O02 Skin cancer service disparities across England: what data can tell us about skin cancer diagnosis, referral pathways and treatment received in different NHS trusts

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Abstract Skin cancer is the most diagnosed cancer in the UK, with increasing incidence and healthcare demands. The 2021 National Dermatology Getting It Right First Time (GIRFT) report highlighted disparities in skin cancer services across England. However, the underlying data did not allow for assessment of different skin cancer types, survival, stage at diagnosis or cancer-specific referral pathways. Using National Disease Registration Service (NDRS) data from 2013 to 2022 on melanoma, basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and rare skin cancers, the aim was to assess geographical variations in service provision, morbidity and mortality across England at NHS trusts and independent providers with NHS contracts. Cancers are allocated to a ‘trust of diagnosis’ based on patient pathway events. In 2022, 128 organizations saw 624 253 urgent suspected skin cancer referrals (USC), a roughly 2.6-fold increase from 2013 (n = 237 847), while the number of organizations has remained stable. The median number of USCs per organization was 4498 with an interquartile range (IQR) of 2703–6675, with one trust seeing 18 269 USCs. The median conversion rate (i.e. a USC converting to a melanoma, cSCC or rare skin cancer diagnosis) was 6.9% in 2022 (IQR 5.3–9.0), a reduction from 8.1% (IQR 6.5–9.9) in 2019. The median conversion rate when BCCs are included also reduced over this same period, from 20.9% (IQR 17.1–24.1) to 17.6% (IQR 13.6–20.8). Total skin cancer counts were relatively stable between 2019 (n = 225 321) and 2022 (n = 230 968). Within this, the total number of melanomas increased (from 15 381 in 2019, to 17 686 in 2022), with 71.4% of organizations diagnosing more in 2022, and some high-volume organizations diagnosing > 400 cases per year (median cases 99, IQR 35–186). Similarly, 63.5% of organizations diagnosed more cSCCs, in line with increases in the total diagnoses from 2019 (n = 48 403) to 2022 (n = 52 973). Although the number of BCCs in 2022 was similar to that in 2019, national statistics mask important differences between organizations. The median numbers of BCCs and cSCC diagnoses in 2022, at 632 (IQR 39–1307) and 262 (IQR 37–476), respectively, notably differ in high-volume trusts, who diagnosed up to 8.2 times the median BCCs and 5.1 times the median cSCCs. These data reveal national and regional dermatology service patterns, highlighting the need for updated national service guidance and healthcare priorities to improve skin cancer outcomes. This analysis can help NHS stakeholders identify and address service gaps and challenges to ensure equitable care in the post-COVID recovery and meet the growing healthcare demands of our ageing population.

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