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Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

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. 

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

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