{"cancerId":"skin-cancer","aliases":["basal-cell-carcinoma","cutaneous-scc","advanced-cutaneous-scc","merkel-cell-carcinoma","melanoma","advanced-melanoma","braf-v600-melanoma","acral-melanoma","mucosal-melanoma"],"cancerName":"Skin cancer","asOf":"2026-09-25","intro":"Most skin cancer is cured, and most of it is cured in a single outpatient appointment with a local anaesthetic. That is the first thing to know, and it is true of the great majority of the roughly 215,000 skin cancers diagnosed in England every year. It is also why the NHS treats this disease differently from every other cancer, in ways that are not obvious and that change what the published figures mean.\n\nSkin is the largest single stream of urgent cancer referrals in the country. In July 2026, 89,978 of the 308,200 urgent suspected cancer referrals made in England were for suspected skin cancer: 29.2 percent of the total, and nearly twice the number for breast. Around 93 percent of the people on that pathway turn out not to have cancer. Dermatology receives more urgent suspected cancer referrals than any other specialty, and it does so with 508 whole-time-equivalent trained consultants, 159 vacant posts and at least ten trusts that have no dermatologist at all.\n\nAnd basal cell carcinoma, which is by far the commonest of these cancers and the commonest cancer in human beings, is written out of the measurement. The national cancer waiting times guidance applies the 31-day and 62-day treatment standards to ICD-10 C00 to C97 \"excluding basal cell carcinoma of Skin\", and names it in its own worked example as a cancer that is not a reportable cancer. The Office for National Statistics excludes the whole of C44 from \"all cancers\" because, in its own words, non-melanoma skin cancer is greatly under-registered. So the 5,733 skin treatments counted against the 62-day standard in July 2026 are not a count of the same disease as the 89,978 referrals, and no incidence total you read for British cancer includes most skin cancer. This page states that plainly at the top because a reader deserves to know the figures are not what they look like.\n\nWhat is here: how you get referred and what the rules actually say, teledermatology and the photograph that now often replaces the first appointment, who is allowed to cut out which lesion and where, what the NHS funds and what it refused, the four nations, and prevention, which for this cancer is a larger lever than every medicine on this page put together. Melanoma has its own depth on this site and this page routes to it rather than repeating it.","presentation":[{"title":"A small mark on the face that will not heal","share":"Around 72 percent of skin cancers: over 155,000 new basal cell carcinomas in England in 2018","detail":"A pearly or waxy nodule, an ulcer with a raised rolled edge, or fine blood vessels around a patch of skin that scabs, bleeds a little and comes back. This is basal cell carcinoma, and it is the commonest cancer there is. It almost never spreads and almost never kills, and it is also the reason this pathway is the size it is. NICE NG12 recommendation 1.7.5 says to consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma, and 1.7.6 says to consider an urgent one only if there is particular concern that a delay would have a significant impact because of the lesion's site or size. In practice a very large number of these lesions are still referred urgently, which is one reason skin dominates the urgent pathway.","sources":[{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"}]},{"title":"A scaly, tender, fast-growing lump, often on a bald scalp, an ear, a lip or the back of a hand","share":"Around 21 percent of skin cancers: around 45,000 new cutaneous squamous cell carcinomas in England in 2018","detail":"Cutaneous squamous cell carcinoma grows faster than a basal cell carcinoma, is often sore, and can spread to lymph nodes, which is why it is treated as a cancer for waiting-time purposes and basal cell carcinoma is not. NG12 recommendation 1.7.4 says to consider a suspected cancer pathway referral. It is the keratinocyte cancer that can kill, and it is much more dangerous in people whose immune system is suppressed, which is why the two UK trials open in this disease are both about immunosuppressed people and about preventing recurrence.","sources":[{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"}]},{"title":"A mole that has changed","share":"Around 7 percent of skin cancers: around 15,000 melanomas in England in 2018, around 19,400 a year across the UK","detail":"Change in size, shape or colour, and to a lesser extent a diameter of 7 mm or more, inflammation, oozing or a change in sensation. NG12 recommendation 1.7.1 turns these into the weighted 7-point checklist, where the three major features score 2 each and the four minor features 1 each, and a score of 3 or more is an urgent suspected cancer referral; 1.7.2 says refer if dermoscopy suggests melanoma, and 1.7.3 covers nodular melanoma, which can be pigmented or not and does not follow the checklist. Melanoma has its own page on this site: this one covers only what it shares with the rest of the pathway.","sources":[{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"Cancer Research UK: melanoma skin cancer incidence statistics. Melanoma is the 5th most common cancer in the UK with around 19,400 new cases a year, 53 a day (2019, 2021 to 2022); rates have risen by 164 percent since the early 1990s and by 26 percent in the last decade, and are projected to reach around 26,500 cases a year by 2038 to 2040","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer/incidence","date":"2026-09-25"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"NICE NG14: melanoma, assessment and management. Published 29 July 2015, last updated 27 July 2022","url":"https://www.nice.org.uk/guidance/ng14/chapter/Recommendations","date":"2022-07-27"},{"label":"NHS: melanoma skin cancer","url":"https://www.nhs.uk/conditions/melanoma-skin-cancer/","date":"2026-09-25"}]},{"title":"A fast-growing, painless, red or violet nodule in an older person or someone immunosuppressed","detail":"Merkel cell carcinoma is rare and aggressive, and is in scope for the waiting-time standards. It is also the clearest case of what rarity costs in this country: there is no clinical indication for it anywhere in the National Genomic Test Directory, the only randomised trial ever attempted in it closed to recruitment in Britain in 2018 with no published result, and it appears in the national statistics only inside a generic Skin heading.","sources":[{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"},{"label":"ISRCTN16290169: rational treatment selection for Merkel cell carcinoma, a randomised phase 3 multicentre trial comparing radical surgery and radical radiotherapy as first definitive treatment for primary Merkel cell carcinoma, with an observational study for people ineligible for the randomised comparison, sponsored by the University of Birmingham, target 400, recruitment 31 March 2016 to 30 December 2018, overall end date 30 September 2020. The registry record lists no publication","url":"https://www.isrctn.com/ISRCTN16290169","date":"2026-09-25"}]},{"title":"Found while something else was being treated, or found because of who you are","detail":"People on long-term immunosuppression after an organ transplant, people with Gorlin syndrome, people with xeroderma pigmentosum and people who have already had one skin cancer are all at much higher risk of another. The national cancer waiting times guidance says explicitly that each squamous cell carcinoma counts, not just the first. The genomic route for the inherited syndromes is through the rare and inherited disease directory (R214 for Gorlin, R227 for xeroderma pigmentosum, R254 for familial melanoma), not the cancer directory.","sources":[{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"NHS England: rare and inherited disease national genomic test directory, version 9. R214.1 nevoid basal cell carcinoma syndrome or Gorlin syndrome, small panel covering PTCH1 and SUFU, specialised inherited cancer service; R254.1 familial melanoma, small panel, specialised inherited cancer service; R227.1 and R227.2 xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome, a small panel and genome-wide DNA repair defect testing, highly specialised dermatology service","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-09-25"}]}],"timeline":[{"id":"gp","label":"Your GP","standard":"No national standard; NG12 sets the referral rules","target":"Same-day decision at the appointment","detail":"NICE NG12 section 1.7 is short and specific. For melanoma: refer on a suspected cancer pathway with a weighted 7-point checklist score of 3 or more (1.7.1), or if dermoscopy suggests melanoma (1.7.2), and consider referral for suspected nodular melanoma (1.7.3). For squamous cell carcinoma: consider a suspected cancer pathway referral (1.7.4). For basal cell carcinoma: consider a non-urgent referral (1.7.5), and only consider an urgent one if delay would have a significant impact because of site or size (1.7.6). Recommendation 1.7.7 sends the GP to CSG8 for who should excise a suspected basal cell carcinoma. The timed pathway asks that the referral carry a locally agreed minimum dataset: site, size, shape, duration, evolution, bleeding, itching, ultraviolet exposure, family history, previous skin cancer, chronic skin inflammation, immunosuppression, anticoagulant status, performance status and whether the person has a pacemaker.","sources":[{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"NICE CSG8: improving outcomes for people with skin tumours including melanoma. Published 22 February 2006, last updated 25 May 2010, last reviewed 23 May 2019; NICE decided in December 2020 to retain but not update it. It recommends two levels of multidisciplinary team, that people with precancerous lesions be treated by their GP or referred, and that people needing specialist diagnosis be referred to a doctor trained to diagnose skin cancer","url":"https://www.nice.org.uk/guidance/csg8","date":"2010-05-25"}]},{"id":"referral","label":"Referral","standard":"Urgent suspected cancer referral, or a routine referral for a suspected basal cell carcinoma","target":"Skin is 29.2 percent of all urgent suspected cancer referrals in England","detail":"In July 2026, 89,978 of England's 308,200 urgent suspected cancer referrals were for suspected skin cancer, the largest single stream and nearly twice the number for breast; across April to July 2026 the figure was 304,485 of 1,124,238, or 27.1 percent. NHS England's own account of the effect is blunt: dermatology receives more urgent referrals for suspected cancer than any other specialty, about half of the million dermatology referrals a year are urgent suspected skin cancer referrals, and about 8 percent of those turn out to be melanoma or squamous cell carcinoma. The timed pathway puts it at around 93 percent of urgently referred people not having cancer, with cancer alliance variation from 81 to 98 percent. The pathway also records that about a third of people who do have squamous cell carcinoma or melanoma were not referred urgently at all.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"NHS England: a teledermatology roadmap, implementing safe and effective teledermatology triage pathways and processes. About 3 million dermatology outpatient appointments in England in the year to April 2022; dermatology receives more urgent referrals for suspected cancer than any other specialty; about half of the 1 million dermatology referrals a year are urgent suspected skin cancer referrals, of which about 8 percent turn out to be melanoma or squamous cell carcinoma; macroscopic images alone can diagnose many benign lesions and send some squamous cell carcinomas and many basal cell carcinomas straight to surgery, but both dermoscopic and macroscopic images are needed for pigmented lesions; rashes and lesions may be harder to assess in people with brown and black skin. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026","url":"https://www.england.nhs.uk/long-read/a-teledermatology-roadmap-implementing-safe-and-effective-teledermatology-triage-pathways-and-processes/","date":"2023-10-26"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"}]},{"id":"triage","label":"The photograph","standard":"Teledermatology triage: a specialist reviews macroscopic and dermoscopic images before any appointment is offered","target":"The clock stops for a non-cancer result on the date you are told","detail":"A large and growing share of this pathway never reaches a face-to-face appointment. The cancer waiting times guidance sets the rule: for a teledermatology pathway the first seen date is the earliest of an appointment in secondary care where a trained professional takes a dermoscopic image, the date a specialist reviews an image taken in primary care before referral, or the date the person is seen in clinic. Where a specialist reviews an image, the person must be told the result either way, and if cancer is ruled out the Faster Diagnosis Standard end date is the date of that communication. NHS England's roadmap is explicit about what images can and cannot do: macroscopic images alone can diagnose many benign lesions and send some squamous cell carcinomas and many basal cell carcinomas straight to surgery, but both macroscopic and dermoscopic images are needed for pigmented lesions, and lesions may be harder to assess in people with brown and black skin.","sources":[{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"NHS England: a teledermatology roadmap, implementing safe and effective teledermatology triage pathways and processes. About 3 million dermatology outpatient appointments in England in the year to April 2022; dermatology receives more urgent referrals for suspected cancer than any other specialty; about half of the 1 million dermatology referrals a year are urgent suspected skin cancer referrals, of which about 8 percent turn out to be melanoma or squamous cell carcinoma; macroscopic images alone can diagnose many benign lesions and send some squamous cell carcinomas and many basal cell carcinomas straight to surgery, but both dermoscopic and macroscopic images are needed for pigmented lesions; rashes and lesions may be harder to assess in people with brown and black skin. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026","url":"https://www.england.nhs.uk/long-read/a-teledermatology-roadmap-implementing-safe-and-effective-teledermatology-triage-pathways-and-processes/","date":"2023-10-26"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"}]},{"id":"ai","label":"Artificial intelligence triage","standard":"NICE HTG746 conditionally allows one device during a three-year evidence generation period","target":"Around 30 percent of cases potentially discharged from the pathway","detail":"NICE recommendation 1.1 of HTG746 allows Deep Ensemble for Recognition of Malignancy (DERM) to be used within teledermatology services in the NHS during a three-year evidence generation period, only while the evidence in the agreed plan is being generated and once the device has regulatory approval including NHS England's Digital Technology Assessment Criteria. Recommendation 1.2 requires a healthcare professional review for people with black or brown skin and regular monitoring of performance. NHS England's response adds that patients must be given information and informed consent before their images are analysed, that a site should start with a second clinical read before moving to autonomous use, and that the second read for people with black or brown skin should continue throughout the three years. NHS England's stated reason for pursuing it is capacity: in 2023/24 over 650,000 people were referred onto the urgent suspected skin cancer pathway and 120,000 did not have cancer diagnosed or ruled out within 28 days.","sources":[{"label":"NICE HTG746: artificial intelligence technologies for assessing and triaging skin lesions referred to the urgent suspected skin cancer pathway, early value assessment. Published 1 May 2025 as HTE24, migrated to HealthTech guidance and last updated 17 March 2026. Recommendation 1.1 allows Deep Ensemble for Recognition of Malignancy (DERM) within teledermatology services during a three-year evidence generation period, only while the evidence in the evidence generation plan is being generated and once it has regulatory approval including NHS England's Digital Technology Assessment Criteria; 1.2 requires a healthcare professional review for people with black or brown skin and regular monitoring of performance","url":"https://www.nice.org.uk/guidance/htg746/chapter/1-Recommendations","date":"2026-03-17"},{"label":"NHS England: AI based skin lesion analysis technology, the national response to the early value assessment. In 2023/24 over 650,000 people were referred onto the urgent suspected skin cancer pathway and 120,000 did not have cancer diagnosed or ruled out within 28 days; DERM has the potential to discharge around 30 percent of cases from the pathway. NHS England asks that patients are given information and give informed consent before DERM is used, that a site starts with a second clinical read, that a second read always takes place for people with black or brown skin throughout the three-year evidence generation period, and that sites join the AI in Dermatology Getting It Right First Time community of practice. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026","url":"https://www.england.nhs.uk/elective-care/best-practice-solutions/ai-based-skin-lesion-analysis-technology/","date":"2025-12-11"}]},{"id":"fds","label":"Diagnosis or all-clear","standard":"28 days from referral to being told (the Faster Diagnosis Standard)","target":"75 percent, rising to 80 percent; skin achieved 87.3 percent in July 2026","detail":"68,719 of 78,719 suspected skin cancer pathways met the 28-day standard in July 2026, 87.3 percent, against 79.3 percent for all cancers. Skin is one of the best performers on this measure and that is not an accident: most of these pathways end with a specialist looking at an image or a lesion and saying no. NHS England's 2023 letter making the Faster Diagnosis Standard the headline measure said performance against breast and skin specifically would need to be above 90 percent for the standard to rise to 80 percent. The timed pathway sets out exactly when the clock stops: when a clinical diagnosis is given, when a histological diagnosis is given after biopsy, or when a decision to treat a lesion is made because cancer cannot be excluded, whichever comes first.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"NHS England: changes to cancer waiting times standards from 1 October 2023. The two-week wait standard was removed in favour of the 28-day Faster Diagnosis Standard and the ten standards were rationalised to three; the letter says performance against breast and skin specifically would need to be above 90 percent for the Faster Diagnosis Standard to rise to 80 percent. