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GPs swamp skin cancer clinics as the two-week rule is branded 'unworkable'

GPs have been criticised for overloading dermatology services with inappropriate urgent referrals for suspected skin cancer and causing longer waiting times for patients who do have the disease.

Experts presenting studies at the British Association of Dermatologists annual scientific meeting earlier this month blamed a lack of GP education in detecting malignant melan-oma and squamous cell carcinoma. But one researcher branded the two-week referral criteria 'unworkable' and call-ed for change.

A study at Norfolk and Norwich University Hospital showed fewer than one in five lesions referred under the rule were actually malignant, while more than a third of urgent referrals were not seen within two weeks because of pressure on services.

The researchers said 'accommodating these patients within two weeks caused an increased waiting time for all other patients including a significant proportion with either squamous cell carcinoma or malignant melanoma'.

They concluded GPs need extra training to improve their judgment and reduce waiting times.

The urgent referral guidelines for skin cancer tell GPs to use this route only for suspected malignant melanomas

or squamous cell carcinomas.

But researchers at University Hospital Birmingham found GPs were failing to specify a diagnosis in a third of urgent referrals and 11 per cent of urgent referrals were for suspected benign lesions. Only 4 per cent of suspected malignant melanomas were later confirmed.

Dr Jeremy Marsden, a consultant dermatologist at the hospital who co-authored the research, blamed the problem on over-sensitive referral criteria, not GPs. He pointed out the referral guidelines warned GPs any mole that had changed in any way could be malignant. He said this criterion was 'ambiguous', adding: 'Dermatologists and GPs in unison need to say to the

Government that this is unworkable.'

Stockton-on-Tees GP Dr Tom Poyner, vice-chair of the Primary Care Dermatology Society, said the two-week rule was a good idea but added: 'We need extra money to fund education for GPs to reduce the burden of referral on secondary care.'

GPs commonly confused seborrhoeic warts with malignant moles, he warned.

Researchers at University Hospital Wales, Cardiff, found GPs in smaller practices referred twice as many patients as an average three-GP

practice.

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