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We should be “embarrassed” by skin cancer wait times

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In response to the news that skin cancer has some of the longest wait times for specialist care, NHS surgeon Dr Owain Rhys Hughes opens up about how there’s “no excuse” for it, in the age of sophisticated technology….

When I read that skin cancer patients are experiencing some of the longest wait times for specialist care, I was shocked. Many patients with suspected skin cancer are now waiting much longer than the recommended two weeks for a specialist consultation. While this may seem to add up given the sharp rise in overall skin cancer cases over the past 18 months, it is far from a necessary correlation.

In fact, we should be embarrassed by the length of skin cancer wait times.

Compared to other cancers, we should realistically expect them to be some of the lowest. Despite the growing number of cases – in part due to an influx of patients who delayed seeking treatment during the pandemic – waiting lists are being unnecessarily lengthened by patients joining who need not have been added to them in the first place.

The tools, and the tech, for change

We have the tools to change this, by streamlining the assessment of skin lesions and eliminating unnecessary referrals to specialist care.

Access to timely advice and guidance can transform the way diagnoses and referrals are carried out within dermatology. As a result, we can deliver more effective patient triage, reduce the number of patients joining specialist waiting lists and speed up access to treatment for those who really need it.

Streamlining the skincare referral pathway

Currently, when a GP suspects a patient may have skin cancer, they can refer them to a specialist via a fast-tracked two-week wait pathway.

Yet with the number of patients being referred using this pathway increasing post-pandemic, it is often much longer than two weeks before a patient can be seen. For those who do have skin cancer, early detection and treatment is key to successful recovery. So reducing these wait times is crucial.

For GPs, without the specialist knowledge to know whether certain moles or lesions may be cancerous, there is often no choice but to refer patients to see a specialist.

To streamline this, an intervention is needed to connect GPs with this knowledge during that initial appointment, enabling them to make a more informed referral decision.

This is where advice and guidance steps in: by providing GPs with direct access to real-time specialist advice from a dermatology consultant, we can enable them to more effectively triage patients.

This will not only reduce the number of patients joining waiting lists for specialist care, but will help those with other skin conditions access an appropriate form of treatment, outside of secondary care, sooner.

Providing a digital infrastructure

Getting this advice into the hands of GPs requires a digital infrastructure which enables quick, reliable, real-time communication between primary and secondary care.

Many clinicians are still having to grapple with clunky, outdated tech systems – arranging referrals through complicated email chains, for example; or waiting on busy phone lines to solicit advice and guidance. What they need is more streamlined, fully-integrated digital platforms through which they can connect at the touch of a button.

Digital platforms & better skin cancer care

Digital advice and guidance platforms enable primary care clinicians to directly request specialist advice from their secondary care colleagues via message, voice or video call.

Those which are fully-integrated enable this information to be shared directly between different digital systems in use across each organisation. This not only makes it easier for advice and guidance to be shared, but reduces the amount of clinical time spent having to manually enter and transfer information.

Within dermatology, being able to attach diagnostic images to these requests can help give specialists a fuller picture of a patient’s condition, enabling them to make an informed remote referral decision.

Special camera attachments called dermatoscopes can be used to capture high-quality images of skin lesions using a clinician’s own smartphone. These can then be securely attached and shared alongside advice and guidance requests, allowing a shared referral decision to be made, without the patient needing to attend an outpatient appointment.

These shared referral decisions can streamline the number of patients being referred via the two week wait pathway for skin cancer. For those who are deemed to potentially need cancer treatment, they can join a shorter waiting list for specialist care and be seen much more quickly. Meanwhile, where a referral is deemed unnecessary, the patient avoids being sent to see a specialist and can be treated sooner by the most appropriate care service for their condition.

Tele-dermatology in action

Through my work with Cinapsis, I have seen this have a significant impact in practice. Cheshire and Merseyside Health and Care Partnership have developed a successful teledermatology project which has given primary care clinicians across the region access to timely digital advice and guidance.


Reducing waiting lists with tech

Using a HEINE dermatoscope, GPs are able to capture images of skin lesions and send these alongside requests for specialist advice through the Cinapsis platform.

So far, the project has enabled 49% of the cases submitted to be handled using advice and guidance alone. This is helping to reduce the number of patients entering the two week wait pathway unnecessarily, and speeding up the route to treatment for those in need of cancer care.

There is no excuse for skin cancer patients to be left facing the highest wait times for specialist care.

We have the tools to help clinicians eliminate unnecessary referrals and streamline waiting lists through more effective communication channels. By arming clinicians with this support, we can dramatically reverse rising waiting lists and ensure those who need urgent skin cancer treatment are able to access it as soon as possible.

Dr Owain Rhys Hughes, 2022

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