title: Can we rely on a general practitioner's referral letter to a skin lesion clinic to prioritize appointments and does it make a difference to the patient's prognosis?
abstract: BACKGROUND
  This study was designed to: (i) determine if the priority of referral letters by general practitioners to a plastic surgery skin lesion clinic adhered to the national guidelines, what happened to these patients, and what was the histological diagnosis; and (ii) analyse whether the prognosis at diagnosis of malignant melanoma had improved since the introduction of the 2-week wait for patients with suspected cancer.
  
  
  METHODS
  The study involved a prospective audit questionnaire, retrospective note review and histology report review in the Plastic Surgery Department in a district general hospital and their 'bespoke' out-patient clinics.
  
  
  RESULTS
  Of 202 referral letters, 58 (29%) were referred as 2-week cancer referrals of which 13 (22%) suggested diagnoses that did not fall within the guidelines, and 11 gave no diagnosis. In addition, 84 (42%) had no indication of priority, though the text may suggest the need for it, either explicitly or implied. The prognostic indices for malignant melanoma have not altered since the 2-week wait rule has been implemented.
  
  
  CONCLUSIONS
  The guidelines are not being adhered to, thus patients with benign lesions are being given undue priority. The history and examination of skin lesions given in the referral letters is insufficient to allow the consultant to prioritize. Since the 2-week rule has be implemented, malignant melanomas have not been diagnosed at an earlier stage.
authors.affiliation: Department of Plastic Surgery, Sandwell General Hospital, Lyndon, West Bromwich, UK.
authors.forename: Jill B
authors.initials: JB
authors.lastname: Webb
authors.forename: A
authors.initials: A
authors.lastname: Khanna
mesh_terms: D001071:Appointments and Schedules; D015709:Correspondence as Topic; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006292:Health Priorities; D006302:Health Services Research; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012871:Skin Diseases / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000175:diagnosis