The ‘Direct to surgery’ pathway was developed by Lucy Smith, Lead cancer Nurse at The Dudley Group, after she identified that many of the common clinically suspicious lesions referred to skin cancer pathway did not need a separate face to face consultant appointment before treatment and could potentially go straight to a nurse-led surgical list instead.
Lucy Smith, Lead Cancer Nurse at The Dudley Group NHS Foundation Trust, said: "We know that being referred with suspected skin cancer can be an anxious time for patients, so we wanted to look at how we could reduce unnecessary delays and hospital visits while maintaining high standards of care. By using teledermatology and a nurse-led approach, suitable patients can move quickly from assessment to biopsy, helping them get answers sooner. The pathway has allowed us to improve the patient experience while making the best use of specialist clinical expertise across our teams."
Referrals for suspected skin cancer have risen sharply in recent years from 4,985 in 2023 to 6,177 in 2024 and 7,793 in 2025. Making it one of the highest-volume cancer pathways, particularly during the summer months. The service enables patients with suspected skin cancer to be assessed and biopsied sooner, reducing delays and easing the anxiety of waiting for tests and results.
A four-month pilot of the pathway ran from June to early October 2025, with a plastic surgeon acting as clinical supervisor for surgery and a dermatologist available for case advice. In that time, 80 patients were treated through the pathway, saving 80 separate rapid-access consultant appointments and 80 additional visits to hospital. Of those patients, 70% had skin cancer, pre-cancerous change or abnormal mole confirmed on histology, and every patient met national cancer waiting-time targets. Since the pilot, the service has continued to grow and now sees around 40 to 50 patients a month.
Richard Alun Jones, who was treated through the pathway and had a melanoma removed on his 61st birthday, said: "Like most people, hearing the words 'suspected cancer' was frightening and the uncertainty was probably the hardest part. What stood out to me was how quickly everything happened and how well I was kept informed throughout. The team explained everything clearly, answered my questions and made me feel supported from start to finish. Being able to have my biopsy so quickly was a huge relief because it meant I wasn't left waiting and worrying for weeks."