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Right Decision Service newsletter: March 2024

Welcome to the Right Decision Service (RDS) newsletter for March 2024. Please forward this newsletter to others who may be interested. They can contact olivia.graham@nhs.scot to be added to the circulation list.

Promotion and communication resources

Promotional flyers are now available in the Learning and Support area of RDS:

What is RDS and what impact does it have? (infographic)

General RDS flyer

Being a partner in my care: Realistic medicine app for citizens

Managing medicines for patients and carers app

Home care decisions app

Child protection app (South Lanarkshire HSCP)

All except the infographic are also available as editable Word versions. Please contact his.decisionsupport@nhs.scot  if you would like Word versions.  

Redesign and improvements to RDS

Search and browse improvements are progressing well and the plan is still to release these in mid-May.  The first stages of work on archiving and version control are complete. User stories (requirements) are being defined for:

  • Deep linking to individual toolkit URLs/QR codes
  • Translating content from a structured Word document directly into RDS
  • Capability to review and edit changes made to shared content

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

A big thank you to all of you who have completed our Impact and Value questionnaire. The data from this will be really helpful in informing the first draft of the business case for long term provision of the RDS. This will be reviewed by the National Advisory Board for RDS later this month.

We welcome further responses. If you haven’t yet completed the survey, please follow this link, and please encourage other RDS toolkit leads and users to do so.

New toolkits

A few examples of toolkits published to live in the last month:

 

Toolkits in development

Some of the toolkits the RDS team are currently working on:

  • Updates to the Respiratory prescribing guidance and Manage Medicines for patients and carers toolkits
  • Respiratory Managed Clinical Network Pathways
  • Child abuse pathways in NHS Tayside
  • Patient information leaflet collection in NHS Borders
  • Referral management toolkit for NHS Borders
  • NHS Lothian – Infectious diseases; Acute oncology guidelines; Royal Infirmary of Edinburgh Emergency Care.

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Learning opportunities

The RDS Learning working group is progressing with developing training resources for editors, and intend to have resources to share by end of June. This includes resources for:

  • Each stage of the development journey for RDS toolkits – Scoping to Implementation/Evaluation and Maintenance.
  • RDS content governance.
  • Core functionality – learning bytes.

 

Editor webinars

Just a reminder that we are offering webinars for existing and potential new editors on the following dates:

  • Wednesday 10 April 3.30-4.30 pm
  • Thursday 18 April 12-1 pm

 

To book for one of these webinars, please complete the registration form at https://forms.office.com/e/eGjKqNVjeF

Quality audit

Many thanks to all of you who have met with me recently to complete or clarify your responses to the quality audit survey at the end of last year.  Work to complete the quality audit for all toolkits published on RDS prior to November last year will continue for the next few months.

Implementation projects

The RDS team is now working with Moray HSCP to evaluate impact of the new RDS toolkit “Preventing progress of diabetes”  (https://preventdiabetes.scot.nhs.uk ) to support people at high risk of diabetes type 2 and those who are candidates for remission. We are looking at the impact of use of the app with SMS prompts on people’s readiness for lifestyle change over an 8 week period. This includes comparing impact in people who have a call with a dietitian in addition to using the app to people who only use the app.

If you have any questions about the content of this newsletter, please contact us on his.decisionsupport@nhs.scot.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

 

Squamous Cell Carcinoma

Squamous cell carcinoma: Squamous cell carcinoma (SCC) often appears as a firm pink lump with a rough or hyperkeratotic surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface. The lump often feels tender when touched, bleeds easily and may develop into an ulcer. SCCs grow significantly quicker than BCCs (visible change over weeks rather than months). SCC predominantly arise on sun-exposed sites and there are often other signs of sun-damaged skin. 

The most commonly affected areas are the backs of hands and forearms, upper part of the face and, especially in males, the scalp, lower lip and pinna. For both SCC and BCC there can sometimes be considerable skin damage if the tumour is not treated. Approximately 25,000 squamous cell carcinomas of the skin are diagnosed each year. A full time GP is likely to diagnose at least one person with squamous cell carcinoma every 1–2 years. Death from squamous cell carcinoma is rare (<5%). The main advantage of early diagnosis is less extensive treatment. 

Treatment/ therapy

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

 Refer via urgent suspicion of cancer (USOC) 

High-risk - Factors relating to high-risk tumours: Diameter 2-4cm; Rapidly growing with less keratin production and irregular features; Location on ear or lip; Tumour arising within scar or area of chronic inflammation; Immunosuppression 

Refer via USOC 

Very High-risk - Factors relating to very high-risk tumours: Diameter >4cm; Organ transplant recipients; Haematological malignancies

Refer via USOC 

Referral Management

Low-risk: Factors relating to low-risk tumours - Diameter <2cm; Slow growing with a keratotic surface and regular features

If alternative diagnoses (actinic keratosis or Bowen’s) have been suspected and treated surgically or non-surgically (topical therapies/cryotherapy), suspicions should be raised for possible SCC if there has been no response to these therapies within 3 months. 

Clinical resources

TNM Staging System - Basal and Squamous Cell Skin Cancer Stages (cancer.org) see also Cancer Research UK 

BAD SCC guidelines 2020 

NICE CKS – skin cancers – recognition and referral 

Patient.Info Doctors- Squamous Cell Carcinoma of Skin 

PCDS- Squamous Cell Carcinoma 

DermNet NZ- Cutaneous Squamous Cell Carcinoma 

Clinical tips

  • SCC predominantly arise in older patients, although immunosuppressed patients and the other high-risk groups e.g., xeroderma pigmentosum, can develop lesions at a much younger age 
  • Lesions may start de-novo or from pre-existing pre-cancerous skin lesions such as AK and Bowen's disease 
  • Transformation can also occur in areas of chronic inflammation such as leg ulcers 
  • Ulceration and granulation tissue more common than scale in poorly differentiated SCCs 
  • Pain/tenderness on palpation supports a diagnosis of SCC 
  • Can be difficult to distinguish from BCC. The latter can have diagnostic features of pearliness and telangiectasia and is more likely to have a history of spontaneous bleeding.  
  • SCCs increase in size significantly over several weeks; BCCs increase in size significantly over months 
  • SCC can be distinguished from AK and Bowen’s by looking for induration (thickening) beneath overlying keratin. When there is doubt lesions should be referred to secondary care.   
  • Beware of diagnosing a pyogenic granuloma in an elderly patient as this could be SCC or amelanotic melanoma 
  • Overlying scale/crust should be removed during clinical assessment where possible – to assess induration (suggestive of SCC)  
  • Have a higher index of suspicion/lower threshold for referral in immunocompromised patients, particularly transplant patients.

Patient information resources

  1. BAD Patient Information Leaflet - SCC 
  2. NHS page on non-melanoma skin cancers 
  3. DermnetNZ Patient Information Leaflet - SCC 
  4. NHS Inform Scotland- Skin Cancer (non-melanoma) 

ICD search categories

Malignant 

ICD11 code - 2C31 

Editorial Information

Last reviewed: 23/05/2023

Next review date: 23/05/2025

Author(s): Adapted from the BAD Referral Guidelines.

Version: BAD 1

Co-Author(s): Publisher: Centre for Sustainable Delivery, Scottish Dermatological Society.

Approved By: Scottish Dermatological Society