266 Malignant Melanoma: Highlighting Delays in the Pathway from Biopsy to WLE (Wide Local Excision) + SLNB (Sentinel Lymph Node Biopsy)
M Davies, D Kyle, M Alrawi- Surgery
Abstract
Aim
To highlight delays in the malignant melanoma (MM) pathway for patients undergoing a Wide Local Excision (WLE) and Sentinel Lymph Node Biopsy (SLNB). Aiming to evaluate if Trust standards are met, to provide a 31-day clock from time of clinic discussion for WLE and SLNB, to date of operation. In particular, comparing pre- (2019) and post-COVID (2022) waiting times.
Method
Retrospective data collection of patients with a MM diagnosis AJCC (American Joint Committee on Cancer) 1B-2C requiring WLE and SLNB, who were operated on between January-December 2019 and January-October 2022. All operations were performed at the Royal Victoria Infirmary, Newcastle. The following parameters were collected: AJCC grade; SLNB site and result; date of: initial biopsy, biopsy result, skin cancer multidisciplinary meeting (MDT), clinic discussion, and operation. Exclusion criteria: AJCC 1A and 3, incomplete original biopsy (i.e. initial 2-week wait clock had not stopped), incomplete documentation of clinic discussion date, extreme delays (3 patients >140 days, due to acute illness and initially declining operation).
Results
The average time from clinic discussion to operation was 35 days in 2019, compared to 53 days in 2022 (p-value <0.05). 56% (n = 79) of 2019 patients underwent their operation within the 31-day target, compared to 13% (n = 14) of 2022 patients, p<0.05. This statistically significant difference was irrespective of AJCC grade and SLNB site.
Conclusions
Statistically significant decrease in the percentage of patients meeting the 31-day target in 2022, compared to 2019. Delays were affected by an increase in number of MM referrals and limited capacity for operating.