Evidence grading key
A simple visible scheme used to tag the evidence basis for management recommendations across the site. Designed to be readable at a glance — not a substitute for the full evidence appraisal, which lives in the article text and references.
The five tags
One of these tags appears next to a recommendation when it is useful to flag the evidence basis quickly. Tags are inline, sit to the LEFT of the claim, and are colour-coded:
The recommendation is taken directly from a current UK national guideline (NICE clinical guideline, BAD, BSDS, BAPRAS, RCPath, BSDS surgical standards, NICE NG12 / NG14 / NG12 etc.). The named guideline is cited in the article references.
The recommendation is supported by published randomised trial evidence (typically Phase 3 in a major journal). Often used alongside the Guideline or NICE TA tag where the trial is what the guideline rests on.
A NICE Technology Appraisal applies to the recommendation — for example checkpoint inhibitors (pembrolizumab, nivolumab, cemiplimab, avelumab) or BRAF / MEK combinations. The TA number is cited in the article; licensed drugs without a positive NICE appraisal are labelled separately.
There is no high-quality randomised evidence and no current UK national guideline to anchor the recommendation. The position is expert consensus — from textbook practice, society opinion or specialist tertiary-centre series. Read with appropriate caution.
The decision sits with the local skin cancer multidisciplinary team and varies legitimately between centres — for example sentinel lymph node biopsy thresholds, adjuvant radiotherapy in head & neck cSCC, or immunosuppression conversion in transplant recipients with multiple cSCCs. The article describes the principles; the call belongs to the MDT.
Where the tags appear
The system is rolled out progressively across the highest-stakes decision points first. Expect to see the tags most often in articles covering:
- Systemic therapy for advanced melanoma, cSCC, BCC and Merkel cell carcinoma
- Sentinel lymph node biopsy indication and thresholds
- Adjuvant radiotherapy decisions
- Management of skin cancer in immunosuppressed patients (especially transplant recipients)
- Rare adnexal and mesenchymal tumours where evidence is sparse
Where a recommendation is uncontroversial and well-established (e.g. WLE for a low-risk BCC with appropriate margins), a tag may not be shown. Absence of a tag should not be interpreted as a formal evidence grade — it may simply mean the recommendation is well-established, or that the article has not yet been fully tagged.
What the tags don't do
- They are not a formal evidence-grading system like GRADE or OCEBM. They are a quick clinical signpost, designed to be readable at glance.
- They do not replace the article's reference list and discussion.
- They do not tell you what to do in an individual patient — that is the function of the MDT and the responsible clinician.
Inline mini-key
Articles that use multiple tags carry a small visible key just above the management section so the reader does not need to leave the page. It looks like this: