Skin - USC (2WW)

Overview

The suspected skin cancer service is provided by UHBristol at the Bristol Royal Infirmary and NBT at Southmead Hospital. The services are for patients who meet the NICE Skin Cancer Two Week Wait criteria.

The service offers consultation with diagnostics and onward referral for treatment as required.

Please note that skin cancer is exceptionally rare in children. Any skin lesions suspicious of cancer in patients aged under 16 should be referred using the Children & Young People 2WW referral form.

Referral

Suspected Skin Cancer Referral Form - this form is embedded in EMIS and details the criteria for 2WW skin referrals, including which head and neck BCCs should be referred via 2WW. 

Referral process:

• Assess patient's skin lesion(s) and take good quality photos and dermoscopy images if possible (and with their consent)
• Complete 2WW skin proforma in EMIS and send via eRS to the Skin 2WW suspected cancer clinic at  NBT or UHBW (or RUH Bath)* attaching any photos.
• If possible please include a patient email address and obtain consent for the patient to be contacted by secure email regarding their appointment if necessary.
• Give the patient the appropriate patient information leaflet** (see below) explaining the process.

Referrals to NBT 

Please note: This service has moved to a RAS at NBT. Therefore, you need to select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.

 *Referrals of lesions near the eye

For referrals of lesions that might be malignant and are within 5mm of the ocular margins, these need to be referred to the Skin 2WW suspected cancer clinic at UHBW so that they can triage into the eye service (no other provider can triage directly into the eye service).

**Patient Leaflet

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

MDT Referrals

If advised to refer into Multidiscipinary Team (MDT), then please submit a 2WW referral to the relevant secondary care team as above, who will ensure that all the required information is available to enable an effective MDT discussion.

Advice and Guidance

Advice and guidance is not suitable for patients with a lesion that meets 2WW criteria, but if you would like advice on a skin lesion that you suspect is NOT high risk (ie NOT a melanoma or invasive squamous cell carcinoma) please consider using the Dermatology Advice & Guidance service (e-RS).

Clinical Guidance

For further guidance including weighted 7 point check list please see NICE Cancer Guidelines 2015 - Skin Cancers

There are useful resources and pictures on the PCDS website at the links below:

Malignant Melanoma

Further information on Acral-lentiginous melanoma (pcds.org.uk) assessment is also available

Squamous Cell Carcinoma

Basal Cell Carcinoma (usually not 2WW unless there is particular concern that a delay in treatment may have a significant impact, because of factors such as lesion site or size. Please see the Suspected Skin Cancer Referral Form for details of which head and neck BCCs should be referred via this route)

Benign Skin Lesions

Please see the Benign Skin Lesions Remedy page. 

Actinic Keratosis

Please note that patients with Actinic Keratosis should not be referred via a 2WW pathway unless malignancy is suspected. Please see the Actinic Keratosis page for further information.

Fast track (2WW) office

Contact details ADULT 2WW office:

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to  fasttrackoffice2ww@nbt.nhs.uk

UHBW - Tel on 0117 342 3277 or email to FastTrackOffice@uhbw.nhs.uk

AI at UHBW

Starting on the 6th June 2022, most patients will be given the option of having photographs taken of their skin lesion for assessment by an AI platform called DERM (provided by Skin Analytics).

The photos will be taken by the UHBW medical illustration team at a local hospital, encrypted and transferred securely for analysis. The platform will advise either for onward review by dermatology (no action required by primary care) or that the lesion is low risk.

If the platform outcome is low risk then the images will also be reviewed by a Skin Analytics Consultant Dermatologist as a safety net. If the lesion needs further review then this will be passed onto dermatology at UHBW who will contact the patient.

There is no change in process for referring clinicians but a Skin Analytics report may be received alongside correspondence from the UHBW dermatology department.

If patients are discharged from the pathway after review of the images then they will receive a letter informing them of the outcome of their referral. (this will have been explained when they consent to the referral being managed on this pathway).

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.