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026","url":"https://www.england.nhs.uk/long-read/changes-to-cancer-waiting-times-standards-from-1-october-2023/","date":"2023-08-17"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"}]},{"id":"treatment31","label":"Treatment","standard":"31 days from the decision to treat to the first treatment","target":"96 percent; skin achieved 88.2 percent in July 2026 (basal cell carcinoma not counted)","detail":"7,936 of 8,994 skin treatments met the 31-day standard in July 2026, 88.2 percent, split 5,875 of 6,605 first treatments (88.9 percent) and 2,061 of 2,389 subsequent treatments (86.3 percent). For most people the treatment is a local anaesthetic excision, often at the same appointment as the diagnosis. The guidance is careful about what counts: a surgical biopsy for diagnosis does not count as a first treatment unless the tumour is effectively removed by it, and neither does a sentinel node biopsy. Each squamous cell carcinoma counts separately, not just the first, though several treated in one appointment can pragmatically be counted as one pathway.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"}]},{"id":"treatment62","label":"Referral to treatment","standard":"62 days from an urgent referral to the first treatment","target":"85 percent; skin achieved 87.4 percent in July 2026 (basal cell carcinoma not counted)","detail":"5,010 of 5,733 met the 62-day standard in July 2026, 87.4 percent, split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Put that 5,733 beside the 89,978 urgent referrals made in the same month and the shape of this pathway is visible in a single comparison. Part of the gap is that most referrals are not cancer. The rest is that the commonest cancer among the ones that are is not counted here at all.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"Office for National Statistics: cancer registration statistics quality and methodology information. \"We have been advised by expert epidemiologists and members of the former Steering Committee on Cancer Registration that non-melanoma skin cancer (NMSC) is greatly under-registered. Therefore, the published tables present counts and rates for all cancers and for all cancers excluding NMSC (code 173 in ICD-8 and ICD-9, and C44 in ICD-10) to ensure that the reported figures are meaningful\"","url":"https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/methodologies/cancerregistrationstatisticsqmi","date":"2026-09-25"}]},{"id":"after","label":"Afterwards","standard":"No national follow-up standard for keratinocyte cancers","target":"Quality statement 4: access to a skin cancer clinical nurse specialist for melanoma, high-risk squamous cell carcinoma or a rare skin cancer","detail":"NICE QS130 statement 4 gives a right to a skin cancer clinical nurse specialist to people with melanoma, high-risk squamous cell carcinoma or a rare skin cancer. It does not extend to basal cell carcinoma, which is consistent with how the rest of the system treats it and is worth knowing if you have one on your face. Having had one skin cancer raises the chance of another, so what most people get afterwards is advice on checking their own skin and on sun protection rather than scheduled scans. Reconstructive or cosmetic surgery after the definitive treatment does not count as a subsequent cancer treatment in the waiting-time dataset, and neither does psychological support.","sources":[{"label":"NICE QS130: skin cancer quality standard, published 21 September 2016, last updated 24 January 2024. Six statements: 1 integrated care boards work with local partners on strategies to raise awareness of skin cancer and the risks of over-exposure to sunlight and artificial ultraviolet light, particularly for at-risk groups (new 2024); 2 people with suspected melanoma, squamous cell carcinoma or a rare skin cancer are referred on a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days; 3 dermoscopy at specialist assessment for suspected melanoma; 4 access to a skin cancer clinical nurse specialist for melanoma, high-risk squamous cell carcinoma or a rare skin cancer; 5 BRAF analysis in stage 2B to 4 primary melanoma; 6 a staging scan in stage 2C to 4 melanoma (new 2024)","url":"https://www.nice.org.uk/guidance/qs130/chapter/Quality-statements","date":"2024-01-24"},{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"NHS: treatment for non-melanoma skin cancer. Surgery is the main treatment; radiotherapy, targeted medicines and immunotherapy, photodynamic therapy and chemotherapy cream are also used","url":"https://www.nhs.uk/conditions/non-melanoma-skin-cancer/treatment/","date":"2026-09-16"}]}],"centres":[{"institutionId":"guys-st-thomas","name":"St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust","trust":"Guy's and St Thomas' NHS Foundation Trust","city":"London","nation":"England","offers":["Basal cell carcinoma, squamous cell carcinoma, melanoma, skin lymphoma, Merkel cell carcinoma and Kaposi's sarcoma","Non-melanoma surgery in the dermatology clinics or the dermatological surgery and laser unit; most melanoma surgery by the plastic surgery team","A named clinical nurse specialist as key worker and a patient tracker","Separate skin lymphoma and melanoma consultant teams"],"url":"https://www.guysandstthomas.nhs.uk/our-services/skin-cancer","sources":[{"label":"Guy's and St Thomas' NHS Foundation Trust: skin cancer. The trust treats basal cell carcinoma, squamous cell carcinoma, melanoma, skin lymphoma, Merkel cell carcinoma and Kaposi's sarcoma; the service is part of St John's Institute of Dermatology; non-melanoma surgery is done in the dermatology clinics or the dermatological surgery and laser unit and most melanoma surgery by the plastic surgery team. Page last updated April 2025. The page answers HTTP 403 to a browser user agent and 200 to a plain request with no extra headers, which is how it was read","url":"https://www.guysandstthomas.nhs.uk/our-services/skin-cancer","date":"2025-04"}],"institutionName":"Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre"},{"institutionId":"leeds-cancer-centre","name":"Dermatology, Leeds Teaching Hospitals NHS Trust","trust":"Leeds Teaching Hospitals NHS Trust","city":"Leeds","nation":"England","offers":["Mohs micrographic surgery","Skin cancer, pigmented lesion and melanoma clinics","Dermatology lymphoma clinic","Photodynamic therapy and photobiology","A minor surgery clinic"],"url":"https://www.leedsth.nhs.uk/services/dermatology/","sources":[{"label":"Leeds Teaching Hospitals NHS Trust: dermatology. The department runs specialist clinics for skin cancer, Mohs micrographic surgery, pigmented lesions, melanoma, dermatology lymphoma, photodynamic therapy and a minor surgery clinic","url":"https://www.leedsth.nhs.uk/services/dermatology/","date":"2026-09-25"}],"institutionName":"Leeds Cancer Centre, St James's University Hospital"},{"name":"The Dermatology Centre, Salford Royal, Northern Care Alliance NHS Foundation Trust","trust":"Northern Care Alliance NHS Foundation Trust","city":"Salford","nation":"England","offers":["Described by the trust as one of the largest dermatology centres of its kind in Europe: around 13,000 new outpatients a year and 26,000 follow-ups","Mohs surgery: the GIRFT report found people living in Salford over ten times more likely to receive Mohs than people in the worst-served parts of England","Academic links to the University of Manchester and The Christie"],"url":"https://www.northerncarealliance.nhs.uk/our-services/dermatology","sources":[{"label":"Northern Care Alliance NHS Foundation Trust: the Dermatology Centre at Salford Royal, described by the trust as one of the largest of its kind in Europe, seeing around 13,000 new outpatients a year with a further 26,000 follow-up appointments, with academic links to the University of Manchester and The Christie","url":"https://www.northerncarealliance.nhs.uk/our-services/dermatology","date":"2026-09-25"},{"label":"Getting It Right First Time: dermatology national specialty report, September 2021. 508 whole-time-equivalent trained NHS dermatologists in England with 159 whole-time-equivalent vacant posts and 143 filled by locums; at least ten trusts have no dermatologist at all and around a third have very severe shortages; NHS dermatology units carry out over 200,000 surgical excisions a year; around 75 percent of patient visits for NHS skin care take place in primary care; skin cancer incidence is rising by around 8 percent a year, doubling at least every 14 to 15 years. On Mohs: just 79 dermatology doctors carrying out Mohs surgery in England, activity concentrated in fewer than 30 specialist centres, patients in Salford over ten times more likely to get Mohs than those in the worst-served areas, and the Dermatology Clinical Reference Group designating 56 English trusts as specialist skin cancer centres (specialist skin cancer multidisciplinary teams, or level 5)","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/DermatologyReport-Sept21o.pdf","date":"2021-09"}]},{"institutionId":"newcastle-cancer-centre","name":"Dermatology, Newcastle Hospitals NHS Foundation Trust","trust":"The Newcastle upon Tyne Hospitals NHS Foundation Trust","city":"Newcastle upon Tyne","nation":"England","offers":["Micrographic (Mohs) surgery for certain skin cancers","General and specialist dermatology clinics for adults and children"],"url":"https://www.newcastle-hospitals.nhs.uk/services/dermatology/","sources":[{"label":"Newcastle Hospitals NHS Foundation Trust: dermatology. Some of the trust's specialists perform micrographic surgery, a type of surgery for removing certain forms of skin cancer","url":"https://www.newcastle-hospitals.nhs.uk/services/dermatology/","date":"2026-09-25"}],"institutionName":"Newcastle Cancer Centre / Northern Centre for Cancer Care"},{"institutionId":"addenbrookes-cambridge","name":"Dermatology, Cambridge University Hospitals NHS Foundation Trust","trust":"Cambridge University Hospitals NHS Foundation Trust","city":"Cambridge","nation":"England","offers":["All consultants see skin cancer patients and carry out minor procedures in the department","Early detection and treatment of skin cancer named as a departmental aim","Combined clinics with other specialties"],"url":"https://www.cuh.nhs.uk/our-services/dermatology/","sources":[{"label":"Cambridge University Hospitals: dermatology. All consultants run general dermatology clinics, see skin cancer patients and carry out minor procedures in the department","url":"https://www.cuh.nhs.uk/our-services/dermatology/","date":"2026-09-25"}],"institutionName":"Addenbrooke's Hospital, Cambridge University Hospitals"},{"name":"Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust","trust":"Norfolk and Norwich University Hospitals NHS Foundation Trust","city":"Norwich","nation":"England","offers":["The department of the Getting It Right First Time national clinical lead for dermatology","Dermatology research and a published consultant and senior staff list"],"url":"https://www.nnuh.nhs.uk/departments/dermatology/","sources":[{"label":"Norfolk and Norwich University Hospitals NHS Foundation Trust: dermatology, the department led by the Getting It Right First Time national dermatology clinical lead","url":"https://www.nnuh.nhs.uk/departments/dermatology/","date":"2026-09-25"},{"label":"Getting It Right First Time: dermatology. One in four people in England and Wales (13.2 million) see their GP about a skin condition every year, with 3.5 million outpatient or day surgery attendances; around half of all cancers in England and Wales are skin cancer and this is increasing by 8 percent a year. The page also records the cancer waiting times change that made the two-week wait clock stop for a teledermatology referral the date a specialist reviews the image rather than the date the patient is told","url":"https://gettingitrightfirsttime.co.uk/medical_specialties/dermatology/","date":"2026-09-25"}]},{"institutionId":"birmingham-cancer-centre","name":"Dermatology, University Hospitals Birmingham NHS Foundation Trust","trust":"University Hospitals Birmingham NHS Foundation Trust","city":"Birmingham","nation":"England","offers":["A full range of dermatology services for diseases of the skin, mucous membrane, hair and nails","The university that sponsored the only randomised trial ever attempted in Merkel cell carcinoma"],"url":"https://www.uhb.nhs.uk/services/dermatology/","sources":[{"label":"University Hospitals Birmingham NHS Foundation Trust: dermatology","url":"https://www.uhb.nhs.uk/services/dermatology/","date":"2026-09-25"},{"label":"ISRCTN16290169: rational treatment selection for Merkel cell carcinoma, a randomised phase 3 multicentre trial comparing radical surgery and radical radiotherapy as first definitive treatment for primary Merkel cell carcinoma, with an observational study for people ineligible for the randomised comparison, sponsored by the University of Birmingham, target 400, recruitment 31 March 2016 to 30 December 2018, overall end date 30 September 2020. The registry record lists no publication","url":"https://www.isrctn.com/ISRCTN16290169","date":"2026-09-25"}],"institutionName":"University Hospitals Birmingham / University of Birmingham Cancer Research Centre"},{"name":"Dermatology, NHS Lothian","trust":"NHS Lothian","city":"Edinburgh","nation":"Scotland","offers":["Patient sections on skin cancer, sun awareness and skin surgery, and on melanoma","Skin surgery within the dermatology outpatient department"],"url":"https://services.nhslothian.scot/dermatology/","sources":[{"label":"NHS Lothian: dermatology, with its own patient sections on skin cancer, sun awareness and skin surgery and on melanoma","url":"https://services.nhslothian.scot/dermatology/","date":"2026-09-25"}]},{"name":"The Welsh Institute of Dermatology, Cardiff and Vale University Health Board","trust":"Cardiff and Vale University Health Board","city":"Cardiff","nation":"Wales","offers":["The Welsh Institute of Dermatology, with a skin cancer service","Sponsor or host of three of the UK's open keratinocyte cancer trials: SPOT-IT and SCC-AFTER (Cardiff University) and EXCISE (the health board)"],"url":"https://cavuhb.nhs.wales/our-services/dermatology/","sources":[{"label":"Cardiff and Vale University Health Board: dermatology, the Welsh Institute of Dermatology, with a skin cancer service","url":"https://cavuhb.nhs.wales/our-services/dermatology/","date":"2026-09-25"},{"label":"ISRCTN80116429: SPOT-IT, cutaneous squamous cell carcinoma prevention using topical therapy in immunosuppressed patients, sponsored by Cardiff University, target 673 participants, end date 31 December 2031","url":"https://www.isrctn.com/ISRCTN80116429","date":"2026-09-25"},{"label":"ISRCTN54806122: SCC-AFTER, adjuvant radiotherapy in people with high-risk primary cutaneous squamous cell carcinoma after surgery, an open-label multicentre two-arm phase 3 randomised trial sponsored by Cardiff University, target 840 participants, end date 1 January 2031","url":"https://www.isrctn.com/ISRCTN54806122","date":"2026-09-25"},{"label":"ISRCTN15382058: EXCISE, examining antibiotics for ulcerated skin cancer surgical excision, a pragmatic double-blinded clinical and cost-effectiveness randomised controlled trial sponsored by Cardiff and Vale University Health Board, target 380 participants, end date 31 December 2027","url":"https://www.isrctn.com/ISRCTN15382058","date":"2026-09-25"}]},{"name":"Dermatology, Belfast Health and Social Care Trust","trust":"Belfast Health and Social Care Trust","city":"Belfast","nation":"Northern Ireland","offers":["Skin cancer service within the regional dermatology department","Diagnosis and treatment of skin, hair and nail conditions for the Belfast trust and regional referrals"],"url":"https://belfasttrust.hscni.net/service/dermatology/","sources":[{"label":"Belfast Health and Social Care Trust: dermatology, with a skin cancer service","url":"https://belfasttrust.hscni.net/service/dermatology/","date":"2026-09-25"}]}],"centresNote":{"text":"Skin cancer has two levels of multidisciplinary team, set by NICE CSG8 in 2006 and updated in 2010: a local skin cancer multidisciplinary team (LSMDT) in most trusts, and a specialist skin cancer multidisciplinary team (SSMDT) for the harder cases. The Getting It Right First Time dermatology report records that the Dermatology Clinical Reference Group designates 56 English trusts as specialist skin cancer centres, that NHS England defines Mohs surgery as a specialist service that should be provided by those centres, and that Mohs activity is in fact concentrated in fewer than 30 of them and done by just 79 dermatology doctors in the whole of England. That is the single sharpest inequality on this page: whether a basal cell carcinoma on your nose is removed layer by layer with the margins checked under a microscope during the operation, or removed with a standard margin and a wider scar, depends on where you live. The report puts the primary reason as the lack of trained surgeons, and says the British Society for Dermatological Surgery now trains around ten Mohs fellows a year.\n\nThe centres listed here are not a designated national list, because NHS England publishes none: the 56 trusts are counted in the GIRFT report but not named there or anywhere else that could be read. These are trusts whose own public pages describe a skin cancer service, chosen to cover all four nations and the specific things a reader might need to find (Mohs, a skin lymphoma service, a trials centre). Most skin cancer is not treated in any of them. It is treated in a general dermatology clinic, a community spot clinic or a GP surgery, and the rules for which of those is allowed to treat what are in the funding table below.","sources":[{"label":"NICE CSG8: improving outcomes for people with skin tumours including melanoma. Published 22 February 2006, last updated 25 May 2010, last reviewed 23 May 2019; NICE decided in December 2020 to retain but not update it. It recommends two levels of multidisciplinary team, that people with precancerous lesions be treated by their GP or referred, and that people needing specialist diagnosis be referred to a doctor trained to diagnose skin cancer","url":"https://www.nice.org.uk/guidance/csg8","date":"2010-05-25"},{"label":"NICE CSG8, the management of low-risk basal cell carcinomas in the community, cancer service guidance update, May 2010. Box 1 sets the criteria for the low-risk nodular basal cell carcinomas a GP with no special interest may excise under a directed or local enhanced service: the person must not be 24 or younger, immunosuppressed or have Gorlin's syndrome, and the lesion must be below the clavicle, under 1 cm with clearly defined margins, not recurrent or persistent after incomplete excision, not morphoeic, infiltrative or basosquamous, and not over important anatomical structures, in an area where primary closure is difficult, where difficult excision may give a poor cosmetic result, or at another highly visible site. Anything else, or any diagnostic doubt, goes to a member of the local skin cancer multidisciplinary team, and every incompletely excised basal cell carcinoma must be discussed with one","url":"https://www.nice.org.uk/guidance/csg8/resources/improving-outcomes-for-people-with-skin-tumours-including-melanoma-2010-partial-update-pdf-773380189","date":"2010-05-25"},{"label":"Getting It Right First Time: dermatology national specialty report, September 2021. 