P203 Outcomes of a novel patient-initiated follow-up pathway for cutaneous squamous cell carcinoma

Abstract

Optimization of dermatology follow-up appointments has been identified as an NHS priority by the Getting it Right First Time Further Faster Follow Up Collaborative. For high-risk squamous cell carcinoma (SCCs), BAD guidelines recommend a minimum of 2 years of face-to-face follow-up. This study aimed to evaluate the outcomes of a novel patient-initiated follow-up (PIFU) pathway for patients with high-risk cutaneous SCC. We undertook a retrospective, single-centre cohort review with 2 years’ follow-up for all patients with histologically confirmed, high-risk primary SCC placed on PIFU between 1 January and 31 December 2023. Risk was allocated by the multidisciplinary team following BAD guidelines. Low-risk patients were discharged and those with very high risk allocated traditional face-to-face follow-up. Review of clinical records was undertaken to identify further dermatology contact, recurrence of SCC and presentation with new skin cancers. In total, 210 patients were identified. The female-to-male ratio was 1 : 2.2, and the mean age was 80.4 years. Overall 54.3% (114 of 210) of patients had further contact with the skin cancer team and 2.9% (6 of 210) had a recurrence of primary SCC. No patients experienced recurrence within 6 months, with 50% recurring within 6–12 months and 50% within 12–24 months. One-third (33.8%, 71 of 210) of patients re-presented with at least one new nonmelanoma skin cancer (NMSC), which is an incidence of 16.9 cases per 100 patients annually. Only 1.9% (4 of 210) re-presented with a new melanoma, including melanoma in situ. The high incidence of new NMSC in our cohort with high-risk SCC correlates with previous evidence and was expected. However, the low recurrence rate of primary SCC within this cohort was reassuring and is interpreted as evidence that PIFU is a reasonable option for optimizing patient flow, saving up to four planned appointments per patient over 2 years. Further work could document and compare recurrence and new cancer rates across all three SCC risk categories.