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Skin Cancer

This section is for health professionals providing skin cancer services and covers areas such as NICE guidance, MDT Structure and Characteristics, Cancer Waiting Times, Faster Diagnosis Standards and National Reform of Cancer MDT Meetings.

Changes to cancer waiting times standards from 1 October 2023

The NHS currently has ten performance standards for cancer, including the Faster Diagnosis Standard introduced in April 2021, but following rigorous consultation and engagement, the government has agreed these targets will be consolidated into three key standards:

  • the 28-Day Faster Diagnosis Standard (FDS) which means patients with suspected cancer who are referred for urgent cancer checks from a GP, screening programme or other route should be diagnosed or have cancer ruled out within 28 days.
  • the 62-day referral to treatment standard which means patients who have been referred for suspected cancer from any source and go on to receive a diagnosis should start treatment within 62 days of their referral.
  • the 31-day decision to treat to treatment standard which means patients who have a cancer diagnosis, and who have had a decision made on their first or subsequent treatment, should then start that treatment within 31 days.

In line with the recommendation of the 2015 Independent Cancer Taskforce, government has approved that the outdated two week wait target will be replaced with the Faster Diagnosis Standard from 1st October 2023.
GPs will still refer people with suspected cancer in the same way, but the focus will rightly be on getting people diagnosed or cancer ruled out within 28 days, rather than simply getting a first appointment.
The faster diagnosis standard means NHS services can embrace greater use of new innovations and technology for diagnosing and treating patients.

See NHS cancer waiting time standards summary for further information

A new set of Cancer Waiting Times technical guidance has been published to support the changes. NHSE have also notified NHS Trusts of the outcome of the consultation report, and what changes will need to be implemented on a local level.

Faster Diagnosis Standard

The Faster Diagnosis pathway guidance document for skin cancer, co-badged with the BAD is available on the NHS website.

Skin Cancer Pathways

We have developed a short-form Skin Cancer Pathways guidance document, available here.

Cancer waiting times system

In August 2023, the NHSE released Cancer Waiting Times v12.0 a new providing information on the Cancer Waiting Times standards, with the updates to the standards applied from the 1 October 2023.

For more information on what the Cancer Waiting Times System does, please visit the NHS Digital website.

In April 2022 the two-week wait skin cancer pathway optimisation guidance was published outlining innovative approaches for systems to consider to support early diagnosis of skin cancer as part of the COVID-19 recovery plan. This includes a new virtual pathway using digital images (teledermatology) and single lesion face-to-face ‘spot clinics’, helping to reduce unnecessary hospital attendances, whilst ensuring face-to-face consultations continue to be available for those patients who need them. Supporting resources are available on the Outpatient Transformation workspace on FutureNHS platform.

Guidance

Multi Disciplinary Teams

February 2006, the National Institute for Health and Clinical Excellence (NICE) published service guidance on skin cancer, ‘Improving outcomes for people with skin tumours including melanoma’ (NICE guidance on cancer services). Many of the recommendations in this guidance were converted into peer review measures published in the ‘Manual for cancer services 2008: skin measures which remain in place today.

The NICE IOG made a key recommendation for two levels of multidisciplinary teams – local hospital skin cancer multidisciplinary teams (LSMDTs) within a Cancer Unit and specialist skin cancer multidisciplinary teams (SSMDTs) within a Cancer Centre.  All health professionals who knowingly treat patients with any type of skin cancer should be members of one of these hospital teams, whether they work in the community or in the hospital setting.

The MDT structure and characteristics is there to standardise care regardless of where the patient is treated and should minimise the risks to patients, because all clinicians who treat patients with skin cancers will be working to the same protocols and have their outcomes audited.

It encourages some treatments for patients with precancerous skin lesions and low-risk BCCs to be carried out in the community but ensures that patients with MM, SCC and high-risk BCC have their care managed by a hospital-based MDT with specialist skills.

All patients with a suspicious pigmented skin lesion, with a skin lesion that may be a high-risk BCC, a squamous cell carcinoma (SCC) (or a malignant melanoma (MM), or where the diagnosis is uncertain, should be referred to a doctor trained in the specialist diagnosis of skin malignancy, normally a dermatologist, who is a member of either an LSMDT or an SSMDT.  add skin flow chart and levels of care

This principle of a given primary care practice stating that patients will be referred to a given MDT is not intended to restrict patients or GP choice.  A rational network of local and specialist MDTs can only be maintained if;

i) there is an agreement on which MDT the patients will normally be referred to and

ii) the resulting referral catchment populations are counted once for planning purposes.

National Reform of Cancer MDT meetings
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