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Concerns over melanoma management

This concern was expressed following an NCCP survey of 16 hospitals. The survey, conducted in November 2013, was aimed at describing the clinical pathway for a patient referred with a pigmented lesion and diagnosed with a melanoma. The document also said that the NCCP pigmented lesion referral form, which was piloted in Cork during 2011 and circulated to all GPs nationally in 2013, was “found to be very useful”.

In one hospital in the area where the form was piloted, 70 per cent of GP referrals were made by the NCCP referral form. However, in other areas, the referral form “has only recently been circulated and most referrals were still made by GP letter”.

An NCCP spokesperson told MI that it routinely engages with GPs in relation to using standardised referral guidelines.

The document, Survey of Practice: Referral and Primary Treatment of Pigmented Lesions — Multi-disciplinary Diagnosis of Melanoma, was dated June 2014 and obtained by MI under Freedom of Information legislation. Regular melanoma MDMs were held in the eight cancer centres. However, there was “variation” in relation to how smaller hospitals linked with MDMs. “They either participate by teleconference, video conference or are informed of the decision of the MDM in writing.”

One “major hospital” stated there was no process in place that ensured all relevant patients were discussed at MDMs. “There were some comments about the lack of availability of resources to co-ordinate MDMs,” stated the document.

MI was informed that the NCCP had recently met with melanoma specialists nationally to discuss the survey results and identify priorities for service developments. A spokesperson told MI that a number of work-streams are underway, including the development of nationally-agreed standard operating procedures for holding melanoma MDMs and nationally-agreed, standardised pathology reporting systems.

Meanwhile, eight hospitals reported the average waiting time for an urgent referral to be seen in the OPD as two weeks or less. Seven stated that urgent referrals were seen in four weeks or less and one said the urgent waiting time was four-to-eight weeks.

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