Efficiency and Sustainability in the Skin Cancer Excision Pathway: Life Cycle Assessment and Process Map.

Background: Skin cancer is the most commonly diagnosed cancer. In secondary care, patients enter a complex pathway, often involving excision. This multistage process likely has a significant carbon footprint, which has not been previously evaluated. Objective: The aims of this study were to quantify the carbon footprint of the skin cancer excision pathway and to identify opportunities for pathway optimization to improve both sustainability and efficiency. Methods: A retrospective process mapping and life cycle analysis of 64 patients undergoing skin cancer excision were performed for patient-facing and organizational steps from diagnosis to follow-up. Estimates for carbon dioxide emissions and areas for pathway remodeling were generated. Results: The carbon footprint of a patient undergoing skin cancer excision was 118.5 kg carbon dioxide equivalent (CO2eq). The perioperative phase had the highest emissions (53.1 kgCO2eq, 44.8%), but the combined diagnostic and follow-up periods had greater emissions (65.4 kgCO2eq, 55.2%). Imaging and nuclear medicine were responsible for over a third of emissions (42.5 kgCO2eq, 35.9%). Conclusions: This is the first study to evaluate the carbon footprint of the secondary care skin cancer excision pathway. Multiple inefficiencies were identified, and opportunities for improvement, pathway stratification, diagnostic justification, and adoption of circular economy principles were suggested to increase sustainability and improve standards of care.