Nurse-Led Models of Service Delivery for Skin Cancer Detection: A Systematic Review

Abstract

Aim: To consolidate evidence on nurse-led models for skin cancer detection by focusing on their roles, comparing their effectiveness to physician-led care and highlighting any value-added benefits.

Design: Systematic review methodology with narrative synthesis.

Data sources: MEDLINE Complete, PubMed, Embase, CINAHL Complete, ScienceDirect, Scopus, BNI, LILACS, PsycINFO, Trip Medical Database, ERIC, EThOS, CDSR, WoS, Google Scholar, ClinicalTrials.gov, ICTRP, CENTRAL and the website 'Getting It Right First Time'.

Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies between January 1992 and September 2024 were evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. The search encompassed both peer-reviewed and grey literature; however, no grey literature met the inclusion criteria.

Results: Of the 6680 records screened, six studies met the inclusion criteria, involving 3325 patients across England, New Zealand and the United States. These studies focused on nurse-led models of care for skin cancer, assessing outcomes such as diagnostic accuracy, treatment effectiveness, cost savings, waiting times, access to care and patient satisfaction. While none directly compared nurse-led to dermatologist-led models, one study demonstrated comparable diagnostic accuracy between nurses and ophthalmologists. Nurse-led models were shown to effectively substitute for or complement physician-led care, though only one study was authored by a nurse consultant, highlighting a gap in nursing-led research. Service users favoured community-based, nurse-led care for its accessibility, convenience and cost-effectiveness, with health education noted as an added benefit in one study.

Conclusion: Nurse-led models demonstrate potential for high diagnostic accuracy in skin cancer, effective treatment delivery and enhanced patient education on skin self-examination. While role delineation remains a challenge, nurses play a critical role in supporting dermatologists in addressing the increasing referral demands associated with skin cancer care.

Trial registration: The systematic review protocol (registration number: CRD42023448950) was developed in collaboration with a patient representative with lived experience of melanoma, alongside academic experts in dermatology nursing and specialist; dermatology clinicians.

Patient contribution: A patient representative with lived experience of melanoma contributed to the review protocol.

Policy and practice implications: Training and Competency Development: Completing nationally recognised dermatology nursing qualifications beyond the Advanced Clinical Practice pathway and practical training to extend assessment, diagnostic and treatment skills are essential for autonomous practice in dermatology. Specific skills in nurse-led skin cancer care are vital to ensure clinical competency. Dermatology Nurse Consultant Training Programme: Policies should prioritise nationally recognised Advanced Nurse Practitioner to Dermatology Nurse Consultant Training Programmes focusing on assessment, diagnostic and treatment skills. A structured, portfolio-based approach to training is crucial for achieving competency and enabling autonomous practice in dermatology, supporting the delivery of high-quality care. Support for Community-Based Care: Policy-level support for community-based care is critical, particularly in rural or underserved regions. These models reduce patient travel, improve timely care access and provide training opportunities for rural clinicians, offering a viable alternative to hospital-based services. Standardising Nurse-Led Models: Developing national or international guidelines is essential for scaling nurse-led models. Standardisation allows these models to adapt to the specific needs of local services while maintaining high standards of care. Delivering Comprehensive Care: Nurse-led models show promise in delivering standard care comparable to physician-led services for specific components of the skin cancer care pathway. They also provide value-added care benefits, such as tailored patient education, enhancing outcomes and satisfaction.

Impact statement: Nurse-led models demonstrate diagnostic accuracy in identifying skin lesions, including skin cancer, while contributing to treatment, patient education and follow-up care. Despite their growing role in skin cancer management, greater dissemination and publication of their outcomes are needed to inform clinical practice. This review highlights the importance of standardising nurse-led approaches into scalable frameworks to support dermatologists, enhance patient outcomes and ensure consistent care standards in skin cancer. Further evaluation is required to assess their efficiency, cost-effectiveness and implementation across diverse healthcare settings.

Keywords: advanced practice; assessment; clinical effectiveness; clinical nurse specialist; dermatology; evidence‐based practice; health education; nurse practitioners; nursing diagnosis; policy.