Periocular lid oncology referral pathway - A need for standardised proforma? An analysis of 199 patients

Abstract

Purpose To evaluate the accuracy of the Local-Regional 2-week wait (2WW) referral pathway for peri-ocular cancers. Methods Clinicodemographic and pathological data available on our electronic health records were extracted for patients referred to specialist periocular oncology service under the suspected eyelid cancer pathway between July 2019 and May 2022. Descriptive statistics were computed along with the chi-square exact test to determine the statistical significance between the referrals and referrals that were rejected/downgraded on the biopsy and biopsy-proven cancer diagnosis rates. Results 199 referrals were included for analysis. 145 of these were from accepted 2WW pathway referrals. Most were referred using the regional suspected ocular tumour form through their general practitioner, 113/145 (78%). The average time to be first seen at our service from the initial referral was 11 days (± 5). 81 out of 145 patients (56%) underwent biopsies with a cancer diagnosis yield of 14/81 cases (17%). The most common cancer diagnosis was basal cell carcinoma representing 12/81 (15%) of all biopsy-proven diagnoses. Conclusion We found the overuse of urgent suspected periocular cancer referral care pathway attributable to incomplete referral information. We recommend the development of a peri-ocular cancer-specific referral form to reduce the burden on services, focusing care to patients who require urgent referrals. More education is required for referring clinicians to ensure they are aware of benign peri-ocular conditions and prevent undue stress to patients. The generalisation of these findings outside the UK population requires corroboration internationally.