DS15 A national survey of the structure and characteristics of specialist skin cancer multidisciplinary teams across the UK

Abstract

The BAD 2024 Service Guidance and Standards for Skin Cancer document sets out essential criteria for safe care provision and national quality assurance for skin cancer services. This includes specialist skin cancer multidisciplinary teams (SSMDTs) and local hospital skin cancer multidisciplinary teams (LSMDTs). To our knowledge, this is the first national survey examining how SSMDTs function in routine practice. We explored the structure and functioning of SSMDTs across the UK, review adherence to guidance and variation in practice, and highlight opportunities for improvement. A survey was distributed to British Society for Dermato­logical Surgery members and multidisciplinary team chairs. Data collected included frequency and duration of meetings, job planning, professional attendance, case mix, attitudes towards SSMDT and suggestions for improvement. Quantitative and qualitative analyses were performed. Forty responses were received from across Britain; 28 SSMDTs also functioned as LSMDTs. Most were held weekly (83%) and lasted 1–3 h (85%), and 66% of respondents felt the time was adequately job planned. The majority were chaired by a dermatology Mohs or plastic surgeon. Core member attendance was generally good, except for head and neck surgeons (58%) and medical oncologists (78%). Extended members were rarely able to attend. Case selection varied. Some centres discuss cases not routinely recommended for SSMDT review: high-grade dysplastic naevi (28%), melanoma in situ/lentigo maligna (48%), low-risk SCCs (25%) and noncomplex BCCs for Mohs (35%). Among SSMDT-only centres, 6 of 12 discuss recurrent or incompletely excised SCCs, despite guidance recommending LSMDT discussion. Only 43% discuss immunocompromised or genetically predisposed patients with skin cancers. Concerns were raised regarding inefficient use of SSMDTs, suboptimal job planning including preparation time, and limited added value for cases with clear management pathways. Improved IT infrastructure, including artificial intelligence support, were suggested. SSMDTs are costly and resource intensive. Variable adherence to guidance may reflect limited agreement or awareness, and overlap with LSMDTs. SSMDT reform, as seen in oncology, may improve efficiency and value. We recommend adopting standard operating procedures and streamlining case selection to only discuss cases without prescriptive national pathways.