Squamous Cell Carcinoma. Basal Cell Carcinoma. Regional Follow-up Guidelines

Transcription

1 West of Scotland Cancer Network Skin Cancer Managed Clinical Network Squamous Cell Carcinoma Basal Cell Carcinoma Regional Follow-up Guidelines Prepared by Dr M Porter, Dr A Matthews Approved by Skin Cancer MCN Advisory Board/Regional Cancer Clinical Leads Group/Regional Cancer Advisory Group Issue date March 2015 Review date March 2018 Version 2.0 (replaces v1.0) West of Scotland Cancer Network Page 1 of 5

2 Regional Follow-up Guideline Review The purpose of a regional follow-up guideline is to ensure consistency of practice across the West of Scotland and the principles of any revision to the follow-up guideline will continue to ensure that management of patients after initial treatment for skin cancer are: Patient-centred; Aligned to recognised current best practice; Equitable across the region; Clinically safe and effective; and Efficiently delivered. The guideline continues to be developed on the basis that the key aims underpinning the purpose of follow-up are to: Manage and treat symptoms and complications; Provide psychological and supportive care; and Detect and treat recurrent disease. Follow-up practice has to be patient centred and, ideally, supported by empirical evidence of improved outcomes and survival. In the absence of good quality evidence, care should be tailored to the needs and preference of patients. The construction of appropriate follow-up guidance requires balancing perceived patient needs with effective utilisation of resources. A review of the existing regional Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC) follow up guidelines commenced in October 2014, led by Dr M Porter, Consultant Dermatologist and Dr A Matthews, Specialist Registrar in Dermatology; both NHS Greater Glasgow and Clyde. An evidence review indicated that there were no changes required to the BCC follow up guideline. The evidence review for SCC utilised the Scottish Intercollegiate Guideline Network review of SCC, (SIGN 140) which was published in June Specific, agreed changes to the follow up of SCC, which have been approved by the Skin Cancer MCN Advisory Board, are as follows: Appendix 1 Low risk patients now have a single follow up appointment Medium risk has been removed as a category High risk has been split into single high risk feature and 2 high risk features Single high risk feature: frequency of follow up has been reduced 2 high risk features: frequency of follow up has been reduced Appendix 2 Changes have been made to the level of thickness, looking at a new category of >6mm (*v. high risk) and the Clark level descriptor has been replaced. Appendices 1 and 2 provide the full follow up guidance for SCC. The BCC follow up guidance is found in Appendix 3. This regional guideline is recommended by the Skin Cancer MCN whose members also recognise that specific needs of individual patients may require to be met by an alternative approach and that this will be provided where necessary and documented in the patient notes. West of Scotland Cancer Network Page 2 of 5

3 Appendix 1 Cutaneous Squamous Cell Carcinoma Follow-up Guidelines Risk Category Low (no high risk features) Schedule of care (FUA = Follow up appointment) Single FUA Total duration of recommended FU Single FUA High Single high risk feature 2 high risk features 2-4 FUAs in year FUAs in year FUAs in years 1 & 2 Additional FUA at 3 years 2 years* 3 years * Follow up at end of year 3 may be desirable in certain circumstances depending on clinical assessment. West of Scotland Cancer Network Page 3 of 5

4 Appendix 2 SCC Risk Assessment Risk High Immunosuppressed? Thickness >4mm >6mm (*v. high risk) * Depth into/through subcut. fat Site ear / cutaneous lip eyelid / scalp / nose non-sun exposed scar / radiotherapy / trauma Size >20mm Grade poor desmoplastic Perineural Invasion? Lymphovascular Invasion? Recurrence? Incomplete Excision? If any boxes ticked: If no boxes ticked: Each visit check: (high risk) (low risk) excision site then F/U - 1 review appointment cervical, axillary and inguinal LNs 3-6 monthly for 2 years If 2 boxes ticked consider one additional appointment at 3 years. (skin surveillance, patient education, advice on self-examination ) full skin survey Consider MDT discussion if any high risk features / difficult anatomical site or specific clinical management issues. West of Scotland Cancer Network Page 4 of 5

5 Appendix 3 Basal Cell Carcinoma Follow-up Guidelines Schedule of care (FUA = Follow up appointment) Discharged at 1st FUA or No Follow-up West of Scotland Cancer Network Page 5 of 5