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FOI 2023 14 - Skin Cancer Pathway Management


Information Requested:

•    What are your current skin cancer patient clinical pathway guidelines e.g., from initial patient symptoms in a GP setting to specialist referral as well as treatment and follow-up procedures and protocol. Attached are two outdated CCG (Clinical Commissioning Group) pathway guidelines for reference. 

•    Does your skin cancer pathway include remote patient-clinic interactions (as opposed to face-to-face interactions), Yes or No and if yes, elaborate what they are and what stage in the pathway they’re used e.g., teledermatology (the use of digital photography to assess patient lesions) at the GP stage. 
•    What were your latest skin cancer pathway guidelines in 2019/2020 prior to the COVID-19 pandemic (announced as a pandemic by WHO on 11 March 2020). 
If possible, the preferred format of this information is electronic word document (.doc/.docx) or PDF. 


Information provided for the answer:

Thank you for your recent request dated 25th January 2023.

1) NICE Guidance NG12 Suspected Cancer: Recognition and Referral (1) is the primary document used by primary care clinicians to direct the process for patient referral. 
Secondary care assessment and treatment, the national NICE Guidance NG14 Melanoma: Assessment and Management (2) last updated 27 July 2022 will apply. 

specific skin cancer guidance published by NICE

In addition to the above-mentioned national NICE guidelines, the following also apply:
NICE QS130 Skin cancer last updated 27 July 2022
BAD Squamous cell carcinoma guidelines published March 2021
BAD Basal cell carcinoma guidelines published November 2021
BAD/RCP Joint melanoma guidelines published September 2007

Currently in development is a National Optimal Pathway (NOP) for Melanoma and this will meet the Welsh Single Cancer Pathway principles for NOPs – as outlined on the SCP pages of the Wales Cancer Network website
All Cancer referrals within Wales are subject to the Single Cancer Pathway Target, which states there should be 62 days between point of suspicion and first treatment.

2)  A National Programme through NHS Wales Planned Care Improvement and Recovery is working to implement Teledermoscopy services in Health Boards across Wales by March 2024. Following their referral to secondary care, this service sees patients (who are triaged as appropriate for the pathway) attend a Clinical Photography appointment to have high-quality Dermoscopic images taken, which are then reviewed remotely by Consultant dermatologists, allowing the clinician to signpost the patient appropriately. A significant number of patients who are referred with skin lesions do not need to be seen face to face and Teledermoscopy allows patients to attend appointments closer to home, reducing the need for them to travel for diagnostics.
Some Health Boards request that GPs send a photograph with their referral into secondary care to help support the triage process. This request varies across Health Boards.

Some Health Boards have virtual clinics for patient review but such clinics do not see cancer patients.
Remote consultations and teledermatology services currently vary across Wales and therefore, for details of more localised service provisions, we would recommend seeking a response from individual Health Boards, contact details are below.

3)  The above-mentioned NG12 and NG14 NICE Guidance were published in 2015 and reviewed in 2021/2. In Wales, prior to February 2021 when our Skin CSG lead was appointed, the skin cancer pathway and services were overseen by the Planned Care Board, rather than as a Cancer Site Group under the Wales Cancer Network. The Planned Care Board currently sits under Welsh Government and they may be able to provide more details in relation to earlier guidelines.  Their contact details are here: Requesting information from the Welsh Government (FOI requests) | GOV.WALES. 

Health Board Contacts:

Aneurin Bevan University Health Board

Betsi Cadwaladr University Health Board

Cardiff and Vale University Health Board 

Cwm Taf Morgannwg University Health Board

Swansea Bay University Health Board

Hywel Dda University Health Board 

Powys Teaching Health Board


If you are unhappy with the service you have received in relation to your request and wish to make a complaint or request a review of the decision, you should write to the Corporate Complaints Manager, Public Health Wales NHS Trust, 3, Number 2, Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ.

If you are not content with the outcome of your complaint or review, you may apply directly to the Information Commissioner for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by the Trust. The Information Commissioner can be contacted at:

Information Commissioner for Wales
2nd Floor
Churchill House
Churchill Way
CF10 2HH

Telephone: 029 2067 8400