508 whole-time-equivalent trained NHS dermatologists in England with 159 whole-time-equivalent vacant posts and 143 filled by locums; at least ten trusts have no dermatologist at all and around a third have very severe shortages; NHS dermatology units carry out over 200,000 surgical excisions a year; around 75 percent of patient visits for NHS skin care take place in primary care; skin cancer incidence is rising by around 8 percent a year, doubling at least every 14 to 15 years. On Mohs: just 79 dermatology doctors carrying out Mohs surgery in England, activity concentrated in fewer than 30 specialist centres, patients in Salford over ten times more likely to get Mohs than those in the worst-served areas, and the Dermatology Clinical Reference Group designating 56 English trusts as specialist skin cancer centres (specialist skin cancer multidisciplinary teams, or level 5)","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/DermatologyReport-Sept21o.pdf","date":"2021-09"},{"label":"Getting It Right First Time: dermatology. One in four people in England and Wales (13.2 million) see their GP about a skin condition every year, with 3.5 million outpatient or day surgery attendances; around half of all cancers in England and Wales are skin cancer and this is increasing by 8 percent a year. The page also records the cancer waiting times change that made the two-week wait clock stop for a teledermatology referral the date a specialist reviews the image rather than the date the patient is told","url":"https://gettingitrightfirsttime.co.uk/medical_specialties/dermatology/","date":"2026-09-25"}]},"funding":[{"line":"Low-risk basal cell carcinoma, in the community","treatment":"Excision by a GP under a directed or local enhanced service, within strict criteria","refs":[],"england":{"body":"NHS England","decision":"Allowed only for a primary nodular low-risk basal cell carcinoma with no diagnostic uncertainty, under the criteria in box 1 of NICE CSG8: the person must not be 24 or younger, immunosuppressed or have Gorlin's syndrome; the lesion must be below the clavicle (so not on the head or neck), under 1 cm with clearly defined margins, not recurrent or persistent after incomplete excision, not morphoeic, infiltrative or basosquamous, and not over important anatomical structures, in an area where primary closure is difficult, where difficult excision may give a poor cosmetic result, or at another highly visible site such as the anterior chest or shoulders. Anything else, or any diagnostic doubt, goes to a member of the local skin cancer multidisciplinary team, and every incompletely excised basal cell carcinoma must be discussed with one. The GP must be accredited, send every specimen to histology and keep a fail-safe log","url":"https://www.nice.org.uk/guidance/csg8/resources/improving-outcomes-for-people-with-skin-tumours-including-melanoma-2010-partial-update-pdf-773380189","date":"2010-05-25"},"scotland":{"body":"NHS Scotland","decision":"Not covered: CSG8 is English and Welsh guidance, and Scotland's arrangements for community skin surgery are set by health boards. No national Scottish equivalent of the box 1 criteria could be read","url":"https://www.nice.org.uk/guidance/csg8"},"wales":"CSG8 applies in Wales; box 1 refers to local health boards as well as primary care trusts.","northernIreland":"No published Northern Ireland equivalent of the box 1 criteria could be read.","note":"This is the most consequential rule on the page and the least known. The evidence review for the 2010 update found studies and audits showing higher rates of incomplete excision of basal cell carcinomas by GPs than by hospital specialists, which is why the criteria are as narrow as they are. If a GP offers to remove a lesion from your face, the criteria say they should not.","refNames":[]},{"line":"Superficial basal cell carcinoma where surgery or cryotherapy is not suitable","treatment":"Imiquimod 5% cream (Aldara), applied daily for six weeks","refs":["imiquimod"],"england":{"body":"NHS England","decision":"Licensed and routinely prescribed; NICE has never appraised it for basal cell carcinoma and there is no technology appraisal for it in NICE's skin cancer product list. Funding is through local formularies","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer/products","date":"2026-09-25"},"scotland":{"body":"SMC","decision":"Accepted for restricted use within NHS Scotland for the topical treatment of small superficial basal cell carcinoma in adults in whom standard treatment with surgery or cryotherapy is contraindicated, supervised by specialists in dermatology; composite clearance 73 to 77 percent at 12 weeks in the randomised trials","date":"2005","url":"https://scottishmedicines.org.uk/medicines-advice/imiquimod-5-cream-aldara-fullsubmission-16705/"},"wales":"As England: licensed and prescribed under local formularies, with no NICE appraisal to follow.","northernIreland":"As England.","note":"SINS, the UK trial that settled how good this is, randomised 501 people at twelve centres and found three-year success of 84 percent with imiquimod against 98 percent with surgery, and five-year success of 82.5 percent against 97.7 percent. It failed its non-inferiority test. Most imiquimod failures happened in the first year, so a lesion that clears early tends to stay clear.","refNames":["Imiquimod"]},{"line":"Superficial or nodular basal cell carcinoma where surgery is not suitable","treatment":"Photodynamic therapy with methyl aminolevulinate (Metvix) cream","refs":[],"england":{"body":"NHS England","decision":"NICE HTG99 (2006) covers photodynamic therapy for non-melanoma skin tumours including premalignant and primary non-metastatic lesions; there is no technology appraisal of the medicine and provision is a local commissioning decision","url":"https://www.nice.org.uk/guidance/htg99","date":"2006-02-22"},"scotland":{"body":"SMC","decision":"Accepted for restricted use within NHS Scotland for basal cell carcinoma in people in whom standard treatment with surgery or cryotherapy is contraindicated, restricted to specialist dermatologists and to superficial lesions where penetration is most effective","date":"2003","url":"https://scottishmedicines.org.uk/medicines-advice/methyl-aminolevulinate-metvix-cream-resubmission-5103/"},"wales":"As England.","northernIreland":"As England.","note":"Scotland has a written national position on both of the non-surgical options for basal cell carcinoma and England has none for either. That is the opposite of the usual direction of travel between the two.","refNames":[]},{"line":"Multiple operable basal cell carcinomas, with or without Gorlin syndrome","treatment":"Vismodegib, continuously or on an intermittent schedule","refs":["vismodegib"],"england":{"body":"NHS England","decision":"Routinely funded from 14 July 2021 under Blueteq form VIS2 in section B of the national Cancer Drugs Fund list, with no technology appraisal number. The criteria require at least six clinically evident non-locally advanced, non-metastatic basal cell carcinomas of which at least three are 5 mm or larger, a person suitable for surgery but where surgery alone has the potential for substantial disfigurement, and a recommendation from a specialised skin cancer or head and neck multidisciplinary team. The form records that vismodegib and the intermittent schedules are not licensed in this indication","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2021-07-14"},"scotland":{"body":"SMC","decision":"No SMC advice exists for this indication; the only vismodegib advice is the 2013 non-submission for advanced disease","url":"https://scottishmedicines.org.uk/medicines-advice/vismodegib-erivedge-nonsubmission-92413/"},"wales":"The national Cancer Drugs Fund list is an NHS England document; no Welsh equivalent for this indication could be read.","northernIreland":"No published Northern Ireland position could be read.","note":"This row matters because it is easy to read TA489 and conclude that the NHS in England does not fund vismodegib at all. It does, for a different group of people, through a commissioning route rather than an appraisal, and off label. A refusal, an appraisal terminated because nobody submitted, and a medicine funded by a route other than appraisal are three different things.","refNames":["Vismodegib"]},{"line":"Locally advanced or metastatic basal cell carcinoma not suitable for surgery or radiotherapy","treatment":"Vismodegib (Erivedge)","refs":["vismodegib"],"england":{"body":"NICE","decision":"Not recommended. Recommendation 1.1: vismodegib is not recommended within its marketing authorisation for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapy, in adults. Recommendation 1.2 protects people who had already started treatment before the guidance was published","ref":"TA489","date":"2017-11-22","url":"https://www.nice.org.uk/guidance/ta489/chapter/1-Recommendations"},"scotland":{"body":"SMC","decision":"Not recommended for use within NHS Scotland in the absence of a submission from the holder of the marketing authorisation. The outcome is the same as England's, the reason is not: NICE appraised the medicine and said no, the SMC was never asked","date":"2013","url":"https://scottishmedicines.org.uk/medicines-advice/vismodegib-erivedge-nonsubmission-92413/"},"wales":"Not routinely funded: NICE guidance applies in Wales and TA489 is a refusal.","northernIreland":"Not routinely funded: NICE guidance applies.","note":"This is the only NICE refusal in the skin cancer list. Advanced basal cell carcinoma is consequently the largest funding gap on this page, and it is the gap the IMPACT trial, testing first-line cemiplimab from University Hospitals Bristol and Weston, exists to close.","refNames":["Vismodegib"]},{"line":"Locally advanced basal cell carcinoma not amenable to curative surgery or radiotherapy","treatment":"Sonidegib (Odomzo)","refs":["sonidegib"],"england":{"body":"NHS England","decision":"Licensed in Great Britain but never appraised: sonidegib does not appear anywhere in NICE's list of 65 skin cancer products, published or in development. There is therefore no recommendation to follow either way, and access is by local decision or individual funding request","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer/products","date":"2026-09-25"},"scotland":{"body":"SMC","decision":"No advice: an SMC keyword search returns no sonidegib entry","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=skin"},"wales":"No NICE appraisal to follow; no AWMSG appraisal could be found.","northernIreland":"No published position could be read.","note":"Not appraised is not the same as refused. A licensed medicine that no body has ever assessed leaves a clinician with nothing to point at, which in practice is often harder than a refusal to argue against.","refNames":["Sonidegib"]},{"line":"Metastatic or locally advanced cutaneous squamous cell carcinoma where curative surgery and radiotherapy are not suitable","treatment":"Cemiplimab (Libtayo), stopped at 24 months","refs":["cemiplimab"],"england":{"body":"NICE","decision":"Recommended, with two conditions: treatment is stopped at 24 months or earlier on progression, and the company provides cemiplimab under the commercial arrangement. TA802 updates and replaces TA592, under which cemiplimab was available through the Cancer Drugs Fund; it is now routine commissioning, on the national list as Blueteq form CEM1 in section B","ref":"TA802","date":"2022-06-29","url":"https://www.nice.org.uk/guidance/ta802/chapter/1-Recommendations"},"scotland":{"body":"SMC","decision":"Accepted for use within NHSScotland following reassessment under the end of life and orphan equivalent medicine process, superseding the earlier interim acceptance SMC2216; objective response rate 45 percent in the phase 2 study; takes account of a Patient and Clinician Engagement meeting","ref":"SMC2584","url":"https://scottishmedicines.org.uk/medicines-advice/cemiplimab-libtayo-reassessment-smc2584/"},"wales":"Follows NICE TA802, available through the New Treatment Fund within 60 days of the appraisal.","northernIreland":"Follows NICE TA802.","note":"This is the one advanced keratinocyte cancer with a funded systemic treatment across the whole UK. Two more appraisals are coming: cemiplimab after surgery and radiotherapy for high-risk disease (ID6659, expected 24 March 2027) and cosibelimab for advanced disease (ID6663, awaiting development, expected 23 September 2027), with pembrolizumab in the adjuvant setting (ID6473) in development with no date.","refNames":["Cemiplimab"]},{"line":"Untreated metastatic Merkel cell carcinoma","treatment":"Avelumab (Bavencio)","refs":["avelumab"],"england":{"body":"NICE","decision":"Recommended for adults who have not had chemotherapy for metastatic disease, only if the company provides avelumab under the commercial arrangement. On the national list as Blueteq form AVE1 in section B, routine commissioning","ref":"TA691","date":"2021-04-21","url":"https://www.nice.org.uk/guidance/ta691/chapter/1-Recommendation"},"scotland":{"body":"SMC","decision":"Accepted for use within NHSScotland following a full submission considered under the ultra-orphan and end of life process, for metastatic Merkel cell carcinoma in adults; takes account of a Patient and Clinician Engagement meeting","date":"2018","url":"https://scottishmedicines.org.uk/medicines-advice/avelumab-bavencio-fullsubmission-131518/"},"wales":"Follows NICE TA691.","northernIreland":"Follows NICE TA691.","note":"TA517 of April 2018 covers the same medicine after one or more lines of chemotherapy and remains live on the national list as form AVE2; recommendation 1.2 of TA517 records that it has been updated and replaced by TA691 for the untreated setting. Retifanlimab is licensed in Britain but NICE has no Merkel cell carcinoma appraisal for it and the only SMC advice for it is in anal cancer, so avelumab is the whole of the funded systemic treatment for this disease in the UK.","refNames":["Avelumab"]},{"line":"Untreated advanced melanoma","treatment":"Nivolumab with ipilimumab, pembrolizumab, or nivolumab with relatlimab","refs":["nivolumab","ipilimumab","pembrolizumab","relatlimab-nivolumab"],"england":{"body":"NICE","decision":"Nivolumab with relatlimab is recommended for untreated unresectable or metastatic melanoma in people 12 and over, only if it is stopped after 2 years or earlier on progression and the company provides it under the commercial arrangement. There is no PD-L1 restriction in the recommendation. The committee's reasoning records that people with advanced melanoma usually have nivolumab with ipilimumab (TA400), and pembrolizumab (TA366) or nivolumab where that is not suitable","ref":"TA950","date":"2024-02-07","url":"https://www.nice.org.uk/guidance/ta950/chapter/1-Recommendations"},"scotland":{"body":"SMC","decision":"Nivolumab with relatlimab accepted for use within NHSScotland for first-line treatment of advanced unresectable or metastatic melanoma in adults and adolescents 12 and over","ref":"SMC2645","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-relatlimab-opdualag-full-smc2645/"},"wales":"Follows NICE.","northernIreland":"Follows NICE.","note":"Melanoma has its own depth on this site; this row is here because the family page is where many readers land and because the corpus recorded TA950 as restricted to PD-L1 below 1 percent, which the recommendation does not say.","refNames":["Nivolumab","Ipilimumab","Pembrolizumab","Relatlimab + nivolumab"]},{"line":"Melanoma after surgery (adjuvant)","treatment":"Pembrolizumab or nivolumab","refs":["pembrolizumab","nivolumab"],"england":{"body":"NICE","decision":"Pembrolizumab is recommended within its marketing authorisation after complete resection of stage 3 melanoma with lymph node involvement in adults (TA766, 2 February 2022) and of stage 2B or 2C melanoma in people 12 and over (TA837, 26 October 2022). Nivolumab is recommended after complete resection of melanoma with lymph node involvement or metastatic disease (TA684, 17 March 2021), which updated and replaced TA558 of January 2019","ref":"TA766","date":"2022-02-02","url":"https://www.nice.org.uk/guidance/ta766/chapter/1-Recommendations"},"scotland":{"body":"SMC","decision":"Pembrolizumab accepted for adjuvant treatment of completely resected stage 2B or 2C melanoma (SMC2526), having previously been accepted for resected stage 3 disease with lymph node involvement (SMC2144). Nivolumab was not recommended for adjuvant stage 2B or 2C melanoma in the absence of a submission from the company (SMC2704)","ref":"SMC2526","url":"https://scottishmedicines.org.uk/medicines-advice/pembrolizumab-keytruda-full-smc2526/"},"wales":"Follows NICE TA766, TA837 and TA684.","northernIreland":"Follows NICE.","note":"NICE TA980, an appraisal of nivolumab for adjuvant treatment of completely resected melanoma at high risk of recurrence in people 12 and over, was terminated on 5 June 2024; the published advice says NICE was unable to make a recommendation because Bristol-Myers Squibb did not provide an evidence submission, and that it will review the decision if the company makes one. A terminated appraisal is not a judgement that the medicine does not work, and it is not the same as the refusal in TA489.","refNames":["Pembrolizumab","Nivolumab"]},{"line":"BRAF V600 mutation-positive advanced melanoma","treatment":"Dabrafenib with trametinib, encorafenib with binimetinib, or vemurafenib with cobimetinib","refs":["dabrafenib-trametinib","encorafenib","binimetinib"],"england":{"body":"NICE","decision":"Trametinib with dabrafenib is recommended for unresectable or metastatic melanoma (TA396, 22 June 2016); encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma (TA562, 27 February 2019); cobimetinib with vemurafenib (TA414, 26 October 2016). Access depends on the BRAF test, which is NICE quality statement 5 of QS130 and clinical indication M7 of the genomic test directory","ref":"TA396","date":"2016-06-22","url":"https://www.nice.org.uk/guidance/ta396"},"scotland":{"body":"SMC","decision":"Encorafenib with binimetinib accepted for use within NHSScotland following a resubmission assessed under the end of life and orphan medicine process and a Patient and Clinician Engagement meeting","ref":"SMC2238","url":"https://scottishmedicines.org.uk/medicines-advice/encorafenib-braftovi-resubmission-smc2238/"},"wales":"Follows NICE.","northernIreland":"Follows NICE.","note":"QS130 statement 5 says people with stage 2B to 4 primary melanoma have BRAF analysis of the tumour, which is what turns this row from a list of medicines into an entitlement.","refNames":["Dabrafenib + trametinib","Encorafenib","Binimetinib"]}],"fundingNote":{"text":"Three things are worth holding on to when reading this table.\n\nFirst, the distinction between kinds of no. TA489 is a refusal: NICE appraised vismodegib for advanced basal cell carcinoma and did not recommend it. TA980 is a terminated appraisal: the company did not submit evidence, so there is no recommendation either way. Sonidegib is not appraised at all: it has a Great Britain licence and appears nowhere in NICE's 65 skin cancer products. And the SMC's no on vismodegib is a fourth thing again, a non-submission rather than an assessment. Those four are not interchangeable, and a patient arguing for access needs to know which one applies.\n\nSecond, the Cancer Drugs Fund carries no skin cancer indication as managed access. Cemiplimab in cutaneous squamous cell carcinoma began in the fund under TA592 and moved to routine commissioning under TA802 in 2022; avelumab in Merkel cell carcinoma is routine under TA691 and TA517. The only skin entry in the national list that is unusual is vismodegib under form VIS2, and that is in the routine section, funded by an NHS England commissioning decision rather than an appraisal, and off label.