Impact of Pigmented Lesion Referral Pathways on Melanoma Detection

Abstract

Aim/Objective
To assess the effectiveness of pigmented lesion referral pathways, particularly the National Cancer Control Programme (NCCP) pathway, in reducing waiting times and improving melanoma detection rates.

Methods
We analysed 2 cohort studies encompassing a prospective 3-month analysis (n=362) and a retrospective 6-month analysis (n=43) of melanoma detection at a tertiary dermatology centre in Ireland. Referral source, reason for referral, waiting times, and histopathological outcomes were evaluated via descriptive analysis.

Results
Referrals through the NCCP pathway were associated with shorter waiting times, with 300 (83%) of melanoma patients seen within 12 weeks. Delays in melanoma diagnosis were linked to incidental pickups or incomplete referral information. Outcomes following dermatology review showed that 89 (24.6%) of primary lesions referred required biopsies, however only 11 (3%) were clinically suspicious for melanoma. Histopathological analysis showed a portion of benign lesions or keratinocyte cancers were referred inappropriately through the NCCP pathway.

Conclusion
Improving diagnostic confidence in primary care through education, standardized referral criteria, and tele-dermatology tools may help optimize referral quality and reduce waiting times for patients with suspected melanomas.