P197 Improving capacity in skin cancer screening clinics by 36% through NICE guideline adherence

Abstract

Dermatology departments review more 2-week-wait referrals for suspected cancer than any other specialty. At the same time, NHS services face sustained pressure on resources, and management of clinic capacity is challenging. The 2022 NICE melanoma guidelines provide clear recommendations for follow-up frequency, imaging, and blood tests. We hypothesized that stricter adherence to national guidelines could generate capacity, reduce unnecessary investigations and optimize patient care. We retrospectively reviewed patients followed up in our centre from 2023 to 2025 with histologically confirmed melanoma or melanoma in situ. The NICE recommendations were presented to our department and displayed as posters in clinic rooms. We then reaudited after 3 months to assess the preliminary impact of our intervention. Overall, 111 preintervention patients (stage 0–IIB) were included, subcategorized by clinical stage and adjusted for years into follow-up. Based on NICE guidance, 201 appointments were recommended, compared with the 274 appointments delivered, representing a potential 36% increase in capacity. Overimaging occurred in lower-risk groups [10 whole-body computed tomography (CT) scans and 11 magnetic resonance imaging (MRI) scans of the head in stage IB and IIA patients]. Underimaging was seen in stage IIB patients, where 18 MRI scans of the head and 18 whole-body CT scans were recommended, but only 6 of each performed. In total, 28 of 111 patients (25%) had a recommended vitamin D level measured, while 22 patients (20%) underwent unnecessary lactate dehydrogenase testing. Preliminary postintervention data confirmed improved capacity, as well as savings related to unnecessary procedures; 8 month postintervention data will be available at the time of the meeting. Closer adherence to the NICE melanoma follow-up guidance offers a clear opportunity to improve capacity, care and cost efficacy.