NICE Releases a Quality Standard in Skin Cancer

Seven statements describe high-priority areas for quality improvement

In September 2016, National Institute for Health and Care Excellence (NICE) in England published Quality standard [QS130] which covers the prevention, assessment, diagnosis and management of skin cancer (malignant melanoma and non-melanoma) in children, young people and adults.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

There are 2 main groups of skin cancer: malignant melanoma, which can prove fatal, and non-melanoma skin cancers (main types: squamous cell carcinoma and basal cell carcinoma), which are rarely fatal. Over the past decade the incidence of malignant melanoma in the UK has increased by almost 50%. There were about 14,500 new cases of malignant melanoma in the UK in 2013.

Non-melanoma skin cancers are much more common than melanomas, but because of current registration practices their true number is significantly underestimated.

The Quality standard in skin cancer consists from a list of 7 statements:

Statement 1. Local authority health promotion activities on preventing skin cancer and recognising early signs are consistent with the messages in any national campaigns.

Statement 2. GPs who manage low‑risk basal cell carcinoma, including GPs with a special interest (GPwSI), maintain and audit records of their caseload.

Statement 3. People with suspected malignant melanoma are referred using a suspected cancer pathway for an appointment within 2 weeks.

Statement 4. People with pigmented skin lesions undergoing a specialist assessment have the lesions examined using dermoscopy.

Statement 5. People with malignant melanoma or squamous cell carcinoma have access to a skin cancer clinical nurse specialist.

Statement 6. People with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.

Statement 7. People with unresectable or metastatic melanoma are offered genetic testing of the tumour.

The quality standard in skin cancer is expected to contribute to improvements in the following:

  • skin cancer prevention
  • skin cancer awareness
  • early diagnosis of skin cancer
  • skin cancer referrals
  • appropriate excisions of skin cancer
  • skin cancer survival
  • patient experience.

This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health: NHS outcomes framework 2016-17, and Public Health Outcomes Framework 2016-19.

This Quality standard is endorsed by NHS England and the Department of Health as required by the Health and Social Care Act (2012).

A number of organisations recognise the benefit of this Quality standard in improving care. They work with NICE to promote it to commissioners and service providers: British Association of Plastic, Reconstructive and Aesthetic Surgeons, and Royal College of General Practitioners.

More about this Quality standard you can find here.