Primary care remains the main initial gatekeeper to skin cancer referrals. The Welsh Government have highlighted skin cancer as a key part of their health bill to improve cancer diagnosis treatment and survival. The British national campaign ‘Sunsmart’ via cancer research UK remains the main voice of sun safe practices to be advised to all patients at risk and who have been diagnosed with skin cancer. This is alongside healthy levels of Vitamin D.
All forms of skin cancer are on the rise across the UK and Wales. Data is increasingly showing younger generations are presenting with skin cancers including BCCs and melanomas compared with generations gone before. GPs should be alert to skin lesions in younger populations, 30-39 years for BCCs, and from 20yrs regarding melanoma. Also aside from referring to dermatology for specific skin lesions considering referral for those in high risk groups for baseline photography and ongoing monitoring.
The main guiding bodies for skin cancer in the UK are provided by NICE, PCDS and BAD. NICE have identified which skin lesions such as Melanoma, SCC and BCC in anatomical sites of concern should be referred as USCs. In addition to this understanding Keratoacanthomas should also be thought of as a SCC until proven otherwise and referred as an USC. Non USC referrals include BCCs, Bowens, AKs, and individuals who are defined as high risk of skin cancer including melanoma >100moles, red hair, atypical moles, >2 first degree family members with diagnosed melanoma.
There are multiple treatment options for treating skin cancer. For this reason, it is vitally important that a shared understanding of these treatment modalities is reached with patients, in order for them to make the treatment decision which suits them best.
Early detection, diagnosis and correct referral pathways improve access to treatment, essential to improving the treatment outcomes for patients and overall reducing the increasing cost burden to the NHS.
It is advised by PCDS that at least 1 GP per surgery should be trained in the use of dermatoscopy. The accredited course provided by the RCGP are advised for this. This should therefore allow in-house referral amongst GPs to help reduce overall referral burden. Widespread improved primary care skin cancer clinics have been established across Wales improving local access via community outreach and DES/LES model skin cancer clinics