin cancer
NICE quality standard says people with malignant melanoma or squamous cell carcinoma should have access to a skin cancer clinical nurse specialist
Essential facts
Skin cancer can be split into 2 groups: malignant melanoma, which can be fatal, and non-melanoma such as squamous cell carcinoma and basal cell carcinomas which are rarely fatal.
Over the past decade rates of malignant melanoma have increased by almost 50% in the UK: in 2013 there were 14,509 new cases and in 2014 2,459 people died from malignant melanoma.
Non-melanoma skin cancers are more common with 72,100 new cases diagnosed in the UK in 2013, although this underestimates true incidence.
More than 90% of people diagnosed with malignant melanoma in England and Wales survive for ten years or more according to 2010/11 figures.
Whats new
The National Institute for Health and Care Excellence (NICE) published a quality
...Essential facts
Skin cancer can be split into 2 groups: malignant melanoma, which can be fatal, and non-melanoma such as squamous cell carcinoma and basal cell carcinomas which are rarely fatal.
Over the past decade rates of malignant melanoma have increased by almost 50% in the UK: in 2013 there were 14,509 new cases and in 2014 2,459 people died from malignant melanoma.
Non-melanoma skin cancers are more common with 72,100 new cases diagnosed in the UK in 2013, although this underestimates true incidence.
More than 90% of people diagnosed with malignant melanoma in England and Wales survive for ten years or more according to 2010/11 figures.
What’s new
The National Institute for Health and Care Excellence (NICE) published a quality standard in September setting out 7 statements where skin cancer services need to improve:
1: Local authority health promotion activities on preventing skin cancer and recognising early signs are consistent with messages in national campaigns.
2: GPs who manage patients with low-risk basal cell carcinoma, including GPs with a special interest, maintain and audit records of their caseload.
3: People with suspected malignant melanoma are referred using a suspected cancer pathway for an appointment in 2 weeks.
4: People with pigmented skin lesions undergoing a specialist assessment have the lesions examined using dermoscopy.
5: People with malignant melanoma or squamous cell carcinoma have access to a skin cancer clinical nurse specialist (CNS).
6: People with stage IB to IIC melanoma with a Breslow thickness of more than 1mm have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.
7: People with unresectable or metastatic melanoma are offered genetic testing of the tumour.
Signs
- A spot or sore that does not heal within 4 weeks.
- A spot or sore that itches, hurts, is scabbed or crusty, or bleeds for more than 4 weeks.
- An ulcer that does not heal within 4 weeks, and patients cannot think why.
Risk factors
Ultraviolet radiation from the sun is the main potentially avoidable risk factor, linked to 86% of malignant melanoma cases in the UK.
Helping patients
Skin cancer CNSs provide guidance and support at all stages of care and treatment, including follow up. They can also provide information about local support groups, psychological support and palliative care if needed.
Expert comment
Gill Godsell is nurse consultant, skin cancer, Nottingham NHS Treatment Centre, Nottingham
This standard will provide equity of service for skin cancer patients, ensuring people have a positive experience of safe, high quality care no matter where they live and where they are seen.
The standard highlights the need for all patients with malignant melanoma or squamous cell carcinoma to have access to a skin cancer CNS. This is important at any stage of the cancer pathway and, although some patients will not need to be seen by the CNS, they must all be given the contact details of a nurse specialist who is suitably trained in skin cancer to provide support and information.
The other important emphasis in the standard is the discussion about sentinel lymph node biopsy (SLNB) for people with stage IB to IIC melanoma, with a Breslow thickness of more than 1mm.
This will have a significant effect as many hospitals do not, at present, offer SLNB. It is now a standard and those discussions need to be had with melanoma patients. We need to discuss the advantages and disadvantages as well as the procedure itself; this adds time to the clinical consultation and to the workload of the CNS.
The standard will provide drivers for the increased provision of services for all patients and will, I hope, see more nurses and more choice for patients.
Find out more
British Association of Skin Cancer Specialist Nurses 2016 annual conference takes place on 24-25 November in Birmingham
RCNi related articles
Aetiology and management of non-melanoma skin cancer. Cancer Nursing Practice. doi.org/10.7748/cnp2010.02.9.1.20.c7547
Diagnosis and management of malignant melanoma. Cancer Nursing Practice. doi.org/10.7748/cnp2011.09.10.7.30.c8696
Skin cancer: an overview of assessment and management. Primary Health Care. doi.org/10.7748/phc2012.04.22.3.28.c9022
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