DEPARTMENTS / CUTANEOUS ONCOLOGY UPDATE
Cutaneous Oncology Update is a section devoted to basic science and clinical aspects of skin cancer. Recent ad-
vances in the literature that have relevance to clinicians will be discussed, and viewpoints on controversial or
“grey-zone” topics will be presented. Anyone wishing to suggest a topic or article for this section should contact
Stanley J. Miller, M.D. at 410-955-1588, 410-955-7100 (fax) or stmiller@jhmi.edu.
The National Comprehensive Cancer Network (NCCN)
Guidelines of Care for Nonmelanoma Skin Cancers
cancer patients receive at the affiliated NCCN institu-
tions, but not necessarily in the community.
Who is the NCCN?
The National Comprehensive Cancer Network (NCCN)
is a consortium of seventeen institutions (Table 1) ded-
icated to excellence in cancer therapy and research. It is
an organization that is run primarily by oncologists.
During the last four years, the NCCN has created
guidelines of care for many human malignancies. In
the first year, breast, colon, and prostate guidelines of
care were developed.1 In the second year, melanoma
was evaluated2 and in the November, 1999 issue of
Oncology, guidelines of care for nonmelanoma skin
cancer (NMSC) were published.3 The two main NMSC
algorithms are reprinted here now. For an in-depth
discussion of these algorithms, see reference 3.
The finished guidelines are then published in the
journal Oncology. Thereafter, they are reviewed and
updated yearly, usually by a conference call by the
working group members; however, if major changes
in disease care have occurred during that year, a meet-
ing is held. Initially, the working groups track patient
care at their institutions, specifically looking for pa-
tients whose care has fallen outside of the guidelines
and why. The NCCN is also in the process of develop-
ing a formal database that they will use to provide
feedback in a more detailed and sophisticated fashion,
and in negotiations with managed care entities.
These guidelines are a work in progress that will be
refined as often as new significant data becomes avail-
able. The NCCN guidelines are a statement of consen-
sus of its authors regarding their views of currently ac-
cepted approaches to treatment. Any clinician seeking
to apply or consult any NCCN guideline is expected
to use independent medical judgment in the context of
individual clinical circumstances to determine any pa-
tient’s care or treatment. The NCCN makes no war-
ranties of any kind whatsoever regarding their content,
use, or application, and disclaims any responsibility for
their application or use in any way.
These guidelines are copyrighted by the National
Comprehensive Cancer Network. All right reserved.
These guidelines and illustrations herein may not be
reproduced in any form for any purpose, without the
express written permission of the NCCN.
How are NCCN guidelines developed?
NCCN guidelines are not strictly “evidence-based”
but developed through consensus. Physicians from
each of the affiliated NCCN institutions form a work-
ing group that discusses the care of cancer patients at
each of the member institutions. An algorithm of care
is developed. Informal evidence-based gathering of in-
formation sometimes occurs, if disagreement about a
specific point or points arises, to try and achieve con-
sensus. Upon completion, the guidelines are then cir-
culated to all other appropriate individuals at each in-
stitution for review. They are then further modified, as
needed, by the working group. The guidelines are thus
designed to reflect the breadth and depth of care that
Stanley J. Miller, MD
Table 1. Affiliated Institutions
Baltimore, Maryland
City of Hope
Dana Farber
Fox Chase
Johns Hopkins
Huntsman (U Utah)
Fred Hutchinson
Arthur G. James (Ohio State)
Sloan-Kettering
H. Lee Moffitt
Northwestern
Roswell Park
St. Jude Children’s
UCSF/Stanford
U Alabama
U Michigan
UNMC/Eppley
MD Anderson
References
1. National Comprehensive Cancer Network: Oncology Practice
Guidelines. Oncology 1997;11:3–346.
2. Houghton A, Coit D. NCCN melanoma practice guidelines. Oncol-
ogy 1998;12:153–77.
3. Miller S. NCCN practice guidelines for nonmelanoma skin cancer.
Oncology 1999;13:529–549.
© 2000 by the American Society for Dermatologic Surgery, Inc. • Published by Blackwell Science, Inc.
ISSN: 1076-0512/00/$15.00/0 • Dermatol Surg 2000;26:289–292
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