Quality standard
Quality statement 6: Imaging
Quality statement 6: Imaging
Rationale
Accurate staging, including the use of imaging, can help in determining clinical follow-up, informing choice of therapy and early detection of metastases. Whole-body contrast enhanced (CE)-CT or MRI and brain CE-CT or MRI should be considered as part of follow-up surveillance for people who have had stage IIC to IV melanoma and so the choice of imaging for staging should be consistent with this.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of adults 25 and over with stage IIC to IV melanoma who have staging with whole-body CE-CT and brain CE-CT or MRI.
Numerator – the number in the denominator who have staging with whole-body CE-CT and brain CE-CT or MRI.
Denominator – the number of adults 25 and over with stage IIC to IV melanoma.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The National Cancer Registration and Analysis Service Cancer Outcomes and Services Dataset – Core records cancer imaging modality, anatomical site and date of procedure as part of the section on imaging.
b) Proportion of under 25s, pregnant women and pregnant people with stage IIC to IV melanoma, who have staging with whole-body and brain MRI.
Numerator – the number in the denominator who have staging with whole-body and brain MRI.
Denominator – the number of under 25s, pregnant women and pregnant people with stage IIC to IV melanoma.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The National Cancer Registration and Analysis Service Cancer Outcomes and Services Dataset – Core records cancer imaging modality, anatomical site and date of procedure as part of the section on imaging.
What the quality statement means for different audiences
Service providers (such as secondary care services or tertiary care services) ensure that systems are in place for people with stage IIC to IV melanoma to have staging confirmed by whole-body and brain CE-CT or MRI as appropriate for the stage of their cancer, their age and whether they are pregnant.
Healthcare professionals (such as dermatologists, clinical or medical oncologists, surgeons and radiologists) use suitable imaging techniques for confirmation of staging in people with stage IIC to IV melanoma. Adults 25 and over with stage IIC to IV melanoma should have whole-body and brain CE-CT and under 25s, pregnant women and pregnant people with stage IIC to IV melanoma, should have whole-body and brain MRI. Brain MRI can be considered for adults 25 and over who are not pregnant if locally available and after discussion and agreement with the specialist skin cancer multidisciplinary team.
Commissioners ensure that they commission services in which people with stage IIC to IV melanoma have staging confirmed by whole-body and brain CE-CT or MRI as appropriate for the stage of their cancer, their age and whether they are pregnant.
People with a type of skin cancer called melanoma (at stages IIC to IV) have a scan that can show how advanced their cancer is. This can help them to choose the right care for them and can help with follow-up after the cancer has been treated.
Source guidance
Melanoma: assessment and management. NICE guideline NG14 (2015, updated 2022), recommendations 1.4.7 to 1.4.9
Definitions of terms used in this quality statement
Staging scan
Adults 25 and over with stage IIC to IV melanoma should have a whole-body and brain CE-CT. Brain MRI can be considered for adults 25 and over who are not pregnant after discussion and agreement with the specialist skin cancer multidisciplinary team. Under 25s, pregnant women and pregnant people with stage IIC to IV melanoma, should have whole-body and brain MRI. This is consistent with the imaging included in the protocol for follow-up after stages I to IV melanoma in the section on planning routine follow-up in NICE's guideline on melanoma. [NICE's guideline on melanoma, recommendations 1.4.7 to 1.4.9]