\n\nThird, almost none of this table touches most people with skin cancer. The great majority are treated by excision under local anaesthetic, or by curettage, cryotherapy, topical treatment or radiotherapy, none of which is appraised by NICE because none of them is a new medicine. The two newer local treatments NICE has looked at are both hedged: electrochemotherapy for primary basal cell and squamous cell carcinoma (HTG333) may be used only with special arrangements for clinical governance, consent and local audit and with data submitted to a register, and epidermal radiotherapy using rhenium-188 paste (HTG714) should be used only inside a research study approved by a research ethics committee. Talimogene laherparepvec is recommended for unresectable metastatic melanoma in England (TA410) and was considered in Scotland only as a non-submission. The rules that actually govern their care are the referral rules, the multidisciplinary team structure and the community excision criteria, which is why those are on this page in the same detail as the appraisals.","sources":[{"label":"NICE TA489: vismodegib for treating basal cell carcinoma, published 22 November 2017. Recommendation 1.1: vismodegib is not recommended within its marketing authorisation for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapy, in adults. Recommendation 1.2 protects people already on treatment","url":"https://www.nice.org.uk/guidance/ta489/chapter/1-Recommendations","date":"2017-11-22"},{"label":"NICE TA980: nivolumab for adjuvant treatment of completely resected melanoma at high risk of recurrence in people 12 years and over, terminated appraisal, 5 June 2024. The advice reads: NICE is unable to make a recommendation because Bristol-Myers Squibb did not provide an evidence submission, and NICE will review the decision if the company decides to make one","url":"https://www.nice.org.uk/guidance/terminated/ta980","date":"2024-06-05"},{"label":"NICE: all products on skin cancer. Sixty-five products, of which two are prevention guidance (PH32 and NG34), one is a cancer service guideline (CSG8), one a quality standard (QS130), and the rest technology appraisals, HealthTech guidance and medtech innovation briefings","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer/products","date":"2026-09-25"},{"label":"Scottish Medicines Consortium 924/13: vismodegib (Erivedge) is not recommended for use within NHS Scotland in the absence of a submission from the holder of the marketing authorisation, for symptomatic metastatic basal cell carcinoma and locally advanced basal cell carcinoma inappropriate for surgery or radiotherapy","url":"https://scottishmedicines.org.uk/medicines-advice/vismodegib-erivedge-nonsubmission-92413/","date":"2026-09-25"},{"label":"NHS England: national Cancer Drugs Fund list version 1.408, 24 September 2026, 320 pages. Section A is what the Cancer Drugs Fund pays for; section B is what NHS England funds routinely. Blueteq form VIS2 sits in section B: vismodegib is routinely funded from 14 July 2021, with no technology appraisal number, for adults with at least six clinically evident non-locally advanced, non-metastatic basal cell carcinomas of which at least three are 5 mm or larger, with or without Gorlin syndrome, where the person is suitable for surgery but surgery alone has the potential for substantial disfigurement, on the recommendation of a specialised skin cancer or head and neck multidisciplinary team. The form records that vismodegib and the intermittent schedules are not licensed in this indication. Forms CEM1 (TA802) and AVE1 and AVE2 (TA691 and TA517) are also in section B, so cemiplimab for advanced cutaneous squamous cell carcinoma and avelumab for Merkel cell carcinoma are routine commissioning and not managed access","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"NICE TA802: cemiplimab for treating advanced cutaneous squamous cell carcinoma, published 29 June 2022. Recommendation 1.1 recommends it for metastatic or locally advanced cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy is not suitable, only if it is stopped at 24 months or earlier on progression and the company provides it under the commercial arrangement. The guidance updates and replaces TA592, under which cemiplimab was available through the Cancer Drugs Fund","url":"https://www.nice.org.uk/guidance/ta802/chapter/1-Recommendations","date":"2022-06-29"},{"label":"NHS: treatment for non-melanoma skin cancer. Surgery is the main treatment; radiotherapy, targeted medicines and immunotherapy, photodynamic therapy and chemotherapy cream are also used","url":"https://www.nhs.uk/conditions/non-melanoma-skin-cancer/treatment/","date":"2026-09-16"},{"label":"NICE TA684: nivolumab for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease, published 17 March 2021. Recommendation 1.1 recommends it within its marketing authorisation with the commercial arrangement. It updated and replaced TA558 of 23 January 2019","url":"https://www.nice.org.uk/guidance/ta684/chapter/1-Recommendations","date":"2021-03-17"},{"label":"NICE TA558: nivolumab for adjuvant treatment of completely resected melanoma with lymph node involvement or metastatic disease, published 23 January 2019. The page states that the guidance has been updated and replaced by TA684","url":"https://www.nice.org.uk/guidance/ta558","date":"2019-01-23"},{"label":"NICE TA837: pembrolizumab for adjuvant treatment of resected stage 2B or 2C melanoma, published 26 October 2022. Recommendation 1.1 recommends it within its marketing authorisation for completely resected stage 2B or 2C melanoma in people 12 years and over, only with the commercial arrangement","url":"https://www.nice.org.uk/guidance/ta837/chapter/1-Recommendations","date":"2022-10-26"},{"label":"NICE TA400: nivolumab in combination with ipilimumab for treating advanced melanoma, published 27 July 2016. Recommendation 1.1 recommends the combination within its marketing authorisation for advanced unresectable or metastatic melanoma in adults, only when the company provides ipilimumab with the patient access scheme discount","url":"https://www.nice.org.uk/guidance/ta400/chapter/1-Recommendations","date":"2016-07-27"},{"label":"NICE TA366: pembrolizumab for advanced melanoma not previously treated with ipilimumab, published 25 November 2015, last updated 12 September 2017","url":"https://www.nice.org.uk/guidance/ta366","date":"2017-09-12"},{"label":"NICE TA562: encorafenib with binimetinib for unresectable or metastatic BRAF V600 mutation-positive melanoma, published 27 February 2019","url":"https://www.nice.org.uk/guidance/ta562","date":"2019-02-27"},{"label":"NICE TA410: talimogene laherparepvec for treating unresectable metastatic melanoma, published 28 September 2016","url":"https://www.nice.org.uk/guidance/ta410","date":"2016-09-28"},{"label":"Scottish Medicines Consortium SMC2704: nivolumab (Opdivo) is not recommended for use within NHSScotland for adjuvant treatment of stage 2B or 2C melanoma in the absence of a submission from the holder of the marketing authorisation","url":"https://scottishmedicines.org.uk/medicines-advice/nivolumab-opdivo-nonsub-smc2704/","date":"2026-09-25"},{"label":"Scottish Medicines Consortium 1248/17: talimogene laherparepvec (Imlygic) considered in the absence of a submission from the holder of the marketing authorisation","url":"https://scottishmedicines.org.uk/medicines-advice/talimogene-laherparepvec-imlygic-nonsubmission-124817/","date":"2026-09-25"},{"label":"NICE: cemiplimab for adjuvant treatment of high-risk cutaneous squamous cell carcinoma after surgery and radiotherapy [ID6659], in development, expected publication 24 March 2027; cosibelimab for treating advanced cutaneous squamous cell carcinoma [ID6663], awaiting development, expected 23 September 2027; pembrolizumab for adjuvant treatment of locally advanced cutaneous squamous cell carcinoma after surgery and radiotherapy [ID6473], in development, publication date to be confirmed","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer/products","date":"2026-09-25"},{"label":"NICE HTG333: electrochemotherapy for primary basal cell carcinoma and primary squamous cell carcinoma, published 26 February 2014 as interventional procedures guidance IPG478 and migrated to HealthTech guidance unchanged. Recommendation 1.1: current evidence on safety raises no major concerns and evidence on efficacy is limited in quantity and quality, so the procedure should only be used with special arrangements for clinical governance, consent and local audit, and with submission of data to a register","url":"https://www.nice.org.uk/guidance/htg333/chapter/1-Recommendations","date":"2014-02-26"},{"label":"NICE HTG714: epidermal radiotherapy using rhenium-188 paste for non-melanoma skin cancer, published 2 April 2024. Recommendation 1.1 says more research is needed and 1.2 says the procedure should only be done as part of a formal research study approved by a research ethics committee","url":"https://www.nice.org.uk/guidance/htg714/chapter/1-Recommendations","date":"2024-04-02"}]},"tests":[{"target":"BRAF, KIT and NRAS","code":"M7.1","test":"Multi-target next-generation sequencing small variant panel","opens":"BRAF V600 opens dabrafenib with trametinib (TA396), encorafenib with binimetinib (TA562) and vemurafenib with cobimetinib (TA414). NICE QS130 statement 5 makes BRAF analysis a quality standard for stage 2B to 4 primary melanoma","how":"Requested by the melanoma multidisciplinary team on the resection or biopsy specimen through one of the seven Genomic Laboratory Hubs. The directory's eligibility is primary melanomas at high risk of recurrence, that is stage 2C, 3 or metastatic","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"},{"label":"NICE QS130: skin cancer quality standard, published 21 September 2016, last updated 24 January 2024. Six statements: 1 integrated care boards work with local partners on strategies to raise awareness of skin cancer and the risks of over-exposure to sunlight and artificial ultraviolet light, particularly for at-risk groups (new 2024); 2 people with suspected melanoma, squamous cell carcinoma or a rare skin cancer are referred on a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days; 3 dermoscopy at specialist assessment for suspected melanoma; 4 access to a skin cancer clinical nurse specialist for melanoma, high-risk squamous cell carcinoma or a rare skin cancer; 5 BRAF analysis in stage 2B to 4 primary melanoma; 6 a staging scan in stage 2C to 4 melanoma (new 2024)","url":"https://www.nice.org.uk/guidance/qs130/chapter/Quality-statements","date":"2024-01-24"}]},{"target":"BRAF hotspot","code":"M7.2","test":"Simple targeted mutation testing","opens":"The same BRAF-directed treatments, where a full panel cannot be delivered","how":"The directory allows it only in rare cases where panel testing cannot be delivered, and notes that use will be subject to close audit","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"}]},{"target":"MYB (6q24), RREB1 (6p25), CCND1 (11q13), MYC (8q24) and CDKN2A (9p21)","code":"M7.5 to M7.9","test":"Fluorescence in situ hybridisation copy number panel","opens":"Not a treatment: a diagnosis. These are the tests used when a pathologist cannot say whether a melanocytic lesion is benign or malignant","how":"Requested by the reporting pathologist where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion of the skin. Genome-wide microarray (M7.10) is a listed alternative","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"}]},{"target":"Whole-lesion copy number to genome-wide resolution","code":"M7.10","test":"Microarray","opens":"The same diagnostic question as the FISH panel, at higher resolution","how":"An alternative to M7.5 to M7.9 for an equivocal melanocytic lesion","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"}]},{"target":"PTCH1 and SUFU","code":"R214.1","test":"Small panel, specialised inherited cancer service","opens":"A diagnosis of nevoid basal cell carcinoma syndrome (Gorlin syndrome), which changes surveillance, excludes radiotherapy as a treatment for the basal cell carcinomas, and is one of the routes into the NHS England commissioning criteria for vismodegib","how":"Through clinical genetics on referral, usually because of multiple basal cell carcinomas at a young age, jaw keratocysts or a family history. CSG8 says people with Gorlin's syndrome should be referred to and managed by the local or specialist skin cancer multidisciplinary team and should not have their basal cell carcinomas treated with radiotherapy","sources":[{"label":"NHS England: rare and inherited disease national genomic test directory, version 9. R214.1 nevoid basal cell carcinoma syndrome or Gorlin syndrome, small panel covering PTCH1 and SUFU, specialised inherited cancer service; R254.1 familial melanoma, small panel, specialised inherited cancer service; R227.1 and R227.2 xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome, a small panel and genome-wide DNA repair defect testing, highly specialised dermatology service","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-09-25"},{"label":"NICE CSG8, the management of low-risk basal cell carcinomas in the community, cancer service guidance update, May 2010. Box 1 sets the criteria for the low-risk nodular basal cell carcinomas a GP with no special interest may excise under a directed or local enhanced service: the person must not be 24 or younger, immunosuppressed or have Gorlin's syndrome, and the lesion must be below the clavicle, under 1 cm with clearly defined margins, not recurrent or persistent after incomplete excision, not morphoeic, infiltrative or basosquamous, and not over important anatomical structures, in an area where primary closure is difficult, where difficult excision may give a poor cosmetic result, or at another highly visible site. Anything else, or any diagnostic doubt, goes to a member of the local skin cancer multidisciplinary team, and every incompletely excised basal cell carcinoma must be discussed with one","url":"https://www.nice.org.uk/guidance/csg8/resources/improving-outcomes-for-people-with-skin-tumours-including-melanoma-2010-partial-update-pdf-773380189","date":"2010-05-25"},{"label":"NHS England: national Cancer Drugs Fund list version 1.408, 24 September 2026, 320 pages. Section A is what the Cancer Drugs Fund pays for; section B is what NHS England funds routinely. Blueteq form VIS2 sits in section B: vismodegib is routinely funded from 14 July 2021, with no technology appraisal number, for adults with at least six clinically evident non-locally advanced, non-metastatic basal cell carcinomas of which at least three are 5 mm or larger, with or without Gorlin syndrome, where the person is suitable for surgery but surgery alone has the potential for substantial disfigurement, on the recommendation of a specialised skin cancer or head and neck multidisciplinary team. The form records that vismodegib and the intermittent schedules are not licensed in this indication. Forms CEM1 (TA802) and AVE1 and AVE2 (TA691 and TA517) are also in section B, so cemiplimab for advanced cutaneous squamous cell carcinoma and avelumab for Merkel cell carcinoma are routine commissioning and not managed access","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"}]},{"target":"Xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome genes; genome-wide DNA repair defect testing","code":"R227.1 and R227.2","test":"Small panel and DNA repair defect testing, highly specialised dermatology service","opens":"A diagnosis that transforms prevention from advice into a medical necessity, and puts the person under a national highly specialised service","how":"Through clinical genetics or a specialist dermatology service, usually in childhood after severe sunburn or early skin cancers","sources":[{"label":"NHS England: rare and inherited disease national genomic test directory, version 9. R214.1 nevoid basal cell carcinoma syndrome or Gorlin syndrome, small panel covering PTCH1 and SUFU, specialised inherited cancer service; R254.1 familial melanoma, small panel, specialised inherited cancer service; R227.1 and R227.2 xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome, a small panel and genome-wide DNA repair defect testing, highly specialised dermatology service","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-09-25"}]},{"target":"Familial melanoma genes","code":"R254.1","test":"Small panel, specialised inherited cancer service","opens":"Surveillance for the person and cascade testing in the family","how":"Through clinical genetics on referral from a melanoma team or a family history clinic","sources":[{"label":"NHS England: rare and inherited disease national genomic test directory, version 9. R214.1 nevoid basal cell carcinoma syndrome or Gorlin syndrome, small panel covering PTCH1 and SUFU, specialised inherited cancer service; R254.1 familial melanoma, small panel, specialised inherited cancer service; R227.1 and R227.2 xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome, a small panel and genome-wide DNA repair defect testing, highly specialised dermatology service","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-09-25"}]},{"target":"Histology of the excised lesion","code":"pathology","test":"Excision or punch biopsy with histopathological reporting","opens":"Everything. This is the test that decides which disease you have, and in most cases the excision that provides it is also the cure","how":"The timed pathway says histology must be reported in time to communicate a diagnosis within the 28-day standard, and that a biopsy intended only to diagnose does not stop the clock: the clock stops when you are told the result. A biopsy taken to decide which type of skin cancer it is does stop the clock at the first appointment, because you have already been told it is a cancer","sources":[{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"}]}],"testsNote":{"text":"The most striking thing about the National Genomic Test Directory for this family is what is not in it. Version 16 of the cancer directory has clinical indications for melanoma (M7), uveal melanoma (M187) and conjunctival melanoma (M241), and nothing at all for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma. Dermatofibrosarcoma protuberans has an indication, but on the sarcoma sheet (M50.1, COL1A1-PDGFB rearrangement by FISH). The cancers that make up more than nine in ten skin cancers have no genomic test on the NHS, because nothing a test could find would change what is done: the treatment is excision, and it works.\n\nThat is a defensible position today and it is worth watching, because it will stop being defensible the moment a targeted treatment for advanced keratinocyte cancer arrives. The inherited syndromes are handled separately, through the rare and inherited disease directory and clinical genetics rather than through the cancer directory.","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"},{"label":"NHS England: rare and inherited disease national genomic test directory, version 9. R214.1 nevoid basal cell carcinoma syndrome or Gorlin syndrome, small panel covering PTCH1 and SUFU, specialised inherited cancer service; R254.1 familial melanoma, small panel, specialised inherited cancer service; R227.1 and R227.2 xeroderma pigmentosum, trichothiodystrophy or Cockayne syndrome, a small panel and genome-wide DNA repair defect testing, highly specialised dermatology service","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-09-25"},{"label":"NHS England: the NHS Genomic Medicine Service, through which seven Genomic Laboratory Hubs deliver the test directory in England (the page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026)","url":"https://www.england.nhs.uk/genomics/nhs-genomic-med-service/","date":"2026-09-25"},{"label":"NICE HTG388: VivaScope 1500 and 3000 imaging systems for detecting skin cancer lesions, published 11 November 2015","url":"https://www.nice.org.uk/guidance/htg388","date":"2015-11-11"},{"label":"NICE MIB311: digital technologies for the detection of melanoma, medtech innovation briefing, published 1 November 2022","url":"https://www.nice.org.uk/guidance/mib311","date":"2022-11-01"}]},"trials":[{"trialId":"impact-bcc","registry":"ISRCTN10511385","name":"IMPACT: first-line cemiplimab in locally advanced basal cell carcinoma","status":"Phase 2, registered end date 30 April 2029","setting":"Locally advanced basal cell carcinoma, first line","sites":["University Hospitals Bristol and Weston NHS Foundation Trust (sponsor)"],"url":"https://www.isrctn.com/ISRCTN10511385","note":"Aimed squarely at the group NICE refused vismodegib for in TA489."