P140 Evaluation of pigmented skin lesion referrals in a tertiary dermatology centre: impact on melanoma detection and waiting time

Abstract There has been a significantly increased number of dermatology referrals in recent years for suspicious skin lesions. This has contributed to long waiting times, which may delay diagnosis and treatment of melanoma. Our aim was to evaluate the effectiveness of our current triage system in diagnosing melanoma accurately and in a timely fashion through dedicated pigmented lesion clinics (PLCs), based on the referral information given. We conducted a prospective study to assess melanoma pickup rates using a dedicated PLC template. We assessed the triaging system in a tertiary dermatology centre, studying referrals for suspicious pigmented skin lesions in a 3-month period. The total waiting time, mode, reason for referral, clinical diagnosis and final histopathology results were recorded. The results of this study were then analysed using descriptive analysis. The study assessed 362 patients over a 3-month period. There were 172 referrals through the national general referral form, 170 referrals through National Cancer Control Programme pigmented lesion referral pathway, and 20 using generic letters. The most common reason for referral was a changing mole (n = 151, 41.7%). Total waiting times ranged from 1 to 45 weeks. Referrals were triaged to be seen within 4 weeks, 12 weeks or > 12 weeks, with the results detailed in the Table. In total 131 primary lesions referred and 47 incidental lesions required a biopsy or excision; however, this also included nonpigmented lesions. The study found that only a small percentage (n = 11, 3%) of primary lesions referred and two (0.5%) incidental lesions were clinically suspicious for melanoma. Of the 11 primary referrals, seven were seen within 12 weeks. Histopathology examination confirmed diagnosis of melanoma in two cases. This study shows that our triage system was effective at stratifying suspicious pigmented lesions to ensure patients were seen within a reasonable timeframe. However, there is still some discrepancy between referral information and clinical assessment, accounting for longer waiting times of suspected melanomas. The significant number of benign lesions referred adds to the ongoing burden of dermatology outpatient waiting times, despite efforts to prioritize urgent referrals. This highlights that better dermatology education and knowledge are needed among primary care physicians, and that adjunctive services such as teledermatology might improve dermatological care.TablePatients and lesions analysed by waiting timeTriage waiting timePatients, n (%)Primary lesions requiring biopsy or excision, n (%)Incidental lesions requiring biopsy or excision, n (%)< 4 weeks29 (8.0)11 (3.0)2 (0.5)4–12 weeks79 (21.8)26 (7.2)6 (1.6)> 12 weeks254 (70.2)94 (26.0)39 (10.8)