NICE Announces Review Of Its Skin Cancer Guidance

Main Category: Melanoma / Skin Cancer
Also Included In: Dermatology
Article Date: 08 Jul 2009 - 4:00 PDT

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The National Institute for Health and Clinical Excellence (NICE) has announced that it will convene a guidance development group to formally review the recommendations relating to the diagnosis and removal of 'low risk' basal cell carcinomas (BCCs) in primary care in its guidance Improving Outcomes in Cancer for people with skin tumours including melanoma (2003).

Early in 2009 NICE was made aware of difficulties arising from the implementation of one aspect of its guidance. These were particularly in relation to the arrangements under which GPs could remove 'low risk' BCCs and how services for skin cancer patients were being commissioned. Some GPs believed that the requirements, especially attendance at hospital multidisciplinary team meetings, were unnecessarily onerous and in some areas it was believed that there was a threat to GP minor surgery in general. As a result of these concerns, NICE held a meeting in April 2009, chaired by the National Cancer Director, Professor Mike Richards and including representatives of some of the key stakeholder groups involved in implementing the NICE guidance including the Royal College of General Practitioners (RCGP), British Medical Association and British Association of Dermatology (BAD). A number of important issues were clarified at this meeting but NICE feels that further formal review is needed.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: "It is vital that patients are accurately diagnosed, receive appropriate treatment and avoid unnecessary or incomplete surgery. We have listened to the concerns of our stakeholders about the difficulty of implementing the recommendations in the guidance around the diagnosis and removal of low risk BCCs in primary care.

We have also taken into account the fact that the management of skin conditions in general is an important part of all GPs' workload, for which they are trained, and that all GPs may undertake some minor procedures - such as curettage, cryotherapy and electrocautery - within their basic contract, and some GPs also carry out 'minor surgery'. It is important to point out that neither the original guidance nor any revisions to it will change this situation. What the expert group will specifically consider are the recommendations in the NICE guidance about the diagnosis and removal of low risk BCCs in primary care. Therefore, the recommendation in the guidance that patients with a suspected malignant melanoma, squamous cell carcinoma or high risk BCC should be referred to the Local Skin Cancer Multidisciplinary Team for diagnosis and management will not be reviewed."

Dr Julia Verne, Deputy Regional Director of Public Health (South West Region) and Director of the South West Public Health Observatory, who chaired the original guidance development group, has agreed to chair this new group, which will consider the research evidence published since the launch of the NICE guidance.

Source
NICE