},{"trialId":"scc-after","registry":"ISRCTN54806122","name":"SCC-AFTER: adjuvant radiotherapy after surgery for high-risk primary cutaneous squamous cell carcinoma","status":"Open-label phase 3, target 840, registered end date 1 January 2031","setting":"High-risk primary cutaneous squamous cell carcinoma after surgery","sites":["Cardiff University (sponsor)","Multicentre UK"],"url":"https://www.isrctn.com/ISRCTN54806122","note":"Tests something the NHS already does routinely and has never tested."},{"trialId":"spot-it","registry":"ISRCTN80116429","name":"SPOT-IT: topical prevention of cutaneous squamous cell carcinoma in immunosuppressed people","status":"Randomised, target 673, registered end date 31 December 2031","setting":"Prevention in immunosuppressed people","sites":["Cardiff University (sponsor)"],"url":"https://www.isrctn.com/ISRCTN80116429"},{"registry":"ISRCTN15382058","name":"EXCISE: antibiotics for ulcerated skin cancer surgical excision","status":"Pragmatic double-blinded randomised controlled trial, target 380, registered end date 31 December 2027","setting":"Surgical excision of an ulcerated skin cancer","sites":["Cardiff and Vale University Health Board (sponsor)"],"url":"https://www.isrctn.com/ISRCTN15382058","note":"A question about ordinary care that affects far more people than any of the systemic treatments on this page."},{"registry":"ISRCTN15698540","name":"OCTOPUS: optical coherence tomography in outpatient dermatology units","status":"Non-randomised pilot cohort study, target 200, registered end date 18 May 2028","setting":"Non-invasive diagnosis of skin cancer in the clinic","sites":["Barts Health NHS Trust (sponsor)"],"url":"https://www.isrctn.com/ISRCTN15698540"}],"trialsNote":{"text":"Three of the five open UK trials on this list are sponsored from Cardiff. That is not a coincidence of sampling: the commonest cancers in the country have almost no randomised evidence base, and most of what is currently being built for them is being built in Wales. A reader in England looking for a keratinocyte cancer trial should expect to travel or to find none.\n\nISRCTN record pages will not open to a program, so every trial here was read through the registry's public application programming interface rather than its web pages. The status and dates are the ones in the registry record, which is not always the same as whether a site near you is recruiting today: ask the team, or search Be Part of Research.","sources":[{"label":"ISRCTN10511385: IMPACT, efficacy and safety of first-line cemiplimab in advanced basal cell carcinoma, a phase 2 trial of three-weekly cemiplimab in people with locally advanced basal cell carcinoma, sponsored by University Hospitals Bristol and Weston NHS Foundation Trust, target 41 participants, end date 30 April 2029","url":"https://www.isrctn.com/ISRCTN10511385","date":"2026-09-25"},{"label":"ISRCTN54806122: SCC-AFTER, adjuvant radiotherapy in people with high-risk primary cutaneous squamous cell carcinoma after surgery, an open-label multicentre two-arm phase 3 randomised trial sponsored by Cardiff University, target 840 participants, end date 1 January 2031","url":"https://www.isrctn.com/ISRCTN54806122","date":"2026-09-25"},{"label":"ISRCTN80116429: SPOT-IT, cutaneous squamous cell carcinoma prevention using topical therapy in immunosuppressed patients, sponsored by Cardiff University, target 673 participants, end date 31 December 2031","url":"https://www.isrctn.com/ISRCTN80116429","date":"2026-09-25"},{"label":"ISRCTN15382058: EXCISE, examining antibiotics for ulcerated skin cancer surgical excision, a pragmatic double-blinded clinical and cost-effectiveness randomised controlled trial sponsored by Cardiff and Vale University Health Board, target 380 participants, end date 31 December 2027","url":"https://www.isrctn.com/ISRCTN15382058","date":"2026-09-25"},{"label":"ISRCTN15698540: OCTOPUS, optical coherence tomography in outpatient dermatology units, a non-randomised pilot cohort study of optical coherence tomography and line-field confocal optical coherence tomography imaging for diagnosing skin cancers, sponsored by Barts Health NHS Trust, target 200 participants, end date 18 May 2028","url":"https://www.isrctn.com/ISRCTN15698540","date":"2026-09-25"}]},"legacy":[{"title":"SINS: the trial that asked whether a cream could replace the knife","trialIds":["sins-trial"],"story":"Basal cell carcinoma is the commonest cancer in the world and until a British trial did it, nobody had run a large randomised comparison of surgery with a topical alternative. SINS, led from the Centre of Evidence Based Dermatology at Nottingham by Hywel Williams and Fiona Bath-Hextall and funded by Cancer Research UK, randomised 501 people at twelve UK centres between 2003 and 2007 to imiquimod 5% cream or excision with a 4 mm margin.\n\nThe answer was clear and it was not the hoped-for one. Three-year clinical success was 84 percent with imiquimod against 98 percent with surgery, a relative risk of 0.84 against a prespecified non-inferiority margin of 0.87; at five years it was 82.5 percent against 97.7 percent. Imiquimod failed the test. But the trial also produced the finding that makes the cream useful: almost all the failures happened in the first year, so a lesion that clears early tends to stay clear. That is why imiquimod sits where it does in British practice and in the Scottish Medicines Consortium's advice, as the option for a small superficial lesion in someone for whom surgery or cryotherapy is contraindicated, rather than as an alternative anybody should be offered instead of an operation.","sources":[{"label":"Bath-Hextall F, Ozolins M, Armstrong SJ, Colver GB, Perkins W, Miller PS, Williams HC. Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial. Lancet Oncology 2014","url":"https://doi.org/10.1016/S1470-2045(13)70530-8","date":"2014"},{"label":"Williams HC, Bath-Hextall F, Ozolins M, Armstrong SJ, Colver GB, Perkins W, Miller PSJ. Surgery versus 5% imiquimod for nodular and superficial basal cell carcinoma: 5-year results of the SINS randomized controlled trial. Journal of Investigative Dermatology 2017. Five-year success 82.5 percent (170 of 206) for imiquimod against 97.7 percent (173 of 177) for surgery, relative risk 0.84 (95 percent confidence interval 0.77 to 0.91); most imiquimod failures occurred in the first year","url":"https://doi.org/10.1016/j.jid.2016.10.019","date":"2017"},{"label":"ISRCTN48755084: SINS, a randomised controlled trial of excisional surgery versus imiquimod 5% cream for nodular and superficial basal cell carcinoma, sponsored by the University of Nottingham, target 501 participants, recruitment 19 June 2003 to 22 February 2007","url":"https://www.isrctn.com/ISRCTN48755084","date":"2026-09-25"},{"label":"Scottish Medicines Consortium 167/05: imiquimod 5% cream (Aldara) accepted for restricted use within NHS Scotland for the topical treatment of small superficial basal cell carcinoma in adults in whom standard treatment with surgery or cryotherapy is contraindicated, supervised by specialists in dermatology; composite clearance 73 to 77 percent at 12 weeks in the randomised trials","url":"https://scottishmedicines.org.uk/medicines-advice/imiquimod-5-cream-aldara-fullsubmission-16705/","date":"2026-09-25"}]},{"title":"MoleMate: the trial that stopped the NHS buying a gadget for every GP","trialIds":["molemate"],"story":"In the late 2000s the obvious way to fix the skin cancer referral problem looked like giving general practitioners a diagnostic device. The MoleMate UK Trial, run from Cambridge by Fiona Walter and Jon Emery in fifteen practices in eastern England, tested it properly: 1,297 adults with 1,580 pigmented lesions, randomised to best practice (history, naked-eye examination and the weighted 7-point checklist) alone or with the MoleMate system added.\n\nThe appropriateness of referral did not improve: 56.8 percent against 64.5 percent, a difference of minus 8.1 percentage points with a confidence interval running from minus 18.0 to 1.8. What did change was that more lesions were referred, 29.8 percent against 22.4 percent, and that agreement with an expert that a lesion was benign fell, from 90.6 to 84.4 percent. Thirty-six melanomas were found and all eighteen in the intervention arm were appropriately referred, so the device was not unsafe; it was simply not better, and it added referrals to a pathway already carrying nearly a third of the country's urgent cancer referrals. British policy since has asked for training and dermoscopy in primary care rather than devices, and has moved the machine question downstream, to artificial intelligence reading images after referral, where NICE HTG746 has now conditionally allowed one device with a three-year evidence requirement attached.","sources":[{"label":"Walter FM, Morris HC, Humphrys E, Hall PN, Prevost AT, Burrows N, Bradshaw L, Wilson EC, Norris P, Walls J, Johnson M, Kinmonth AL, Emery JD. Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised controlled trial. BMJ 2012 (the DOI resolves to bmj.com, which answers HTTP 403 to a program; the abstract and figures above were read from the Europe PMC record, PubMed id 22763392)","url":"https://doi.org/10.1136/bmj.e4110","date":"2012"},{"label":"ISRCTN79932379: the MoleMate UK Trial, the management of suspicious pigmented lesions in primary care, sponsored by the University of Cambridge and Cambridgeshire NHS Primary Care Trust, target 1,800 and final enrolment 1,297","url":"https://www.isrctn.com/ISRCTN79932379","date":"2026-09-25"},{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},{"label":"NICE HTG746: artificial intelligence technologies for assessing and triaging skin lesions referred to the urgent suspected skin cancer pathway, early value assessment. Published 1 May 2025 as HTE24, migrated to HealthTech guidance and last updated 17 March 2026. Recommendation 1.1 allows Deep Ensemble for Recognition of Malignancy (DERM) within teledermatology services during a three-year evidence generation period, only while the evidence in the evidence generation plan is being generated and once it has regulatory approval including NHS England's Digital Technology Assessment Criteria; 1.2 requires a healthcare professional review for people with black or brown skin and regular monitoring of performance","url":"https://www.nice.org.uk/guidance/htg746/chapter/1-Recommendations","date":"2026-03-17"}]},{"title":"Merkel cell carcinoma: the randomised trial that has no published answer","trialIds":["mcc-rational-treatment"],"story":"Merkel cell carcinoma is aggressive, rare, and almost entirely governed by retrospective series. In 2016 the University of Birmingham opened the one randomised trial anyone has ever attempted in it: radical surgery against radical radiotherapy as first definitive treatment for primary disease, with loco-regional treatment failure over two years as the primary outcome and an observational arm for people who could not be randomised. The registered target was 400 and the registry records no final enrolment. Recruitment closed on 30 December 2018 and the registered overall end date was 30 September 2020. The ISRCTN record lists no publication.\n\nIt is on this page because it stands for what rarity costs inside a national system that is otherwise good at trials. Merkel cell carcinoma has no clinical indication in the National Genomic Test Directory, no patient charity of its own, no separate line in three of the four nations' waiting-time statistics, and now a randomised trial with no public result. What the NHS does fund for it is avelumab, in both the untreated and previously treated metastatic settings, which is more than most countries fund and less than a single answered question would be worth.","sources":[{"label":"ISRCTN16290169: rational treatment selection for Merkel cell carcinoma, a randomised phase 3 multicentre trial comparing radical surgery and radical radiotherapy as first definitive treatment for primary Merkel cell carcinoma, with an observational study for people ineligible for the randomised comparison, sponsored by the University of Birmingham, target 400, recruitment 31 March 2016 to 30 December 2018, overall end date 30 September 2020. The registry record lists no publication","url":"https://www.isrctn.com/ISRCTN16290169","date":"2026-09-25"},{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"},{"label":"NICE TA691: avelumab for untreated metastatic Merkel cell carcinoma, published 21 April 2021. Recommendation 1.1 recommends it for adults who have not had chemotherapy for metastatic disease, only with the commercial arrangement","url":"https://www.nice.org.uk/guidance/ta691/chapter/1-Recommendation","date":"2021-04-21"},{"label":"NICE TA517: avelumab for treating metastatic Merkel cell carcinoma, published 11 April 2018 and last updated 21 April 2021. Recommendation 1.1 recommends it after 1 or more lines of chemotherapy for metastatic disease, only with the commercial arrangement; 1.2 records that the recommendation has been updated and replaced by TA691 for untreated disease","url":"https://www.nice.org.uk/guidance/ta517/chapter/1-Recommendations","date":"2021-04-21"}]}],"figures":[{"label":"Share of all urgent suspected cancer referrals that are for suspected skin cancer","value":"29.2% (89,978 of 308,200)","nation":"England","period":"July 2026","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},"note":"The largest single stream, and nearly twice the number for suspected breast cancer (48,176). Across April to July 2026 it was 27.1 percent, 304,485 of 1,124,238."},{"label":"People referred urgently with a suspicious skin lesion who do not have cancer","value":"Around 93%, with cancer alliance variation from 81% to 98%","nation":"England","period":"Read from the timed diagnostic pathway, published 21 October 2022","source":{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"}},{"label":"Skin cancers diagnosed a year","value":"Around 215,000, of which over 155,000 were basal cell carcinomas (around 72%), around 45,000 cutaneous squamous cell carcinomas (21%) and around 15,000 melanomas (7%)","nation":"England","period":"2018, the latest year in the pathway document","source":{"label":"NHS England: implementing a timed skin cancer diagnostic pathway, publication approval reference PAR1350, 21 October 2022. Around 215,000 skin cancers a year in England; over 155,000 new basal cell carcinomas in 2018 (around 72 percent of skin cancers), around 45,000 cutaneous squamous cell carcinomas (21 percent) and around 15,000 melanomas (7 percent); around 93 percent of people referred urgently with a suspicious skin lesion do not have cancer, with cancer alliance variation from 81 to 98 percent; the slowest 5 percent of referrals take 27 days or longer to be seen; about a third of people with squamous cell carcinoma or melanoma are not referred on an urgent cancer pathway; annex 1 puts basal cell carcinoma out of scope","url":"https://www.england.nhs.uk/wp-content/uploads/2018/04/B1350_Skin-cancer-timed-diagnostic-pathway.pdf","date":"2022-10-21"},"note":"NHS England calls skin cancer the most common cause of cancer in England on the strength of this count."},{"label":"New non-melanoma skin cancer cases a year","value":"Around 156,000, nearly 430 a day","nation":"UK","period":"2019, 2021 to 2022","source":{"label":"Cancer Research UK: non-melanoma skin cancer statistics. Around 156,000 new cases a year in the UK, nearly 430 a day (2019, 2021 to 2022); 1,200 deaths a year (2022 to 2024); 48 percent of new cases in people aged 75 and over","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer","date":"2026-09-25"},"note":"Around 67,500 in females and 88,500 in males on the 2016 to 2018 split; 48 percent of cases are in people aged 75 and over."},{"label":"Non-melanoma skin cancer in the national statistics","value":"Excluded from every \"all cancers\" count, because it is \"greatly under-registered\"","nation":"England (ONS cancer registration statistics)","period":"Quality and methodology information, read 25 September 2026","source":{"label":"Office for National Statistics: cancer registration statistics quality and methodology information. \"We have been advised by expert epidemiologists and members of the former Steering Committee on Cancer Registration that non-melanoma skin cancer (NMSC) is greatly under-registered. Therefore, the published tables present counts and rates for all cancers and for all cancers excluding NMSC (code 173 in ICD-8 and ICD-9, and C44 in ICD-10) to ensure that the reported figures are meaningful\"","url":"https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/methodologies/cancerregistrationstatisticsqmi","date":"2026-09-25"},"note":"The published tables give counts and rates both for all cancers and for all cancers excluding ICD-10 C44, and it is the second that is quoted as the national total. The waiting-time standards make the matching exclusion by name: the treatment standards apply to C00 to C97 excluding basal cell carcinoma of skin."},{"label":"Deaths from non-melanoma skin cancer a year","value":"1,200","nation":"UK","period":"2022 to 2024","source":{"label":"Cancer Research UK: non-melanoma skin cancer statistics. Around 156,000 new cases a year in the UK, nearly 430 a day (2019, 2021 to 2022); 1,200 deaths a year (2022 to 2024); 48 percent of new cases in people aged 75 and over","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer","date":"2026-09-25"},"note":"Set beside 156,000 cases: these are, overwhelmingly, cancers people survive."},{"label":"New melanoma cases a year","value":"Around 19,400, 53 a day; the 5th most common cancer in the UK","nation":"UK","period":"2019, 2021 to 2022","source":{"label":"Cancer Research UK: melanoma skin cancer incidence statistics. Melanoma is the 5th most common cancer in the UK with around 19,400 new cases a year, 53 a day (2019, 2021 to 2022); rates have risen by 164 percent since the early 1990s and by 26 percent in the last decade, and are projected to reach around 26,500 cases a year by 2038 to 2040","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer/incidence","date":"2026-09-25"},"note":"Projected to reach around 26,500 a year by 2038 to 2040."