The UK Government two-week rule and its impact on melanoma prognosis: an evidence-based study

Abstract

Introduction: In order to tackle increasing waiting lists the UK Government's 'two-week rule' was introduced for a number of cancers, including melanoma, in 2000. Whilst there is evidence that secondary prevention (i. e. early diagnosis) improves patient outcome, particularly in melanoma where early surgical excision is the only intervention to improve survival, there is as yet no evidence base for a 2-week limit. Any survival benefit from this Government target will not be demonstrable until long-term follow-up is available, realistically 10-year mortality figures in 2010.

Patients and methods: To investigate an evidence base for the two-week rule in melanoma, we performed a retrospective study on patients with suspected skin cancers referred to a rapid access Pigmented Lesion Clinic (PLC) over a 4-year period with long-term survival data, and compared them to a historical control group.

Results: A total of 4399 patients attended the PLC from January 1993 to December 1996 and all were seen within 2 weeks. Ninety-six melanomas were diagnosed during this period with 96% treated within 2 weeks of GP referral, the majority (74%) excised on the day of PLC attendance. Melanoma patients (n = 78) diagnosed in the 2 years prior to the inception of the PLC waited 3-34 days for consultation and 4-74 days for treatment. Melanoma patients diagnosed in the PLC had significantly thinner tumours (Mann Whitney test, P < 0.001) and improved overall survival (chi(2) 18.1924; P < 0.001) compared with melanoma patients diagnosed before the inception of the clinic.

Conclusions: This is, to our knowledge, the first example that consultation within a 2-week time-frame of GP referral impacts patient survival and the first evidence base behind Government guidelines for this particular cancer.

Figure 1

Results demonstrating differences in Breslow depth between patients seen within 2 weeks in the PLC and the control ‘pre-PLC’ group.

Figure 2

Survival curves comparing PLC (1993–1996) patients with pre-PLC (1991–1992) patients. Log rank χ² 18.1924, P < 0.001. PLC patients, solid line; pre-PLC patients, dashed line.