Quality standard

Quality statement 2: Suspected cancer pathway referrals

Quality statement 2: Suspected cancer pathway referrals

Quality statement

People with suspected melanoma, squamous cell carcinoma or a rare skin cancer are referred for an assessment using a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days of referral. [2016, updated 2024]

Rationale

Timely referral to a specialist for assessment is important for a quick and accurate diagnosis of skin cancer. This may be referral for a face-to-face appointment or a virtual referral for assessment of images of the skin lesion. The specialist will usually be working as part of the local hospital skin cancer multidisciplinary team and can provide rapid diagnosis, treatment, management and follow‑up for most people with skin cancer.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of confirmed melanomas, squamous cell carcinomas and rare skin cancers that were referred for an assessment using a suspected cancer pathway.

Numerator – the number in the denominator that were referred for an assessment using a suspected cancer pathway.

Denominator – the number of confirmed melanomas, squamous cell carcinomas and rare skin cancers.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Proportion of melanoma, squamous cell carcinoma and rare skin cancers in which the person had a diagnosis of cancer confirmed or ruled out within 28 days of referral.

Numerator – the number in the denominator in which the person had a diagnosis of cancer confirmed or ruled out within 28 days of referral.

Denominator – the number of suspected melanomas, squamous cell carcinomas and rare skin cancers.

Data source: NHS England's Cancer waiting times reports waiting times for people with suspected cancer including the 28-day faster diagnosis standard for suspected skin cancer. Details of coding and data collection are available in NHS England's National Cancer Waiting Times monitoring dataset guidance (v12.0).

b) Proportion of melanoma, squamous cell carcinoma and rare skin cancers that were first treated within 31 days of the decision to treat.

Numerator – the number in the denominator that were first treated within 31 days of the decision to treat.

Denominator – the number of melanomas, squamous cell carcinomas and rare skin cancers.

Data source: NHS England's Cancer waiting times reports waiting times for people with suspected cancer including the 31-day wait from decision to treat to treatment of cancer. Details of coding and data collection are available in NHS England's National Cancer Waiting Times monitoring dataset guidance (v12.0).

c) Proportion of melanoma, squamous cell carcinoma and rare skin cancers that were first treated within 62 days of referral.

Numerator – the number in the denominator that were first treated within 62 days of referral.

Denominator – the number of melanomas, squamous cell carcinomas and rare skin cancers.

Data source: NHS England's Cancer waiting times reports waiting times for people with suspected cancer including the 62-day wait from referral to first treatment of cancer. Details of coding and data collection are available in NHS England's National Cancer Waiting Times monitoring dataset guidance (v12.0).

What the quality statement means for different audiences

Service providers (such as GP practices, community hubs and secondary care services) ensure that systems are in place for people presenting with suspected melanoma, squamous cell carcinoma or a rare skin cancer to be referred for an assessment using a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days of referral. In accordance with NHS England's Faster diagnostic pathways: implementing a timed skin cancer diagnostic pathway, guidance for local health and care systems; 28-day best practice timed pathway, referrals should include a locally agreed minimum dataset, and macroscopic and dermatoscopic images to an agreed standard and format if a virtual referral is used. Services should have the necessary equipment and digital tools to take and transfer high-quality images of the skin lesion if a virtual referral is used (see NHS England's A teledermatology roadmap: implementing safe and effective teledermatology triage pathways and processes).

Healthcare professionals (such as GPs) ensure that they refer people with suspected melanoma, squamous cell carcinoma or a rare skin cancer for an assessment using a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days of referral.

Commissioners ensure that services they commission refer people with suspected melanoma, squamous cell carcinoma or a rare skin cancer for an assessment using a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days of referral. If virtual referral services are used locally, commissioners should ensure that services have the necessary equipment and digital tools.

People who have skin lesions, such as damaged or injured patches of skin or new, changing or unusual looking moles and whose GP thinks it is a type of cancer called melanoma, squamous cell carcinoma or a rare skin cancer are referred for an urgent assessment of their lesion by a specialist.

Source guidance

Definitions of terms used in this quality statement

Rare skin cancer

Including epidermal and appendage tumours and dermal and subcutaneous tumours. [NICE's guideline on improving outcomes for people with skin tumours including melanoma, appendix 1]

Suspected cancer pathway referral

People with suspected melanoma, squamous cell carcinoma or a rare skin cancer receive a diagnosis or ruling out of cancer within 28 days of being referred urgently by their GP. For further details, see NHS England's webpage on faster diagnosis of cancer. [NICE's guideline on suspected cancer, terms used in this guideline]

Assessment

Face-to-face clinical assessment or a virtual (teledermatology) referral by the local skin cancer team working within the multidisciplinary team. Face-to-face clinical assessment could take place in a standard skin cancer diagnosis clinic, one-stop skin cancer clinic, or community- or hospital-based 'Spot' clinic. An assessment following virtual (teledermatology) referral uses high-quality images including dermatoscopic images by a clinician experienced in teledermatology and teledermoscopy and supported by a systematic quality assurance process. [NHS England's Faster diagnostic pathways: implementing a timed skin cancer diagnostic pathway, guidance for local health and care systems; 28-day best practice timed pathway]