Evaluating the Diagnostic Accuracy and Challenges of the Two-Week Wait Referral Pathway for Skin Cancers in Primary Care.

Skin cancers are among the most common cancers in the Western world, with incidence rates increasing significantly over time. Skin cancer survival rates are highly dependent upon early identification. In the United Kingdom (UK), initial assessment of skin lesions is carried out via general practitioners (GPs) who identify and refer suspected cases under the two-week pathway in compliance with the National Institute for Health and Care Excellence (NICE) guidelines. A major challenge in this pathway is the relatively low proportion of these referrals resulting in a skin cancer diagnosis. This retrospective study, conducted at a general practice encompassing 17,000 patients, evaluated the efficacy of primary care referral pathways for suspected skin malignancies and examined the key factors affecting diagnostic accuracy. The  patient database was used to identify referral letters for suspected skin cancers, including squamous cell carcinoma, basal cell carcinoma, and melanoma, in a period between September 8th, 2021, and July 28th, 2022. A total of 146 referral letters were reviewed, with 35 selected for further analysis. The study highlighted that only 13% of referrals resulted in a confirmed diagnosis of skin cancer, falling below the local audit standard of 50%. Additionally, while 74% of patients were seen by a dermatologist within the two-week timeframe, this did not meet the 100% standard set by NICE guidelines. These findings not only demonstrate the exponentially increasing burden placed on tertiary specialist services but also highlight the need for improved referral efficiency and diagnostic accuracy within primary care. The contributing factors identified include limited post-graduate dermatology training for GPs and the promotion of referrals for uncertain lesions. Proposed interventions to enhance referral pathways include the development of e-learning modules to improve GP education, the implementation of teledermatology and artificial intelligence services to effectively triage cases, and regular reviews of referral patterns by local primary care services. Through earlier and more targeted diagnosis, the suggested techniques may improve the effectiveness of the referral process and have the potential to improve outcomes for patients with suspected skin malignancies.