SRS145 - High referral burden, low malignancy yield: evaluating skin cancer pathway targets post-FDS implementation

Abstract Introduction The Royal Free London is the largest skin cancer provider in London, receiving a high annual referral volume. In October 2023, the 28-day Faster Diagnosis Standard (FDS, 75% target) replaced the Two-Week Wait (2WW, 93% target). Methods We reviewed total referrals received in 2023–2024, the percentage diagnosed malignant, and year-on-year change. A deep dive of two intervals was undertaken: 100 patients in September 2023 and February 2024 were audited to assess adherence to 2WW and FDS. Inclusion of standard and dermatoscopic photographs in referrals was reviewed. Results Nearly 11 000 referrals were received in 2023–2024, rising by 11.2% in 2024–2025 (n = 12 093). The malignancy rate was 9.08%. Malignant lesions were identified in 14/136 (10.1%) referrals in September 2023 and 23/138 (16.6%) in February 2024. 18% of September referrals included photography (15% standard, 1% dermatoscopic, 2% standard and dermatoscopic). 22% of referrals in February included photography (3% standard, 1% dermatoscopic, 14 standard and dermatoscopic). Therefore only around 1/5 of patients could be eligible for teledermatology. FDS adherence was 50.39% in September 2023 and 51.94% in February 2024. 2WW adherence was 37.98% in September 2023 and 13.53% in February 2024. Conclusions A significantly high volume of referrals were non-cancerous lesions. Dealing with a high volume of poor quality referrals with low occurrence of malignancy is very challenging. The changeover of the 2WW to FDS in this timeframe has masked our failure to meet the 2WW target. The change of targets can mask a drop in standards.