The U.K. skin cancer 'two-week rule' referral system: Audit to ascertain appropriate referralsĀ at our institution

Objective: The two week wait (2WW) referral system in the UK received criticism for low rates of cancer detection and misuse of the service. GPs have difficulty differentiating seborrheic keratosis (SK) and benign melanocytic nevus from other pigmented lesions. We sought to establish the clinical appropriateness of 2WW referrals at our institution, and how many were diagnosed with cancer.
Method: A retrospective audit of patients referred from April 2015 to March 2016 to our institution via the 2WW pathway was conducted. Patient demographics, final diagnosis and whether histology was used for diagnosis were obtained from case notes. Clinically appropriate referrals were defined as referrals requiring histology to confirm diagnosis.
Results: 1795 referrals were obtained. Mean age was 63.7 years, 46.4% male, 53.6% female. 35 [46.5%] of the lesions were benign; 534 [29.7%] were malignant; 280 [15.6%] were pre-malignant and 146 [8.13%] had other diagnoses. 72.2% of cases referred required histology for diagnosis. 96 [18 %] of the malignant lesions were melanoma; 243 [45.5%] were basal cell carcinoma and 187 [35%] were squamous cell carcinoma (SCC). 400 [47.9%] of benign lesions were benign nevus; 279 [33.4%] were SK. 58.3% of benign nevus did not require histological diagnosis. 49.8% of SK did not require histological diagnosis.
Conclusion: The number of cases of SCC and melanoma detected via the 2WW referral pathway was low. A large number of cases of SK and benign nevus were inappropriately referred. Experience at our institution supports further dermatological training for General Practitioners

Dr. Sarah Dawood