The Intricacy of Setting Up a Service to Bridge the Gap in Skin Malignancy Treatment for the Frail Population

TL;DR

This paper describes a new outpatient service using electrochemotherapy to treat skin cancer in elderly or frail patients who cannot undergo surgery.

Contribution

The study introduces a multidisciplinary electrochemotherapy service tailored for frail patients with skin malignancies.

Findings

ECT reduced complications and wound care needs compared to surgery in frail patients.

ECT was implemented successfully with streamlined workflows and multidisciplinary collaboration.

ECT improved recovery times and patient satisfaction in a pilot study.

Abstract

Skin malignancies such as basal cell carcinoma, squamous cell carcinoma, and melanoma are increasingly prevalent in the UK, particularly among frail and elderly patients who are often unsuitable for surgical intervention due to comorbidities, anticoagulation, or impaired wound healing. This study describes the development and implementation of an outpatient electrochemotherapy (ECT) service designed to address this treatment gap. ECT combines local chemotherapy with electroporation to enhance drug uptake by tumour cells and is a minimally invasive, National Institute for Health and Care Excellence (NICE)-approved technique that can be performed under local anaesthesia.

A pilot study conducted between February 2022 and July 2024 demonstrated the clinical and economic benefits of this approach, with patients experiencing fewer complications, reduced wound care requirements, and faster recovery compared to conventional surgical excision. The service was established through close collaboration between plastic surgeons, oncologists, pharmacists, nurses, and administrative teams. Key components included the creation of streamlined workflows, simplified consent documentation, tailored patient information, and a structured care pathway. Challenges encountered during implementation, such as interdepartmental communication, pain management, and wound care education, were addressed through ongoing quality improvement efforts, including regular multidisciplinary meetings, clinical audits, and outcome tracking (patient-reported outcome measures).

Electrochemotherapy offers a safe, effective, and accessible alternative for the treatment of skin malignancies in frail patients. Despite the logistical and organisational challenges involved in its implementation, the service has shown clear benefits in terms of reduced morbidity, improved recovery, and patient satisfaction, supporting its potential for broader adoption across the National Health Service (NHS).

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