Coversheet for Network Site Specific Group Agreed Documentation
This sheet is to accompany all documentation agreed by Pan Birmingham Cancer Network Site
Specific Groups. This will assist the Network Governance Committee to endorse the documentation
and request implementation.
Document Title
Skin Pathways
Document Date
June 2009
Document Purpose
This document is to assist health care professionals and
Cancer Management Teams to plan the care pathways
for patients with Skin Cancers
Authors
Members of the Skin Network Site Specific Group
References
Basal Cell Carcinoma Care Pathway
Malignant Melanoma Care Pathway
T-Cell Lymphoma Care Pathway
Squamous Cell Carcinoma Care Pathway
Rare Skin Cancers Care Pathway
Consultation was with the Skin Network Site Specific
Group
Consultation Process
Review Date
June 2012
(must be within three years)
Approval Signatures:
Network Site Specific
Group Clinical Chair
Date Approved by Network Governance Committee
10/06/09
Skin Cancer Care Pathways
Version History
Version
0.1
0.2
1
Date
April
2009
02/06/09
10/06/09
Summary of change/ process
Document draft circulated for initial consultation to Skin Network
Site Specific Group
Approved by the Skin Network Site Specific Group
Approved by the Governance Committee Guidelines Sub Group
1.
Scope of the Guideline
These pathways have been produced to support the following:

Assist health care professionals and Cancer Management Teams to plan the care
pathways for patients with skin cancer.
2.
Guideline Background
The pathways were written to accompany the British Association of Dermatologists
guidelines.
Monitoring of the Guideline
Implementation of these pathways will be considered as a topic for audit by the NSSG in 2012.
Authors
Members of the Skin Network Site Specific Group
References
Approval Date of Network Site Specific Group
Date: 2 June 2009
Approval Date of the Governance Committee
Date: 10 June 2009
Approval Signatures
Pan Birmingham Cancer Network Governance Committee Chair
Name:
Doug Wulff
Signature:
Date: 10 June 2009
Pan Birmingham Cancer Network Manager
Name:
Karen Metcalf
Signature:
Date: 10 June 2009
Network Site Specific Group Clinical Chair
Name:
Shireen Velangi
Signature:
Date: 2 June 2009
CARE PATHWAY - BASAL CELL CARCINOMA (May 2009)
Refer back to GP
Patient with suspected BCC
Refer back to GP
Refer to dermatologist or plastic surgeon
who is a core member of LSMDT
No
Clinical
Suspicion?
Biopsy required
for
Yes
treatment planning?
Yes
Non-surgical
treatment
 Radiotherapy
 Photodynamic
therapy
 Imiquimod or 5FU
No
Biopsy
Yes
Stages
1,2 or 3a?
No
For
consideration of
Moh’s
surgery?
No
No
Stage
4?
Stage
3b?
Treatment
by LSMDT
Yes
Yes
No
Referral to SSMDT
at UHBFT
Head and Neck
Disease?
Yes
Referral to SSMDT at
UHBFT or HOEFT
Review by SSMDT
Yes
No
Treatment by SSMDT
Refer back to GP
Local management
possible?
No
Follow up
necessary?
Yes
Specialist follow up
Yes
Recurrence
of disease?
No
No
Local follow up
possible?
Yes
Local follow-up
Recurrence
of disease?
Yes
No
CARE PATHWAY – MALIGNANT MELANOMA (May
2009)
Suspected malignant melanoma
Fast track referral to LSMDT
Biopsy






Patient aged 16-19 years?
Non-skin primary (e.g. gynaecological, sino-nasal)?
Satellites (macro or micro)?
Multiple primary disease?
Any other reason for SSMDT discussion?
Patients eligible for adjuvant trials for the Network
Yes
No
Refer to
SSMDT (UHBFT)
No
Stage 1 or 2a?
(<2mm with
ulceration/<4mm
without ulceration)
Yes
Local
treatment
Treatment by
SSMDT (UHBFT)
Yes
Local
follow-up
possible?
Local follow up
No
Specialist follow
up (UHBFT)
Clinical
recurrence
Manage according to Pan
Birmingham Cancer
Network Guidelines
Clinical
recurrence
CARE PATHWAY - T-CELL LYMPHOMA (May 2009)
v
Suspected T-Cell
Lymphoma
Refer rapid
access clinic
Biopsy
Yes
Stages
1a &1b?
Review and
treatment by
LSMDT
No
Stage
2a and
above?
Refer to SSMDT
Yes
Review by SSDMT
at UHBFT
Yes
Local
treatment
possible?
No
Treatment by
SSMDT
Local
follow
up
Yes
No
Decision re local
treatment SSMDT or
Electron beam or
photopheresis
required
Photopheresis
refer to Rotherham
Follow
up by
SSMDT
Electron beam
refer to Coventry
CARE PATHWAY - SQUAMOUS CELL CARCINOMA (May 2009)
Patient with suspected SCC
Refer to rapid access skin cancer
clinic
Diagnosis confirmed by either
biopsy or excision
LSMDT Review
Yes
Stages
1 & 2?
Treatment
by
LSMDT
Stages
3a or b?
Stage
4?
Yes
Yes
Rapid referral to
SSMDT at UHBFT
using PBCN rapid
referral form
No
Yes
Head and Neck
Disease?
Rapid referral to
SSMDT at UHBFT or
HOEFT using PBCN
rapid
referral form
Review by SSMDT
Local management
possible?
(for 3a disease only)
Treatment by SSMDT
No
Local follow
up
possible?
Yes
Local followup
Yes
No
Specialist follow up
Yes
Recurrence
of disease?
No
Recurrence
of disease?
Yes
No
CARE PATHWAY - RARE SKIN CANCERS (May 2009)
(see pages 128 and 129 of IOG for list of rare skin cancers)
Suspected Skin Cancer which is clinically differentiated from SCC, BCC and MM
Refer to rapid access
Review by LSMDT
No
Diagnosis
confirmed?
Clinical
suspicion –
repeat biopsy
within one
week or refer
Yes
Yes
Review one
week post-biopsy
Refer to
SSMDT (UHBFT)
Review and treatment
by SSMDT (UHBFT)
Specialist
follow up (UHBFT)
Diagnosis
confirmed?
No
Review as
appropriate