DS02 British Society for Dermatological Surgery sustainability guidance
Authors: Ali Fatima , Nikookam Yasmin , Hunt William , Holloran Sophie , Ang Eshen , Chaolin Catriona , Charlambides Maria , Lowe Ashima , Brindley Luke , Abbott Rachel , Wernham Aaron 
Published: June 2023

Abstract
Skin surgery and the patient pathway for those with skin cancer significantly contribute to the climate crisis. Dermatological surgeons recognize the role of global climate change as a significant contributor to increasing skin cancer rates and hence increase service demand. The British Society for Dermatological Surgery (BSDS) sustainability subgroup’s aim is to facilitate the integration of sustainability within all levels of service provision through the development of national sustainability guidance. We systematically searched MEDLINE, Embase, Google Scholar and the grey literature for English-language published articles related to sustainability in skin surgery. Relevant selected evidence-based articles were critically evaluated for inclusion by 11 authors and, if sufficiently rigorous, were included in the final recommendations. The guidance then underwent multiple iterations of appraisal by the guidance development group consisting of expert consultant dermatologists and Mohs surgeons, trainees and patient–public involvement. A system-wide change in service provision is required to reduce long-term service demand. This can be achieved through a focus on skin cancer prevention, patient education and facilitating early recognition of skin cancer in primary care. Another aspect includes encouraging patient empowerment through self-monitoring, thus reducing the frequency of follow-up. Lean dermatology service delivery reduces waste by utilizing efficiency, optimizing teledermatology and one-stop see-and-treat clinics, reducing travel distances, using electronic health records and identifying unnecessary/missed appointments. Reducing carbon intensity involves using low-carbon alternatives for patient/staff transport, sustainable staff food options and a wider review of procurement and supply chain that reflects sustainable trade standards. Skin surgery must re-evaluate its consumption and waste, involving reusable equipment and surgical clothing, opting for repair over machinery replacement, reducing single-use sets and using absorbable sutures and single-wrapped biodegradable packaging. Departments should preserve water used in surgery/handwashing, conserve electricity and use renewable energy sources, in addition to surgical waste management through segregation, recycling, proper disposal of environmentally harmful waste and surgical smoke evacuation. Dermatological surgery departments can advocate system-wide change by establishing a sustainability policy, which incorporates departmental sustainability education for their staff, prioritizing waste auditing and life cycle assessments and encouraging ethical purchasing. Further skin surgery sustainability research and innovation are necessary to encourage circular economy solutions for consumables and equipment use and develop sustainability quality-improvement projects and new methods of sustainable dermatological surgery service delivery. The BSDS sustainability guidance is publicly available (https://bsds.org.uk/wp-content/uploads/2022/09/2022-BSDS_Sustainability_Guidance.pdf) to inform and inspire dermatological surgery sustainability.