P033 Do suspected cancer pathway referrals to dermatology meet the NICE criteria for referral?

• Published in: British journal of dermatology (1951) Vol. 191; no. Supplement_1; p. i29
• Main Authors: O’Neill, Harriet, Sharma, Maulina, Shahidullah, Hossain
• Format: Journal Article
• Language: English
• Published: 28-06-2024
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1093/bjd/ljae090.060

Abstract Suspected cancer pathway referrals to dermatology are increasing to an extent that is overwhelming services, yet only 6% of these receive a diagnosis of melanoma or squamous cell carcinoma [Cancer Waiting Times (CWT) urgent suspected cancer referrals: referral, conversion and detection rates. Available at: https://www.cancerdata.nhs.uk/cwt_conversion_and_detection (last accessed 5 February 2024)]. There is an urgent need to identify factors that might reduce inappropriate referrals and improve this conversion rate. We analysed 100 urgent suspected skin cancer referrals from primary care, received consecutively from 1 October. Data were extracted for referring healthcare practitioner, suspected diagnosis and whether the referral was judged to meet the NICE criteria for referral of suspected skin cancers. Only 68% (n = 68) of referrals met the NICE referral criteria for urgent suspected skin cancer. In total, 97% (n = 31) of the referrals that did not meet these criteria had an eventual diagnosis of a benign lesion or nonsignificant basal cell carcinoma (BCC); one referral judged inappropriate had the clinical outcome of a BCC on the nasal tip, which would have met the NICE criteria. Overall, 17% (n = 17) of referrals came from non-general practitioners (GPs) such as physician associates or advanced nurse practitioners. These referrals were less likely to be judged to meet the NICE referral criteria than those from GPs: 41% (n = 7) of non-GP referrals were deemed appropriate vs. 73% (n = 61) of referrals from GPs. Adherence to the NICE criteria for referring suspected skin cancers to dermatology is disappointing. Crucially, less than half of referrals from non-GPs met these criteria, compared with nearly three-quarters of those from qualified GPs. This raises the case for only accepting referrals for suspected skin cancer from qualified GPs. Our evidence suggests that such a stance could potentially lead to a 5% reduction in referrals overall. It is also significant that not one of the referrals deemed to be inappropriate on paper led to an eventual diagnosis of melanoma or squamous cell carcinoma. This suggests that triaging referrals at the pre-appointment stage with the option of querying or even rejecting referrals that do not meet NICE criteria would be low risk. This could potentially reduce urgent suspected skin cancer referrals by 32%.