},{"label":"Change in non-melanoma skin cancer incidence rates since the early 1990s","value":"Up 169%, and up 42% in the last decade","nation":"UK","period":"to 2016 to 2018","source":{"label":"Cancer Research UK: non-melanoma skin cancer incidence statistics. Around 67,500 new cases a year in females and 88,500 in males (2016 to 2018); rates have risen by 169 percent since the early 1990s and by 42 percent in the last decade; in England the European age-standardised rate is 40 percent lower in females and 42 percent lower in males in the most deprived fifth than in the least deprived (2013 to 2017), so around 25,000 fewer cases a year occur than if every deprivation quintile had the incidence of the least deprived","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/incidence","date":"2026-09-25"}},{"label":"Non-melanoma skin cancer incidence by deprivation","value":"40% lower in females and 42% lower in males in the most deprived fifth than in the least deprived","nation":"England","period":"2013 to 2017","source":{"label":"Cancer Research UK: non-melanoma skin cancer incidence statistics. Around 67,500 new cases a year in females and 88,500 in males (2016 to 2018); rates have risen by 169 percent since the early 1990s and by 42 percent in the last decade; in England the European age-standardised rate is 40 percent lower in females and 42 percent lower in males in the most deprived fifth than in the least deprived (2013 to 2017), so around 25,000 fewer cases a year occur than if every deprivation quintile had the incidence of the least deprived","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/incidence","date":"2026-09-25"},"note":"The gradient runs the opposite way to almost every other cancer. Cancer Research UK estimates around 25,000 fewer cases a year occur in England than if every quintile had the incidence of the least deprived. Part of this is ultraviolet exposure through leisure and part is very likely under-diagnosis in more deprived groups; the published figures cannot separate the two."},{"label":"Melanoma cases caused by overexposure to ultraviolet radiation","value":"86%","nation":"UK","period":"Cancer Research UK attributable-risk estimate","source":{"label":"Cancer Research UK: melanoma skin cancer risk factors. 86 percent of melanoma cases in the UK are preventable and 86 percent are caused by overexposure to ultraviolet radiation; an estimated 100 melanoma deaths a year in the UK are caused by sunbed use; melanoma risk is 16 to 25 percent higher in people who have ever used a sunbed and 59 percent higher in people who first used one before 35; 5 to 6 percent of young people use or have used sunbeds on 2008 and 2009 data, and 2 percent of British adults trying to get a tan do so with a sunbed only on 1999 data","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer/risk-factors","date":"2026-09-25"},"note":"The same page gives 86 percent of melanoma cases as preventable. For the keratinocyte cancers the estimate is 50 to 70 percent of squamous cell carcinoma and 50 to 90 percent of basal cell carcinoma in fair-skinned people."},{"label":"Melanoma deaths a year caused by sunbed use","value":"Around 100","nation":"UK","period":"Cancer Research UK estimate","source":{"label":"Cancer Research UK: melanoma skin cancer risk factors. 86 percent of melanoma cases in the UK are preventable and 86 percent are caused by overexposure to ultraviolet radiation; an estimated 100 melanoma deaths a year in the UK are caused by sunbed use; melanoma risk is 16 to 25 percent higher in people who have ever used a sunbed and 59 percent higher in people who first used one before 35; 5 to 6 percent of young people use or have used sunbeds on 2008 and 2009 data, and 2 percent of British adults trying to get a tan do so with a sunbed only on 1999 data","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer/risk-factors","date":"2026-09-25"}},{"label":"Skin cancer risk in outdoor workers","value":"Basal cell carcinoma 43% higher; squamous cell carcinoma 77% higher than in indoor workers","nation":"Meta-analyses cited by Cancer Research UK","period":"Reviewed 14 June 2018","source":{"label":"Cancer Research UK: non-melanoma skin cancer risk factors. An estimated 50 to 70 percent of squamous cell carcinoma and 50 to 90 percent of basal cell carcinoma in fair-skinned people are caused by ultraviolet radiation; basal cell carcinoma risk is 43 percent higher in people who work outdoors and squamous cell carcinoma risk 77 percent higher in outdoor workers than indoor workers, on meta-analyses; squamous cell carcinoma risk is at least 67 percent higher and basal cell carcinoma risk up to 29 percent higher in people who have ever used a sunbed, and basal cell carcinoma risk 40 percent higher in people who first used one before 25; an estimated 7 percent of non-melanoma skin cancers in men and 1 percent in women in Britain are due to occupational exposures including solar radiation","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/risk-factors","date":"2026-09-25"},"note":"An estimated 7 percent of non-melanoma skin cancers in men and 1 percent in women in Britain are attributed to occupational exposures including solar radiation."},{"label":"Trained NHS dermatologists in England","value":"508 whole-time equivalents, with 159 vacant posts and 143 posts filled by locums; at least ten trusts with no dermatologist at all","nation":"England","period":"GIRFT dermatology national specialty report, September 2021","source":{"label":"Getting It Right First Time: dermatology national specialty report, September 2021. 508 whole-time-equivalent trained NHS dermatologists in England with 159 whole-time-equivalent vacant posts and 143 filled by locums; at least ten trusts have no dermatologist at all and around a third have very severe shortages; NHS dermatology units carry out over 200,000 surgical excisions a year; around 75 percent of patient visits for NHS skin care take place in primary care; skin cancer incidence is rising by around 8 percent a year, doubling at least every 14 to 15 years. On Mohs: just 79 dermatology doctors carrying out Mohs surgery in England, activity concentrated in fewer than 30 specialist centres, patients in Salford over ten times more likely to get Mohs than those in the worst-served areas, and the Dermatology Clinical Reference Group designating 56 English trusts as specialist skin cancer centres (specialist skin cancer multidisciplinary teams, or level 5)","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/DermatologyReport-Sept21o.pdf","date":"2021-09"}},{"label":"Dermatology doctors performing Mohs micrographic surgery in England","value":"79, with activity concentrated in fewer than 30 centres against 56 designated specialist skin cancer centres","nation":"England","period":"GIRFT dermatology national specialty report, September 2021","source":{"label":"Getting It Right First Time: dermatology national specialty report, September 2021. 508 whole-time-equivalent trained NHS dermatologists in England with 159 whole-time-equivalent vacant posts and 143 filled by locums; at least ten trusts have no dermatologist at all and around a third have very severe shortages; NHS dermatology units carry out over 200,000 surgical excisions a year; around 75 percent of patient visits for NHS skin care take place in primary care; skin cancer incidence is rising by around 8 percent a year, doubling at least every 14 to 15 years. On Mohs: just 79 dermatology doctors carrying out Mohs surgery in England, activity concentrated in fewer than 30 specialist centres, patients in Salford over ten times more likely to get Mohs than those in the worst-served areas, and the Dermatology Clinical Reference Group designating 56 English trusts as specialist skin cancer centres (specialist skin cancer multidisciplinary teams, or level 5)","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/DermatologyReport-Sept21o.pdf","date":"2021-09"},"note":"People living in Salford were found to be over ten times more likely to receive Mohs surgery than people in the worst-served areas."},{"label":"Surgical excisions carried out by NHS dermatology units a year","value":"Over 200,000","nation":"England","period":"GIRFT dermatology national specialty report, September 2021","source":{"label":"Getting It Right First Time: dermatology national specialty report, September 2021. 508 whole-time-equivalent trained NHS dermatologists in England with 159 whole-time-equivalent vacant posts and 143 filled by locums; at least ten trusts have no dermatologist at all and around a third have very severe shortages; NHS dermatology units carry out over 200,000 surgical excisions a year; around 75 percent of patient visits for NHS skin care take place in primary care; skin cancer incidence is rising by around 8 percent a year, doubling at least every 14 to 15 years. On Mohs: just 79 dermatology doctors carrying out Mohs surgery in England, activity concentrated in fewer than 30 specialist centres, patients in Salford over ten times more likely to get Mohs than those in the worst-served areas, and the Dermatology Clinical Reference Group designating 56 English trusts as specialist skin cancer centres (specialist skin cancer multidisciplinary teams, or level 5)","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/DermatologyReport-Sept21o.pdf","date":"2021-09"}},{"label":"People referred onto the urgent suspected skin cancer pathway who were not given a diagnosis or all-clear within 28 days","value":"120,000 of over 650,000","nation":"England","period":"2023/24","source":{"label":"NHS England: AI based skin lesion analysis technology, the national response to the early value assessment. In 2023/24 over 650,000 people were referred onto the urgent suspected skin cancer pathway and 120,000 did not have cancer diagnosed or ruled out within 28 days; DERM has the potential to discharge around 30 percent of cases from the pathway. NHS England asks that patients are given information and give informed consent before DERM is used, that a site starts with a second clinical read, that a second read always takes place for people with black or brown skin throughout the three-year evidence generation period, and that sites join the AI in Dermatology Getting It Right First Time community of practice. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026","url":"https://www.england.nhs.uk/elective-care/best-practice-solutions/ai-based-skin-lesion-analysis-technology/","date":"2025-12-11"}},{"label":"Faster Diagnosis Standard performance, suspected skin cancer","value":"87.3% (68,719 of 78,719) against 79.3% for all cancers","nation":"England","period":"July 2026","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"}},{"label":"62-day standard performance, skin cancer","value":"87.4% (5,010 of 5,733 treatments)","nation":"England","period":"July 2026","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},"note":"5,733 treatments against 89,978 urgent referrals in the same month, and basal cell carcinoma is excluded from the count entirely."},{"label":"62-day standard performance, melanoma","value":"86.7% (163 of 188), median wait 25 days, 95th percentile 110 days","nation":"Scotland","period":"Quarter ending 31 March 2026","source":{"label":"Public Health Scotland: cancer waiting times table 1, compliance with standard, quarter ending 31 March 2026. The inclusion criteria list the cancer types for which Scotland records data, and the skin entry reads \"melanoma, new primary invasive (i.e. Clark level greater than 1, melanoma of any site except eye); includes C43 (Skin)\": C44 is not on the list at all, so no keratinocyte cancer, including cutaneous squamous cell carcinoma, is covered by a Scottish waiting-time standard. In the quarter, 163 of 188 eligible melanoma referrals started treatment within 62 days (86.7 percent), with a median wait of 25 days and a 95th percentile of 110 days, against 3,372 of 4,668 (72.2 percent) for all cancer types","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},"note":"Scotland records melanoma only. No keratinocyte cancer is covered by a Scottish waiting-time standard, so there is no Scottish equivalent of England's skin figure."},{"label":"31-day standard performance, skin cancers","value":"89.5% (399 of 446) across the quarter; 95.1% (116 of 122) in March, median 0 days","nation":"Northern Ireland","period":"January to March 2026","source":{"label":"Department of Health (Northern Ireland): cancer waiting times workbook, quarter ending March 2026, 31-day wait by tumour site. Skin cancers: 166 of 190 within 31 days in January 2026, 117 of 134 in February and 116 of 122 in March, 399 of 446 across the quarter (89.5 percent), with a median wait of 0 days and a 95th percentile of 31 days in March. The workbook answers HTTP 403 to a browser user agent and 200 to a plain request with no extra headers, which is how it was read","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-q4-25-26.xlsx","date":"2026-07"}},{"label":"62-day standard performance, all cancers","value":"29.6% against a 95% target","nation":"Northern Ireland","period":"Quarter ending 31 March 2026","source":{"label":"Department of Health (Northern Ireland): cancer waiting times, revised 62-day waits for quarters ending December 2023 to March 2026, published September 2026. The target is that at least 95 percent of patients begin first definitive treatment within 62 days of an urgent GP referral for suspected cancer; in the quarter ending 31 March 2026, 29.6 percent did. There is no tumour-site split. The file answers HTTP 403 to a browser user agent and 200 to a plain request","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09"},"note":"Northern Ireland publishes no 62-day split by tumour site, so there is no skin figure."},{"label":"62-day performance, all cancers","value":"60.1% against a 75% target, on 2,248 treatments and 18,429 new pathways","nation":"Wales","period":"July 2026","source":{"label":"Welsh Government: NHS activity and performance summary, July and August 2026. In July 2026, 60.1 percent of suspected cancer pathways started first definitive treatment within 62 days of a suspicion of cancer, against a 75 percent target, on 2,248 treatments; 18,429 new suspected cancer pathways were opened and 15,052 were closed after the patient was told they did not have cancer; Cwm Taf Morgannwg was highest at 67.5 percent and Swansea Bay lowest at 44.7 percent. The summary is all-cancer and publishes no tumour-site split","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09"},"note":"Wales publishes no tumour-site split at all, so there is no Welsh skin cancer waiting-time figure."}],"support":[{"institutionId":"melanoma-focus","name":"Melanoma Focus and the Melanoma Helpline","kind":"charity","provides":["A confidential freephone helpline on 0808 801 0777 staffed by specialist skin cancer nurses, open 1pm to 2pm and 7pm to 9pm Monday to Friday and 7pm to 9pm on Sunday, with a message service outside those hours","Support groups and information for patients, carers and healthcare professionals","Guidance on how to take a photograph if a GP asks for one","It says plainly that the nurses cannot diagnose melanoma by telephone or from a photograph"],"url":"https://melanomafocus.org/melanoma-helpline/","source":{"label":"Melanoma Focus: the Melanoma Helpline, a confidential freephone service on 0808 801 0777 staffed by specialist skin cancer nurses, open 1pm to 2pm and 7pm to 9pm Monday to Friday and 7pm to 9pm on Sunday, with a message service outside those hours. The page states plainly that the nurses cannot diagnose melanoma on the telephone or from a photograph","url":"https://melanomafocus.org/melanoma-helpline/","date":"2026-09-25"}},{"institutionId":"british-association-of-dermatologists","name":"British Association of Dermatologists patient information (Skin Health Info)","kind":"charity","provides":["Patient leaflets on basal cell carcinoma, squamous cell carcinoma, melanoma and the treatments used for them","A jargon buster and a directory of patient advocacy and support groups","The service standards the NHS skin cancer service is measured against, including for Mohs surgery"],"url":"https://www.skinhealthinfo.org.uk/condition/basal-cell-carcinoma/","source":{"label":"British Association of Dermatologists: Skin Health Info, the association's patient information service, with a leaflet for basal cell carcinoma","url":"https://www.skinhealthinfo.org.uk/condition/basal-cell-carcinoma/","date":"2026-09-25"}},{"institutionId":"skcin","name":"Skcin (the Karen Clifford Skin Cancer Charity)","kind":"charity","provides":["Prevention and early detection campaigns covering both melanoma and the keratinocyte cancers","Accreditation schemes for schools, nurseries, workplaces and outdoor venues","The VAT Burn campaign to reclassify SPF30 and above sunscreen as an essential healthcare item rather than a product subject to the standard 20 percent VAT rate"],"url":"https://www.skcin.org/","source":{"label":"Skcin, the Karen Clifford Skin Cancer Charity: the VAT Burn campaign, which asks the government to reclassify SPF30 and above sunscreen as an essential healthcare item rather than a luxury subject to VAT. The page cites research conducted for Tesco with Skcin in 2021 in which 57 percent of the UK population considered sunscreen expensive, 31 percent of parents said they could not always afford it for the whole family and 44 percent said they put it on their children but not on themselves or their partner because of cost, and quotes the government's reply that VAT brings in vital public funds, that changing it for an individual product involves a trade-off, and that sunscreen is available to some on prescription","url":"https://www.skcin.org/resources/vat-burn-campaign/","date":"2026-09-25"}},{"name":"Changing Faces","kind":"charity","provides":["A Skin Camouflage Service and a support and information line on 0300 012 0275","Support for people living with a visible difference, including a scar on the face after skin cancer surgery","This is the charity that covers the part of this disease nothing else does: most skin cancer is cured, and a proportion of the people it is cured in are left with a changed face"],"url":"https://www.changingfaces.org.uk/"},{"name":"Macmillan Cancer Support","kind":"charity","provides":["Support line, welfare rights advice, grants and information centres","Skin cancer information for patients and families"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/skin-cancer","source":{"label":"Macmillan Cancer Support: skin cancer information and support","url":"https://www.macmillan.org.uk/cancer-information-and-support/skin-cancer","date":"2026-09-25"}},{"name":"NHS skin cancer information","kind":"nhs","provides":["Non-melanoma skin cancer: what it is, symptoms, causes, tests and next steps, and treatment, reviewed 16 September 2026","Melanoma skin cancer","Sunscreen and sun safety: shade between 11am and 3pm from March to October, clothing, a wide-brimmed hat, sunglasses, and at least SPF30 with a 4-star UVA rating, applied generously and reapplied"],"url":"https://www.nhs.uk/conditions/non-melanoma-skin-cancer/","source":{"label":"NHS: sunscreen and sun safety. The NHS advice is shade between 11am and 3pm from March to October in the UK, clothing, a wide-brimmed hat, sunglasses, and at least SPF30 with a 4-star UVA rating applied generously and reapplied","url":"https://www.nhs.uk/live-well/seasonal-health/sunscreen-and-sun-safety/","date":"2026-09-25"}},{"name":"Free NHS prescriptions in England (medical exemption certificate)","kind":"benefit","provides":["Anyone being treated for cancer, the effects of cancer or the effects of cancer treatment is entitled to a medical exemption certificate, valid five years for cancer; ask the hospital or GP for form FP92A","It applies to a basal cell carcinoma as much as to a melanoma","Prescriptions are free for everyone in Scotland, Wales and Northern Ireland"],"url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","source":{"label":"NHS Business Services Authority: medical exemption