Sustainable Skin Cancer Care
Skin cancer is one of the most common cancers worldwide, and its prevalence is going to continue to rise due to changes in lifestyle and a growing ageing population. In the UK, skin cancer now accounts for almost 50% of the dermatological workload.
In 2020, skin cancer cost the NHS over £180 million. Whilst there is a financial cost, there is increasing awareness of the social and environment cost associated with its treatment. Patient travel, surgical, histopathology and medication waste, all carry a significant carbon footprint.
Healthcare systems can adopt the ‘triple bottom line’ approach to prioritise sustainable skin cancer care, which includes balancing the social aspects of patient care, cost-effectiveness and being environmentally responsible. By focusing on prevention, empowerment for patients and introducing innovative models of care, we can reduce the impact of skin cancer care on both individuals and the planet. Figure 1 below shows examples of how healthcare professionals treating skin cancer can think about applying the principles of sustainable healthcare.
Prevention
The greenest form of treatment
By preventing skin cancer, this will not only be medically effective but also it is the most sustainable. We can encourage the general population to use broad-spectrum sunscreen, wear protective clothing, avoid tanning beds and conduct their own regular skin check to help with early detection.
By reducing the incidence of skin cancer, we reduce the need for surgeries, hospital visits and pharmaceuticals – leading to a more sustainable healthcare system.
Empowering patients
Healthier outcomes with fewer emissions
Patients can be powerful with sustainability, if we empower our patients to take ownership of their skin health, this can help support in reducing unnecessary medical appointments, improve efficiency of hospitals and lower the emissions linked to travelling to appointments.
It is important to encourage patient-initiated follow-ups as this reduces the unnecessary visits to the hospital and allows individuals to only book a review when required. This will reduce the strain on clinical services and cuts down on the carbon emissions from patient travel.
Leaner care pathways
Doing more with less
Each year, there are over one million people in the UK who are referred to a secondary care dermatology service. With streamlined care pathways, more of these referrals can be managed more efficiently and sustainably.
One major innovation is teledermatology, which allows clinicians to triage skin lesions remotely which reduces unnecessary face-to-face appointments and in turn will lower carbon emissions related to travel. This will also save the patients time, money and stress.
Another model is the ‘See and Treat’ service which allows patients to receive a diagnosis and treatment within a single visit to the dermatology department. Similarly, consultant-led ‘spots’ clinics, as seen in Lincolnshire, bring dermatology services into the community setting, allowing it more accessible and reduces the need for hospital travel.
All of these approaches not only reduce the waiting times for patients, but they will significantly cut emissions that are linked to patient and staff travel and facility operations.
Low-carbon treatments
Sustainable surgery and smarter prescribing
When skin cancers cannot be prevented, the next best step is to reduce the environmental impact of treatment.
One simple intervention is responsible prescribing and avoiding unnecessary prescriptions, this limits pharmaceutical waste. An average 4 week wasted prescription costs:
- £34
- 15kg of CO2 equivalent – comparable to driving 88km in an average car.
Sourcing supplies for skin cancer from local areas is another strategy but can be challenging. Currently, manufacturing is heavily based in Asia. To reduce transport emissions and improving supply chain resilience, it would be beneficial to support UK-based production and local suppliers.
Promoting active travel, car-sharing and public transport among dermatology teams can also support sustainability goals. The community-based clinics and on-stop preoperative services will also contribute to reducing patient travel.
Surgical consumables: less waste, more impact
Surgical procedures often involve large volumes of single-use items, many of which are not biodegradable. However, we can reduce this waste without compromising hygiene or safety. For example:
- Repurposing Single-Use Tools: When this is safe to do so, this can minimise surgical waste. For example, single use surgical marker pens.
- Single-Wrapped Sterile Packaging: Carries no higher risk of contamination than double wrapping and reduces the environmental burden.
- Absorbable Sutures: This is a smart alternative to traditional sutures and reduces the need for a follow-up appointment for suture removal.
Following NICE guidelines, which recommend soap and water for handwashing before surgery and alcohol gel for disinfection between cases, unless hands are visibly soiled, is both safe and sustainable.
Sustainable skin cancer care: summary
Dermatology services are under a lot of pressure, especially with skin cancer-related lesions. By embedding sustainability at every level of care, from prevention to treatment, dermatology can become a model for low-carbon, high-quality healthcare.
Encouraging prevention, empowerment for patients, rethinking and redesigning pathways can all be used to contribute to healthier planet and improve healthcare systems.
The British Society of Dermatological Surgery have produced Guidelines on Sustainable Skin Surgery. Some of the ideas from these guidelines are shown in the driver diagram and the information below. We recommend reading the original guidelines. This work has been recognised by the Royal College of Physicians.
Members of the British association of Dermatologists (BAD) can also join the Environment and Sustainability Sub-Committee – British Association of Dermatologists if they have an interest in this field.