Introduction Skin cancer rates in the UK are 250,000 annually and are due to increase by 60% in the next decade. This increased demand may lead to delays in treatment and adverse patient events. The objective of this study is to quantify delays and identify the main causes.

Methods Over the last 10 years the skin cancer service has grown from 200 referrals/month to approximately 750. A deeper analysis of data from 2021 to 2023, consisting of 26,114 referrals to the Royal Free Hospital was conducted. Pathway breaches were collected prospectively and analysed using root cause analysis.

Results 1326 referrals required treatment for suspected skin cancer. 657 patients breached the two week diagnostic wait. Results for the root cause analysis identified the main causes for delays as being: admin delay (26%), inadequate capacity (12%), medical delay (9%) and patient initiated delay (7%), etc. 87.9% of patients who missed the 31 day treatment target also missed the 2 week wait (2WW) target for their initial appointment.

Conclusions Admin issues account for majority of pathway delay, notably within the 2WW referrals. Missing the 2WW target significantly increases the risk of a patient missing the treatment targets which may lead to clinical harm. Inadequate capacity in clinics cause delay in our pathway suggesting that the current infrastructure is not sufficient to meet patient needs. This analysis has identified the key issues which need to be addressed to optimise patient transit through the treatment pathway.