certificates, valid five years for cancer, the effects of cancer or its treatment","url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","date":"2026-09-25"}}],"nations":[{"topic":"Which of these diseases counts as a cancer for waiting-time purposes","england":"The treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin. Section 5.10 of the monitoring guidance puts C43 and C44 in scope but excludes basal cell carcinoma, multicentric, morphoeic and fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma, and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as carcinoma in situ or benign. Cutaneous squamous cell carcinoma and Merkel cell carcinoma are in.","scotland":"Narrower than England. The inclusion criteria cover melanoma only: new primary invasive melanoma of any site except the eye, including C43. C44 does not appear in the list at all, so no keratinocyte cancer, not even cutaneous squamous cell carcinoma, is covered by a Scottish waiting-time standard.","wales":"Wales reports a single all-cancer suspected cancer pathway with no tumour-site split published, so the question cannot be answered from a published Welsh page.","northernIreland":"As England. The ICD-10 mapping maps C43 and C44 to the Skin Cancers tumour site, and labels C44 explicitly as \"other malignant neoplasms of skin (except basal cell carcinoma)\".","sources":[{"label":"NHS England: national cancer waiting times monitoring dataset guidance. Section 3.2: the treatment standards apply to ICD-10 C00 to C97 excluding basal cell carcinoma of skin, and to D05; section 5.10 puts C43 and C44 in scope but names seven excluded conditions (basal cell carcinoma, multicentric basal cell carcinoma, morphoeic basal cell carcinoma, fibroepithelial basal cell carcinoma, basosquamous carcinoma, metatypical carcinoma and pilomatrix carcinoma) and puts lentigo maligna, Bowen's disease, intraepidermal carcinoma and keratoacanthoma out of scope as well. The page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026; its full text was read through the site's own WordPress interface","url":"https://www.england.nhs.uk/long-read/national-cancer-waiting-times-monitoring-dataset-guidance/","date":"2025-04-09"},{"label":"Public Health Scotland: cancer waiting times table 1, compliance with standard, quarter ending 31 March 2026. The inclusion criteria list the cancer types for which Scotland records data, and the skin entry reads \"melanoma, new primary invasive (i.e. Clark level greater than 1, melanoma of any site except eye); includes C43 (Skin)\": C44 is not on the list at all, so no keratinocyte cancer, including cutaneous squamous cell carcinoma, is covered by a Scottish waiting-time standard. In the quarter, 163 of 188 eligible melanoma referrals started treatment within 62 days (86.7 percent), with a median wait of 25 days and a 95th percentile of 110 days, against 3,372 of 4,668 (72.2 percent) for all cancer types","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026. In July 2026, 60.1 percent of suspected cancer pathways started first definitive treatment within 62 days of a suspicion of cancer, against a 75 percent target, on 2,248 treatments; 18,429 new suspected cancer pathways were opened and 15,052 were closed after the patient was told they did not have cancer; Cwm Taf Morgannwg was highest at 67.5 percent and Swansea Bay lowest at 44.7 percent. The summary is all-cancer and publishes no tumour-site split","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09"},{"label":"Department of Health (Northern Ireland): cancer waiting times ICD-10 mapping, quarter ending March 2026. C43 malignant melanoma of skin and C44 \"other malignant neoplasms of skin (except basal cell carcinoma)\" both map to the Skin Cancers tumour site, so Northern Ireland counts cutaneous squamous cell carcinoma and excludes basal cell carcinoma, as England does. The workbook answers HTTP 403 to a browser user agent and 200 to a plain request","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-icd10-q4-25-26.xlsx","date":"2026-07"}]},{"topic":"What is published, and what a reader can therefore compare","england":"Monthly, by tumour type, for the 28-day, 31-day and 62-day standards, with referral counts by suspected cancer type, in a downloadable file.","scotland":"Quarterly, by cancer type and health board, for the 62-day and 31-day standards, with median and 95th percentile waits. Melanoma only.","wales":"Monthly, all cancers together. No tumour-site split resolves: the replacement StatsWales service renders in a browser only and its cancer waiting times cube offers no download route that answers.","northernIreland":"Quarterly, by tumour site, for the 31-day standard, with median and 95th percentile waits. The 62-day figures are published separately and without any tumour-site split, and were withheld for the quarter ending March 2026 pending validation.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. July 2026, England provider totals: 89,978 of 308,200 urgent suspected cancer referrals were for suspected skin cancer; 68,719 of 78,719 suspected skin cancer pathways met the 28-day Faster Diagnosis Standard (87.3 percent); 7,936 of 8,994 skin treatments met the 31-day standard (88.2 percent); 5,010 of 5,733 met the 62-day standard (87.4 percent), split 3,814 of 4,421 on the urgent suspected cancer route (86.3 percent) and 1,196 of 1,312 on the consultant upgrade route (91.2 percent). Across April to July 2026, 304,485 of 1,124,238 urgent suspected cancer referrals were for suspected skin cancer, 27.1 percent","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times table 1, compliance with standard, quarter ending 31 March 2026. The inclusion criteria list the cancer types for which Scotland records data, and the skin entry reads \"melanoma, new primary invasive (i.e. Clark level greater than 1, melanoma of any site except eye); includes C43 (Skin)\": C44 is not on the list at all, so no keratinocyte cancer, including cutaneous squamous cell carcinoma, is covered by a Scottish waiting-time standard. In the quarter, 163 of 188 eligible melanoma referrals started treatment within 62 days (86.7 percent), with a median wait of 25 days and a 95th percentile of 110 days, against 3,372 of 4,668 (72.2 percent) for all cancer types","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026. In July 2026, 60.1 percent of suspected cancer pathways started first definitive treatment within 62 days of a suspicion of cancer, against a 75 percent target, on 2,248 treatments; 18,429 new suspected cancer pathways were opened and 15,052 were closed after the patient was told they did not have cancer; Cwm Taf Morgannwg was highest at 67.5 percent and Swansea Bay lowest at 44.7 percent. The summary is all-cancer and publishes no tumour-site split","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09"},{"label":"Department of Health (Northern Ireland): cancer waiting times workbook, quarter ending March 2026, 31-day wait by tumour site. Skin cancers: 166 of 190 within 31 days in January 2026, 117 of 134 in February and 116 of 122 in March, 399 of 446 across the quarter (89.5 percent), with a median wait of 0 days and a 95th percentile of 31 days in March. The workbook answers HTTP 403 to a browser user agent and 200 to a plain request with no extra headers, which is how it was read","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-q4-25-26.xlsx","date":"2026-07"},{"label":"Department of Health (Northern Ireland): cancer waiting times, revised 62-day waits for quarters ending December 2023 to March 2026, published September 2026. The target is that at least 95 percent of patients begin first definitive treatment within 62 days of an urgent GP referral for suspected cancer; in the quarter ending 31 March 2026, 29.6 percent did. There is no tumour-site split. The file answers HTTP 403 to a browser user agent and 200 to a plain request","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09"}]},{"topic":"The referral rules","england":"NICE NG12 section 1.7, last updated 15 April 2026, with the weighted 7-point checklist and the non-urgent default for suspected basal cell carcinoma.","scotland":"The Scottish Referral Guidelines for Suspected Cancer, which Public Health Scotland's definitions cite as the standard for what counts as an urgent referral.","wales":"NG12 applies.","northernIreland":"NG12 applies.","sources":[{"label":"NICE NG12: suspected cancer, recognition and referral, section 1.7 skin cancers. 1.7.1 refer on a suspected cancer pathway for melanoma with a weighted 7-point checklist score of 3 or more; 1.7.2 refer if dermoscopy suggests melanoma; 1.7.3 consider referral for nodular melanoma; 1.7.4 consider a suspected cancer pathway referral for a lesion that raises the suspicion of squamous cell carcinoma; 1.7.5 consider a non-urgent referral for a lesion that raises the suspicion of a basal cell carcinoma; 1.7.6 only consider an urgent referral for a suspected basal cell carcinoma if delay would have a significant impact because of site or size; 1.7.7 follow CSG8 on who should excise suspected basal cell carcinomas. Guideline published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"Public Health Scotland: cancer waiting times table 1, compliance with standard, quarter ending 31 March 2026. The inclusion criteria list the cancer types for which Scotland records data, and the skin entry reads \"melanoma, new primary invasive (i.e. Clark level greater than 1, melanoma of any site except eye); includes C43 (Skin)\": C44 is not on the list at all, so no keratinocyte cancer, including cutaneous squamous cell carcinoma, is covered by a Scottish waiting-time standard. In the quarter, 163 of 188 eligible melanoma referrals started treatment within 62 days (86.7 percent), with a median wait of 25 days and a 95th percentile of 110 days, against 3,372 of 4,668 (72.2 percent) for all cancer types","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}]},{"topic":"Who may excise which lesion","england":"NICE CSG8 with its 2010 community update: two levels of multidisciplinary team, and box 1's criteria for the low-risk nodular basal cell carcinomas a GP may excise under a directed or local enhanced service.","scotland":"CSG8 is English and Welsh guidance. No published Scottish national equivalent could be read; arrangements are set by health boards.","wales":"CSG8 applies, and box 1 refers to local health boards alongside primary care trusts.","northernIreland":"No published Northern Ireland equivalent of the box 1 criteria could be read.","sources":[{"label":"NICE CSG8: improving outcomes for people with skin tumours including melanoma. Published 22 February 2006, last updated 25 May 2010, last reviewed 23 May 2019; NICE decided in December 2020 to retain but not update it. It recommends two levels of multidisciplinary team, that people with precancerous lesions be treated by their GP or referred, and that people needing specialist diagnosis be referred to a doctor trained to diagnose skin cancer","url":"https://www.nice.org.uk/guidance/csg8","date":"2010-05-25"},{"label":"NICE CSG8, the management of low-risk basal cell carcinomas in the community, cancer service guidance update, May 2010. Box 1 sets the criteria for the low-risk nodular basal cell carcinomas a GP with no special interest may excise under a directed or local enhanced service: the person must not be 24 or younger, immunosuppressed or have Gorlin's syndrome, and the lesion must be below the clavicle, under 1 cm with clearly defined margins, not recurrent or persistent after incomplete excision, not morphoeic, infiltrative or basosquamous, and not over important anatomical structures, in an area where primary closure is difficult, where difficult excision may give a poor cosmetic result, or at another highly visible site. Anything else, or any diagnostic doubt, goes to a member of the local skin cancer multidisciplinary team, and every incompletely excised basal cell carcinoma must be discussed with one","url":"https://www.nice.org.uk/guidance/csg8/resources/improving-outcomes-for-people-with-skin-tumours-including-melanoma-2010-partial-update-pdf-773380189","date":"2010-05-25"}]},{"topic":"Sunbeds","england":"The Sunbeds (Regulation) Act 2010 bans use by under-18s on commercial premises and makes it an offence to offer one to a person under 18 or to allow a person under 18 into a restricted zone. Sections 4, 5 and 6 give ministers power to require supervision, to restrict sale or hire, to require health information and to require protective eyewear. No statutory instrument has ever been made under those sections for England, so unsupervised and coin-operated sunbeds remain lawful and no health warning is required.","scotland":"Public Health etc. (Scotland) Act 2008 Part 8, in force from 1 December 2009 and wider than England's: as well as the under-18 ban (section 95) and the sale and hire ban (96), section 98 makes it an offence to allow unsupervised use, section 100 imposes a duty to provide prescribed health information every time, and section 101 a duty to display an information notice.","wales":"The same 2010 Act, plus the Sunbeds (Regulation) Act 2010 (Wales) Regulations 2011, which used the powers England has never used: supervision, a sale and hire ban to under-18s, remote sale, prescribed health information provided and displayed, and protective eyewear.","northernIreland":"Sunbeds Act (Northern Ireland) 2011: the widest of the four. It adds to the under-18 and supervision provisions a prohibition on displaying other health claims, protective eyewear, requirements for staff training and for the sunbeds themselves, fixed penalties, and a power to register or license sunbed premises and operators.","sources":[{"label":"Sunbeds (Regulation) Act 2010 (2010 chapter 20), which extends to England and Wales only. Section 2 makes it an offence for a sunbed business to let anyone under 18 use a sunbed on relevant premises, to offer one to a person under 18, or to allow a person under 18 into a restricted zone. Sections 4, 5 and 6 are powers, not duties: regulations may require supervision, may prohibit or restrict the sale or hire of sunbeds to under-18s, may require health information to be provided and displayed and may require protective eyewear. Section 7 puts enforcement on local authorities","url":"https://www.legislation.gov.uk/ukpga/2010/20/data.htm","date":"2026-09-25"},{"label":"Public Health etc. (Scotland) Act 2008, Part 8, regulation of provision of sunbeds, in force from 1 December 2009. Section 95 makes it an offence to allow a person under 18 to use a sunbed on sunbed premises, 96 to sell or hire a sunbed to a person under 18, 97 covers remote sale or hire, 98 makes it an offence to allow unsupervised use of a sunbed, 100 imposes a duty to provide prescribed health information every time a person proposes to use a sunbed, and 101 a duty to display an information notice","url":"https://www.legislation.gov.uk/asp/2008/5/part/8","date":"2026-09-25"},{"label":"The Sunbeds (Regulation) Act 2010 (Wales) Regulations 2011, 2011 No. 1130 (W. 156). Wales used the powers in sections 4 to 6 of the Act: regulation 3 prevents sunbed use by children on domestic premises, 4 requires supervision of sunbed use, 5 prohibits the sale or hire of sunbeds to under-18s, 6 covers remote sale or hire, 7 requires prescribed health information to be provided and displayed, and 8 requires protective eyewear","url":"https://www.legislation.gov.uk/wsi/2011/1130/contents/made","date":"2026-09-25"},{"label":"Sunbeds Act (Northern Ireland) 2011 (2011 chapter 19). It is the widest of the four: as well as the under-18 prohibitions in sections 1 and 2 it prohibits unsupervised use (section 3), imposes duties to provide and display information (4 and 5), prohibits the display of other health claims (6), requires protective eyewear (7), sets requirements for staff training (8) and for the sunbeds themselves (9), and provides for fixed penalties (12) and for the registration or licensing of sunbed premises or operators (14)","url":"https://www.legislation.gov.uk/nia/2011/19/contents","date":"2026-09-25"},{"label":"legislation.gov.uk title search for \"sunbeds\", which returns ten results: the 2010 Act, the Northern Ireland Act of 2011 and its three statutory rules, the Welsh regulations of 2011, and two Scottish statutory instruments. No statutory instrument has ever been made under sections 4, 5 or 6 of the 2010 Act for England","url":"https://www.legislation.gov.uk/all?title=sunbeds","date":"2026-09-25"}]},{"topic":"Prevention policy","england":"NICE PH32 now consists of a single recommendation, number 6, asking architects, designers, developers, planners and employers to consider shade when designing new buildings and communal outdoor areas. NG34's eighteen recommendations are about messages and campaigns. QS130 statement 1, new in 2024, asks integrated care boards to work with local partners on awareness strategies. There is no national skin cancer prevention programme, no statutory duty on employers about solar radiation, and no reduced rate of VAT on sunscreen.","scotland":"NICE public health guidance is not automatically adopted in Scotland; NG34 and PH32 are English guidance. Scotland's sunbed law is the strongest of the pre-2011 legislation.","wales":"PH32 and NG34 apply.","northernIreland":"PH32 and NG34 apply, alongside the 2011 sunbeds Act and its information regulations.","sources":[{"label":"NICE PH32: skin cancer prevention, published 26 January 2011, last updated 9 February 2016. Recommendations 1 to 5 were replaced by NG34 in February 2016, leaving recommendation 6 on providing shade when designing and constructing new buildings and when developing communal outdoor areas. The guidance records that no recommendation was made on multi-component interventions or on adding shade structures to existing buildings because they were not cost effective, that no recommendation was made on protective clothing or sunscreen alone because no studies were identified, and that policy, fiscal and legislative actions such as banning unsupervised or coin-operated sunbed facilities, or reducing VAT on sunscreen products, were excluded because they were not in the remit","url":"https://www.nice.org.uk/guidance/ph32/chapter/Recommendations","date":"2016-02-09"},{"label":"NICE NG34: sunlight exposure, risks and benefits, published 9 February 2016. Eighteen recommendations, 1.1.1 to 1.1.18, all of them about who is at risk, what message to give, mass media campaigns and a local strategic approach. Recommendation 1.1.1 names outdoor workers and people with outdoor hobbies among the at-risk groups; the guideline contains no recommendation on regulation, taxation, provision of sunscreen or protective clothing","url":"https://www.nice.org.uk/guidance/ng34/chapter/Recommendations","date":"2016-02-09"},{"label":"NICE QS130: skin cancer quality standard, published 21 September 2016, last updated 24 January 2024. Six statements: 1 integrated care boards work with local partners on strategies to raise awareness of skin cancer and the risks of over-exposure to sunlight and artificial ultraviolet light, particularly for at-risk groups (new 2024); 2 people with suspected melanoma, squamous cell carcinoma or a rare skin cancer are referred on a suspected cancer pathway to have a diagnosis confirmed or ruled out within 28 days; 3 dermoscopy at specialist assessment for suspected melanoma; 4 access to a skin cancer clinical nurse specialist for melanoma, high-risk squamous cell carcinoma or a rare skin cancer; 5 BRAF