Non-melanoma skin cancer is the most common group of cancers, accounting for roughly 20% of all new malignancies and 90% of all skin cancers in the UK and Ireland.

Before the early 1990s only a relatively small proportion of cancer patients benefited from their care being managed by a Multi-disciplinary Team (MDT) of cancer specialists. MDTs were introduced to reduce variation in decision-making and access to best care for patients with cancer and their carers. MDTs are considered central to delivering gold standard cancer services by bringing in continuity and reducing variation in access to treatments, ultimately improving outcomes for patients.

Over time, however, clinicians and particularly those involved in diagnostic services found that the increasing requirements for Multidisciplinary Team Meetings (MDTMs) were adding to the increasing pressures within the system. This is due to the increasing numbers of patients being discussed as well as the complexity of patients and management options; due to an ageing population with multiple comorbidities and the number of treatment options becoming available.

The IOG (Improving Outcomes Guidelines) and MDTMs have not been adapted to cope with this increased demand. As a result, longer meetings are required with limited time to discuss each patient’s case. In order to maintain high standards of care, there is a need to review the way MDT Meetings are organised to ensure they remain valuable and fit for purpose.

The BAD facilitated a Skin Cancer MDT Meeting workshop in November 2017 with invitations extended to all of the identified national and professional organisations involved or interested in the management of skin cancer. This meeting identified and discussed many of the concerns and issues affecting Skin MDTMs and consensus recommendations are proposed as below to promote best practice.

Key Messages

This meeting identified and discussed many of the concerns and issues affecting Skin MDTMs and consensus recommendations were proposed in the NHS England Reform of Cancer Multidisciplinary Team (MDT) Meetings: The Skin MDT Response Report, available in full below.

The key messages from this report were:

• MDTs remain a valuable resource but:
  • Need to be reformed to improve productivity while maintaining value;
  • Must not create delays in management when protocols are straightforward;
  • Should be better focused to discuss appropriate cases.
• MDT should review cases, agree and document management pathways to reduce the requirement for extended discussion of routine cases that can be treated as per protocol. Appropriate cases should still be listed and registered without exclusion.
• The MDTM fulfils an additional role as a source of support, education and management updates for the clinicians and trainees in a constantly and rapidly changing area.

The BAD would like to thank our many stakeholders for their participation and input in compiling this consensus report:

• British Association of Head and Neck Oncologists (BAHNO)
• British Association of Oral and Maxillofacial Surgeons (BAOMS)
• British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)
• British Association of Surgical Oncology (BASO)
• British Oculoplastic Surgery Society (BOPSS)
• Cheshire and Merseyside Strategic Clinical Network
• East of England Strategic Clinical Network
• Faculty of Clinical Oncology
• London Strategic Clinical Network
• NHS England Skin Cancer Clinical Expert Group
• Primary Care Dermatology Society (PCDS)
• Royal College of Physicians
• UCLH Cancer Collaborative
• Wessex Strategic Clinical Network
• Yorkshire and the Humber Strategic Clinical Network