DOI: 10.1093/bjs/znad258.470 ISSN:

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



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.


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).


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.


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.

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