Dermatology is a rapidly developing speciality, both in primary and secondary care. The urgency for diagnostic biopsies for suspected skin cancers has grown dramatically with the implementation of government cancer waiting time targets (The NHS Plan, 2000). Reform was very much at the centre of this Government document, including the expansion of the nursing role to streamline cancer services around the needs of the patient. Several other publications including Making a Difference (1999), the NHS Improvement Plan (2004) and Modernising Nursing Careers (2006) have encouraged the expansion of the nursing role and this has been widely evident in Trusts around the country including in Nottingham, Southampton and London.

The introduction of the Dermatology Specialist Nurse role to the Dermatology Department at Ashford and St Peter’s Hospital NHS Trust (ASPH) has transpired from the cumulative effect of these influences on the healthcare setting, and the desire by this Trust to deliver a high-quality, clinically effective service. At present there are two Dermatology Specialist Nurses with two distinct roles; one is lead nurse in phototherapy, the other lead nurse in skin cancer, surgery, and clinical patient support. Both have attended the Nottingham University Hospitals NHS Trust Skin Surgery for Nurses course, with a view to both undertaking autonomous minor surgery lists in the future.

This document has been written to support the expansion of the Dermatology Specialist Nurse’s role, by providing a framework for the service, and a protocol for practice. Assessment and achievement of competence are central to this document, to ensure standards are maintained at this advanced level of patient care.



If a patient is seen by their General Practitioner, and they suspect that the patient has a type of skin cancer, they are referred into secondary care via a pathway called the two week referral.

This is a Government-driven initiative to ensure that patients with suspected cancers do not wait longer than two weeks before they are seen by a specialist (NHS Cancer Plan, 2000).This mechanism, together with increased public awareness has led to a year on year increase in skin cancer patients being referred, seen by a consultant and operated on by this department (ASPH Skin Cancer MDT Annual Report 2009).

As the numbers of patients requiring biopsies increase, medical capacity and patient choice decreases. The strict time parameters set out by the NHS Plan (2000) for not only the patient to be seen, but also to be treated, create great logistical challenges. If these were undertaken during a regular Consultant Dermatologist clinic, it would result in disruption of the clinic time schedule and substantial delays in patients being seen by the doctor. This is the current situation. However, with increased capacity for suitable diagnostic biopsies provided by the Specialist Dermatology Nurses, it would greatly ease this situation.

It is clear that this policy resulting in the development of the nurse-led diagnostic biopsy service has the potential to greatly improve the patient’s experience. It offers the possibility of the patient being seen by a doctor, and the nurse being able to carry out the diagnostic biopsy during the same clinic session. Naturally, this option would not be suitable for every patient but if patients were prepared prior to their appointment for this, then it would provide a swift and effective service, ensuring prompt diagnosis based on histological results. It would improve patient choice and also increase the procedural capacity for the department.


Policy Details

Download: PDF version
Compiled by: Lucy Daffarn, Dermatology Specialist Nurse
Ratified by: National Midwifery Committee
Date Ratified: November 2014
Date Issued: November 2014
Review Date: November 2017
Target Audience: Dermatology Specialist Nurses
Contact name: Lucy Daffarn, Dermatology Specialist Nurse


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