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UK skin-cancer MDT principles

Skin cancer multidisciplinary team · SSMDT (Specialist Skin Cancer MDT) · LSMDT (Local Skin Cancer MDT)

UK skin-cancer multidisciplinary teams (MDTs) provide structured discussion of complex skin-cancer cases, integrating dermatology, plastic surgery, oncology, pathology, radiology, clinical nurse specialists, palliative care and clinical genetics. Operating within the NHSE skin-cancer service specification, MDTs are stratified into Local Skin Cancer MDTs (LSMDTs) for low-risk disease and Specialist Skin Cancer MDTs (SSMDTs) for high-risk / complex / metastatic disease. RCS / NICE / IOG (Improving Outcomes Guidance) require regular scheduled meetings (commonly weekly for SSMDT) sufficient to meet timed-pathway targets, named lead clinicians, structured documentation and audit.

CurrentLast reviewed 16 May 2026

Levels of MDT in UK skin-cancer pathway

  • Local Skin Cancer MDT (LSMDT):
    • Operates at acute trust / regional level.
    • Manages low-risk BCC, low-risk cSCC, low-risk melanoma (in situ, stage IA), benign-borderline lesions.
    • Refers complex / high-risk cases to SSMDT.
  • Specialist Skin Cancer MDT (SSMDT):
    • Operates at tertiary / regional cancer centre level.
    • Manages: melanoma stage IB+, high-risk cSCC, MCC, locally-advanced / metastatic BCC, cutaneous sarcoma, cutaneous lymphoma (with separate haematology MDT input), rare adnexal carcinoma, paediatric skin cancer.
    • Provides systemic therapy access, advanced reconstruction, clinical trials.
  • Supra-regional MDTs for rare entities: ocular melanoma, mucosal melanoma, DFSP / sarcoma networks.

Core composition (NHSE service specification)

  • Mandatory core members with named lead and deputy:
    • Consultant dermatologist (LSMDT lead in many centres).
    • Consultant plastic / reconstructive surgeon.
    • Consultant oncologist (medical and / or clinical).
    • Consultant histopathologist with skin specialism.
    • Consultant radiologist.
    • Clinical nurse specialist (CNS) — skin cancer.
    • Skin cancer MDT coordinator.
  • Co-opted as needed:
    • Mohs surgeon, ENT, ophthalmology, maxillofacial.
    • Palliative care.
    • Clinical genetics.
    • Sarcoma / haematology MDT representation for cutaneous sarcoma / lymphoma.
    • Clinical trials team.
    • Allied health: psychology, lymphoedema, dietetics.
  • Quorum: typically at least one of each core specialty present per meeting.

MDT function and governance

  • Meeting frequency: minimum weekly (SSMDT) or fortnightly (LSMDT); IOG / NHSE specifies access for new cancer diagnoses within timed pathway.
  • Documentation:
    • Structured proforma with patient demographics, diagnosis, staging, performance status, comorbidity, current management.
    • Recommendation recorded with named clinician responsible for delivery, follow-up plan, trial eligibility, data submission to COSD / NCRAS.
    • Recommendation communicated to GP, primary surgeon, patient within agreed timeline.
  • Audit:
    • Compliance with NICE quality standards, IOG, RCS / BAD / BSDS guidelines.
    • Wait-time metrics (2-week wait, FDS, 31-day, 62-day).
    • Outcome data — recurrence, survival, complication rates.
    • National audit submissions (NCRAS, NCAA — National Cancer Audit and Analysis).
  • Quality:
    • Peer-review external assessment every 2-3 years.
    • Mortality and morbidity reviews.
    • Patient experience: PROMs, focus groups.

MDT-driven UK skin-cancer pathway

  • Referral: NICE NG12 / 2-week-wait or routine; suspected skin cancer triage.
  • Diagnosis: skin clinic / dermoscopy / biopsy.
  • Staging: per tumour, e.g. melanoma stage IIB+ → PET-CT, brain MRI.
  • MDT discussion: documented within timed pathway; recommendation.
  • Treatment: surgery / radiotherapy / systemic / clinical trial.
  • Follow-up: per BAD / NICE; structured data entry.
  • Cross-MDT pathways for specific entities (sarcoma network, haematology, paediatric oncology, palliative).

Quality standards

  • NICE quality standard: QS130 (Skin cancer; last updated 24 January 2024). Cancer waiting-time standards are NHS England operational standards rather than skin-cancer NICE quality standards.
  • IOG 2010: Improving outcomes for people with skin tumours including melanoma — manual for cancer services.
  • RCS / NHSE skin-cancer service specification — detailed specification for LSMDT / SSMDT.
  • NHS Long-Term Plan commitments: 75% Stage 1-2 detection rate by 2028; FDS within 28 days.
  • National Cancer Audit (NCAA): outcome benchmarking.

References

  1. NHS England. Service specification: complex specialised skin cancer surgery. London: NHSE; 2022.
  2. NICE. Improving outcomes for people with skin tumours including melanoma (IOG). London: NICE; 2006 (updated 2010 and supplementary 2015).
  3. NICE QS130. Skin cancer. London: NICE; 2016 (last updated 24 January 2024).
  4. NHS England. Cancer waiting times standards and monthly statistics. London: NHS England; accessed 18 May 2026.
  5. NICE NG12. Suspected cancer: recognition and referral. London: NICE; 2015 (last updated 15 April 2026).
  6. NICE NG14. Melanoma: assessment and management. London: NICE; 2015 (last updated 27 July 2022).

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