DP09 A national skin cancer service review reporting on geographical variation at the NHS trust level among 2013–2023 diagnoses in England

Abstract

Between 2013 and 2023 NHS England’s National Disease Registration Service reported 2 330 904 skin cancers. With increasing pressure on dermatology services, it is important to identify and investigate variation in care provision. This review aimed to assess geographical disparities in service provision and mortality across England, incorporating new insights into treatment, survival and mortality. Melanoma, basal cell carcinoma, cutaneous squamous cell carcinoma (cSCC) and rare skin cancers allocated to a ‘trust of diagnosis’ were evaluated for geographical variations in urgent suspected skin cancer referrals (USSCRs), incidence, treatment, pathway, survival and mortality. Across trusts, the median number of USSCRs has increased from 1889 to 5543 from 2013 to 2023 (+193%). Meanwhile, the median conversion rate [i.e. referrals resulting in a diagnosis (melanoma, cSCC, rare)] has decreased from 9.8% in 2013 to 7.0% in 2023. The median time from USSCR to first definitive surgical treatment for melanoma increased from 56 days in 2013 [interquartile range (IQR) 48–65] to 90 days in 2023 (IQR 78–102). In 2023, the median number of lymph node biopsies recorded was 39 (IQR 25–56), and the median time between a date of diagnosis and lymph node biopsy was 97 days (IQR 82.0–116). The median proportion of melanomas recorded as receiving radiotherapy decreased from 4.3% (IQR 2.5–5.9) in 2013 to 1.6% (IQR 0.9–2.9) in 2023. Use of systematic anticancer therapy has increased from 3.3% (2013; IQR 2.0–4.9) to 14.5% (2023; IQR 10.3–17.7). The melanoma age-standardized mortality rate varied from 2.93 per 100 000 in ‘London’ to 4.43 per 100 000 in the ‘South-East’ in 2024. The mortality rate in ‘London’ was the lowest across regions, while the ‘South-West’ saw the highest recorded mortality rate across 2013–2024. These data reveal insights that will help clinicians and commissioners identify areas where equitable access to care could be improved and highlight the need for updated national guidance to improve skin cancer outcomes.