analysis in stage 2B to 4 primary melanoma; 6 a staging scan in stage 2C to 4 melanoma (new 2024)","url":"https://www.nice.org.uk/guidance/qs130/chapter/Quality-statements","date":"2024-01-24"},{"label":"Public Health etc. (Scotland) Act 2008, Part 8, regulation of provision of sunbeds, in force from 1 December 2009. Section 95 makes it an offence to allow a person under 18 to use a sunbed on sunbed premises, 96 to sell or hire a sunbed to a person under 18, 97 covers remote sale or hire, 98 makes it an offence to allow unsupervised use of a sunbed, 100 imposes a duty to provide prescribed health information every time a person proposes to use a sunbed, and 101 a duty to display an information notice","url":"https://www.legislation.gov.uk/asp/2008/5/part/8","date":"2026-09-25"}]},{"topic":"Drug funding","england":"NICE technology appraisals, funded from baseline commissioning; the national Cancer Drugs Fund list carries no skin indication as managed access, and one skin indication (vismodegib for multiple operable basal cell carcinomas) is funded in the routine section by commissioning decision rather than appraisal.","scotland":"The Scottish Medicines Consortium, with the Patient and Clinician Engagement process. It has written national positions on imiquimod and methyl aminolevulinate for basal cell carcinoma that England does not have, and refused vismodegib for advanced disease as a non-submission rather than after an appraisal.","wales":"NICE guidance applies; the AWMSG does not appraise a medicine NICE is appraising, and the New Treatment Fund makes recommended medicines available within 60 days.","northernIreland":"NICE guidance applies.","sources":[{"label":"NHS England: national Cancer Drugs Fund list version 1.408, 24 September 2026, 320 pages. Section A is what the Cancer Drugs Fund pays for; section B is what NHS England funds routinely. Blueteq form VIS2 sits in section B: vismodegib is routinely funded from 14 July 2021, with no technology appraisal number, for adults with at least six clinically evident non-locally advanced, non-metastatic basal cell carcinomas of which at least three are 5 mm or larger, with or without Gorlin syndrome, where the person is suitable for surgery but surgery alone has the potential for substantial disfigurement, on the recommendation of a specialised skin cancer or head and neck multidisciplinary team. The form records that vismodegib and the intermittent schedules are not licensed in this indication. Forms CEM1 (TA802) and AVE1 and AVE2 (TA691 and TA517) are also in section B, so cemiplimab for advanced cutaneous squamous cell carcinoma and avelumab for Merkel cell carcinoma are routine commissioning and not managed access","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"Scottish Medicines Consortium: medicines advice (the keywords parameter, which the search form does not offer, returns the advices with their SMC numbers in the slug)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=skin","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: AWMSG in relation to NICE. The AWMSG does not appraise a medicine that NICE is appraising; NICE guidance applies in Wales","url":"https://awttc.nhs.wales/accessing-medicines/pharmaceutical-industry-submissions/submit-for-awmsg-appraisal/invisible/awmsg-in-relation-to-nice1/","date":"2026-09-25"},{"label":"Welsh Government: the New Treatment Fund, which makes medicines recommended by NICE and the AWMSG available within 60 days","url":"https://www.gov.wales/new-treatment-fund-improving-and-prolonging-lives-across-wales-0","date":"2026-09-25"}]},{"topic":"Outdoor workers and occupational ultraviolet exposure","england":"Advice, not duty. The Health and Safety Executive's guidance names farm and construction workers, market gardeners, outdoor activity workers and some public service workers as at risk and advises covering up, shade, SPF30 and self-examination; it imposes no requirement to provide sunscreen or shade. Solar radiation is not covered by the regulations on artificial optical radiation at work. The Industrial Injuries Advisory Council reviewed the evidence and decided in April 2018 not to recommend adding non-melanoma skin cancer from occupational ultraviolet exposure to the list of prescribed diseases, so an outdoor worker cannot claim Industrial Injuries Disablement Benefit for it. NICE NG34 recommendation 1.1.1 names outdoor workers as an at-risk group and asks for messages.","scotland":"The same reserved framework: health and safety at work and social security benefits are both reserved, so the Health and Safety Executive's guidance and the Industrial Injuries Disablement Benefit list apply as in England.","wales":"As England.","northernIreland":"Health and safety and industrial injuries benefits are transferred matters in Northern Ireland but the schemes mirror Great Britain's; no separate Northern Ireland prescription for occupational skin cancer could be found.","sources":[{"label":"Health and Safety Executive: skin at work, outdoor workers and sun exposure. The guidance names farm and construction workers, market gardeners, outdoor activity workers and some public service workers as at risk, and advises keeping a top on, a hat with a brim or flap, shade during breaks, sunscreen of at least SPF30 on exposed skin, water, and regular self-examination. It is advice: the page imposes no duty to provide sunscreen or shade","url":"https://www.hse.gov.uk/skin/sunprotect.htm","date":"2026-09-25"},{"label":"Industrial Injuries Advisory Council and Department for Work and Pensions: non-melanoma skin cancer and occupational exposure to (natural) UV radiation, information note published 25 April 2018. After reviewing the evidence the Council decided not to make any recommendation for changes to the list of prescribed diseases for which people can claim Industrial Injuries Disablement Benefit","url":"https://www.gov.uk/government/publications/non-melanoma-skin-cancer-and-occupational-exposure-to-natural-uv-radiation-iiac-information-note","date":"2018-04-25"},{"label":"NICE NG34: sunlight exposure, risks and benefits, published 9 February 2016. Eighteen recommendations, 1.1.1 to 1.1.18, all of them about who is at risk, what message to give, mass media campaigns and a local strategic approach. Recommendation 1.1.1 names outdoor workers and people with outdoor hobbies among the at-risk groups; the guideline contains no recommendation on regulation, taxation, provision of sunscreen or protective clothing","url":"https://www.nice.org.uk/guidance/ng34/chapter/Recommendations","date":"2016-02-09"},{"label":"Cancer Research UK: non-melanoma skin cancer risk factors. An estimated 50 to 70 percent of squamous cell carcinoma and 50 to 90 percent of basal cell carcinoma in fair-skinned people are caused by ultraviolet radiation; basal cell carcinoma risk is 43 percent higher in people who work outdoors and squamous cell carcinoma risk 77 percent higher in outdoor workers than indoor workers, on meta-analyses; squamous cell carcinoma risk is at least 67 percent higher and basal cell carcinoma risk up to 29 percent higher in people who have ever used a sunbed, and basal cell carcinoma risk 40 percent higher in people who first used one before 25; an estimated 7 percent of non-melanoma skin cancers in men and 1 percent in women in Britain are due to occupational exposures including solar radiation","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/non-melanoma-skin-cancer/risk-factors","date":"2026-09-25"}]},{"topic":"Sunscreen","england":"Sunscreen is a consumer product at the standard 20 percent rate of VAT and there is no NHS entitlement to it for prevention. NICE PH32 made no recommendation on sunscreen or protective clothing alone because it found no studies, and explicitly put fiscal and legislative actions, including reducing VAT on sunscreen, outside its remit. The NHS advice is shade between 11am and 3pm from March to October, clothing, a wide-brimmed hat, sunglasses, and at least SPF30 with a 4-star UVA rating applied generously and reapplied. Skcin's VAT Burn campaign asks for reclassification as an essential healthcare item.","scotland":"VAT is reserved, so the same rate applies; the NHS inform and NHS advice are the same.","wales":"As England.","northernIreland":"As England.","sources":[{"label":"GOV.UK: VAT rates. The standard rate is 20 percent and applies to most goods and services","url":"https://www.gov.uk/vat-rates","date":"2026-09-25"},{"label":"Skcin, the Karen Clifford Skin Cancer Charity: the VAT Burn campaign, which asks the government to reclassify SPF30 and above sunscreen as an essential healthcare item rather than a luxury subject to VAT. The page cites research conducted for Tesco with Skcin in 2021 in which 57 percent of the UK population considered sunscreen expensive, 31 percent of parents said they could not always afford it for the whole family and 44 percent said they put it on their children but not on themselves or their partner because of cost, and quotes the government's reply that VAT brings in vital public funds, that changing it for an individual product involves a trade-off, and that sunscreen is available to some on prescription","url":"https://www.skcin.org/resources/vat-burn-campaign/","date":"2026-09-25"},{"label":"NHS: sunscreen and sun safety. The NHS advice is shade between 11am and 3pm from March to October in the UK, clothing, a wide-brimmed hat, sunglasses, and at least SPF30 with a 4-star UVA rating applied generously and reapplied","url":"https://www.nhs.uk/live-well/seasonal-health/sunscreen-and-sun-safety/","date":"2026-09-25"},{"label":"Cancer Research UK: sun, UV and cancer, the public-facing prevention information behind the SunSmart messages","url":"https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer","date":"2026-09-25"},{"label":"NICE PH32: skin cancer prevention, published 26 January 2011, last updated 9 February 2016. Recommendations 1 to 5 were replaced by NG34 in February 2016, leaving recommendation 6 on providing shade when designing and constructing new buildings and when developing communal outdoor areas. The guidance records that no recommendation was made on multi-component interventions or on adding shade structures to existing buildings because they were not cost effective, that no recommendation was made on protective clothing or sunscreen alone because no studies were identified, and that policy, fiscal and legislative actions such as banning unsupervised or coin-operated sunbed facilities, or reducing VAT on sunscreen products, were excluded because they were not in the remit","url":"https://www.nice.org.uk/guidance/ph32/chapter/Recommendations","date":"2016-02-09"}]},{"topic":"Genomic testing route","england":"Seven Genomic Laboratory Hubs deliver the National Genomic Test Directory. Melanoma is clinical indication M7; there is no indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma.","scotland":"The Scottish Genomic Test Directory through four regional laboratories.","wales":"The All Wales Medical Genomics Service.","northernIreland":"The Northern Ireland Regional Genetics Service.","sources":[{"label":"NHS England: cancer (non-central nervous system) national genomic test directory, version 16. Clinical indication M7 melanoma in adults: M7.1 multi-target next-generation sequencing small variant panel covering BRAF, KIT and NRAS, for primary melanomas at high risk of recurrence (stage 2C, 3 or 4); M7.2 BRAF hotspot testing where a panel cannot be delivered; M7.5 to M7.9 fluorescence in situ hybridisation for MYB, RREB1, CCND1, MYC and CDKN2A, and M7.10 genome-wide copy number by microarray, where molecular assessment will aid the diagnosis or management of an equivocal melanocytic lesion. M187 uveal melanoma and M241 conjunctival melanoma have their own indications. There is no clinical indication for basal cell carcinoma, cutaneous squamous cell carcinoma or Merkel cell carcinoma anywhere in the directory; dermatofibrosarcoma protuberans is M50.1 on the sarcoma sheet","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-09-25"},{"label":"NHS England: the NHS Genomic Medicine Service, through which seven Genomic Laboratory Hubs deliver the test directory in England (the page answered HTTP 202 with an empty web application firewall challenge to OnCo on 25 September 2026)","url":"https://www.england.nhs.uk/genomics/nhs-genomic-med-service/","date":"2026-09-25"}]}],"gaps":["There is no published list of the 56 English trusts designated as specialist skin cancer centres. The number comes from the GIRFT dermatology national specialty report, which counts them but does not name them, and NHS England publishes no directory of designated skin cancer multidisciplinary teams that could be read. Nor is there any list of the fewer than 30 centres that actually provide Mohs surgery, so a person told they need Mohs cannot find out from a public page where it is done. The centres on this page are trusts whose own websites describe a skin cancer service, not a designated list.","The Mohs and workforce figures on this page are from September 2021 and there is no newer national count. GIRFT said in the same report that it was considering a separate skin cancer workstream to look at these services in more detail; no such report could be found. So the 79 Mohs surgeons, the 508 whole-time-equivalent dermatologists and the 159 vacancies are five years old and are the most recent national numbers that exist.","Wales publishes no tumour-site waiting-time figure of any kind. The monthly NHS activity and performance summary reports all cancers together; StatsWales has migrated to stats.gov.wales, whose cancer waiting times cube does carry a tumour-site dimension but renders in a browser only with no comma-separated, JSON or interface download route that answers, and the legacy open data host no longer resolves. Every Welsh row on this page is therefore all-cancer. Northern Ireland publishes skin cancer against the 31-day standard but no 62-day split by tumour site at all, and withheld its 62-day figures for the quarter ending March 2026 pending validation.","No incidence figure for basal cell carcinoma or cutaneous squamous cell carcinoma on this page should be treated as a count of tumours. The Office for National Statistics excludes C44 from all-cancer totals because non-melanoma skin cancer is greatly under-registered; registries have historically recorded a person rather than each lesion; and the two figures available (NHS England's 155,000 basal cell carcinomas in England in 2018 and Cancer Research UK's 156,000 non-melanoma skin cancers across the UK for 2019 and 2021 to 2022) are close enough to each other to be suspicious, given that one is England only and the other is the whole UK and includes squamous cell carcinoma. The exact registration rule for multiple keratinocyte tumours in the same person could not be read on any published national methodology page.","Cancer Research UK's non-melanoma skin cancer incidence page is still reporting the sex split, the age distribution and the trend from 2016 to 2018, and its risk-factor page was last reviewed in June 2018, while the headline count has moved to 2019 and 2021 to 2022. The deprivation analysis is from 2013 to 2017 and was calculated in April 2020. No age-standardised rate per 100,000 for UK non-melanoma skin cancer could be read from a served page, because the rate-level breakdowns have moved into interactive data hubs.","The deprivation gradient for these cancers runs the opposite way to almost every other cancer, and nothing published separates how much of that is genuinely lower ultraviolet exposure and how much is under-diagnosis and under-registration in more deprived groups. Cancer Research UK states the gradient and does not resolve it, and no NHS England analysis of routes to diagnosis for keratinocyte cancer by deprivation could be found.","No national figure could be found for how many urgent suspected skin cancer referrals are now triaged by teledermatology rather than a face-to-face appointment, or for how many trusts have deployed DERM. NHS England's roadmap and its response to the early value assessment both describe the direction without giving a denominator, and the cancer waiting times dataset records a first seen date without recording whether it was an image or a person.","No published figure could be found for how many basal cell carcinomas are excised in general practice under a directed or local enhanced service, in England or anywhere else in the UK, or for the current rate of incomplete excision by setting. CSG8's 2010 update cites studies and audits showing higher rates of incomplete excision by GPs than by hospital specialists and asks for quarterly histology feedback to commissioners, but no national collation of that feedback is published.","The Merkel cell carcinoma randomised trial has no published result. The ISRCTN record lists none, recruitment closed in December 2018 and the registered end date was September 2020; whether the trial reached its target of 400, and what it found, could not be established from any public page.","NICE CSG8 is the document that governs who may treat which skin cancer and where, and it was published in 2006, last updated in 2010, last reviewed in 2019, and formally retained without update in December 2020. Its criteria still refer to primary care trusts, which have not existed since 2013. Nothing published states what has replaced the accreditation and quarterly-feedback machinery it describes.","The Northern Ireland Cancer Registry's pages at Queen's University Belfast answered HTTP 403 to every request, with a browser user agent and without one, so no Northern Ireland incidence or survival figure for skin cancer appears on this page. The NHS England pages for the National Genomic Test Directory and the Cancer Drugs Fund list answer a program with an empty web application firewall challenge; the workbooks and PDF they link to under wp-content/uploads do open, and that is where those rows were read.","No source could be found for what proportion of the UK population uses sunbeds now. The figures Cancer Research UK publishes are from 1999 for adults and 2008 and 2009 for young people, and no more recent national survey could be found. Nor is there any published count of prosecutions or fixed penalties under any of the four sunbed laws, so there is no way to say from a public page whether the under-18 ban is enforced.","Sunscreen is standard-rated for VAT and there is no NHS entitlement to it for prevention. Skcin's VAT Burn campaign page is the source for the campaign and for the government's reply; no HMRC page could be found that states the rating for sun protection products directly, and no public page sets out the criteria under which sunscreen may be prescribed on the NHS for photodermatoses, so that route is named here without a figure.","Solar radiation is not covered by the Control of Artificial Optical Radiation at Work Regulations, which regulate artificial sources, and the Industrial Injuries Advisory Council decided in April 2018 not to recommend adding non-melanoma skin cancer from occupational ultraviolet exposure to the list of prescribed diseases. So an outdoor worker whose skin cancer was caused by the sun at work cannot claim Industrial Injuries Disablement Benefit for it. The Health and Safety Executive's guidance is advice rather than duty. No figure could be found for how many UK outdoor workers are covered by an employer sun protection 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