MONDAY, July 1, 2024 -- A new rules-based referral pathway is associated with improved patient stratification for skin cancer diagnoses and shorter referral to first encounter time among high-risk patients, according to a study published online June 26 in JAMA Dermatology.

Yiqun Chen, Ph.D., from Stanford University in California, and colleagues examined whether a rules-based triage system was associated with better skin cancer risk stratification of patients in a retrospective quality improvement cohort study. Data were included for 37,478 patients: 12,302 seen after and 25,176 seen before the implementation of the new triage pathway. The rules-based triage system was based on previously-determined high-risk lesion characteristics.

The researchers found that for patients seen after and before implementation of the new triage pathway, the rates of aggregate biopsy, malignant biopsy specimens, and melanoma were comparable. Compared with those not seen through the pathway, patients seen through the lesion pathway had a higher risk of malignancy biopsy results and melanoma (adjusted risk ratios, 1.6 and 2.0, respectively). Increased risk of skin cancer was seen in association with lesions that were concerning to referring clinicians for skin cancer (adjusted risk ratios, 2.8 and 2.02 for all skin cancer and melanoma, respectively). In the new triage pathway, the three high-risk lesion groups were seen faster (mean reduction, 26 days).

"Our findings might improve in-clinic resource allocation and reduce patient wait time by prioritizing those more likely to require biopsies," the authors write.

One author disclosed ties to the dermatology and biopharmaceutical industries.