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Referral
Skin
Scope
This guidance covers the referral of a patient presenting with skin lesions suggestive of skin cancer or in whom a biopsy has confirmed skin cancer to a team specialising in skin cancer.
Refer patients with persistent or slowly evolving unresponsive skin conditions with uncertain diagnosis to a dermatologist.
If you perform minor surgery you should have received appropriate accredited training in relevant aspects of skin surgery including cryotherapy, curettage, and incisional and excisional biopsy techniques, and should undertake appropriate continuing professional development.
GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.
Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.
All pigmented lesions that are not viewed as suspicious of melanoma but are excised should have a lateral excision margin of 2mm of clinically normal skin and cut to include subcutaneous fat in depth.
Send all excised skin specimens for pathological examination.
When referring a patient in whom an excised lesion has been diagnosed as malignant, send a copy of the pathology report with the referral correspondence.
Referral Criteria
Malignant melanoma
- dermoscopy suggests melanoma of the skin
- suspicious pigmented skin lesion with a weighted 7 point checklist score of 3 or more (see below)
- pigmented or non pigmented skin lesion that suggests nodular melanoma e.g. bleeding or vascular nodule unless definite benign diagnosis
NICE Referral Guidelines on lesions suspicious of malignant melanoma. Patients with a score of 3 or more as follows:
- Major features (scoring 2 points each):
- change in size
- irregular shape
- irregular colour
- Minor features (scoring 1 point each):
- largest diameter 7 mm or more
- inflammation
- oozing
- change in sensation
Squamous cell carcinoma
- skin lesion that raises the suspicion of squamous cell carcinoma or where SCC is in your differential diagnosis
- (eg keratoacanthoma or atypical wart), including keratotic lesions that you think are harmless but want to rule out.
-
- lesion site (please specify)
- lesion size (please specify)
Basal cell carcinoma
- only refer if there is a concern that a delay will have a significant impact because of factors such as size or site (e.g. tip of nose, near eye, upper lip) or pattern of growth (e.g. large, infiltrative, growing fast)
- lesion site (please specify)
- lesion size (please specify)
Referral Instructions
The GP should use e-Referral Service to book an appointment or send the referral.
Please ensure you include:
- The patient's NHS number
- Tell the patient that this is an urgent referral and they will be seen within 14 days
e-Referral selection
- Specialty: 2WW
- Clinic type: 2WW Skin
- Service: 2WW Dermatology - NDHCT - Litchdon M/C - RBZ / 2WW Plastic Surgery - NDHCT - NDDH - RBZ
For any patients that you are unable to process through NHS e-Referral please contact the drss.helpdesk@nhs.net
Referral Forms
Suspected Skin cancer referral form - No merge field
Suspected cancer referral form -EMIS
Evidence
NICE referral guidelines for suspected cancer
GP Information
Suspected Cancer Guidelines A-Z
NICE referral guidelines for suspected cancer
bmj - New NICE guidance on referral for cancer
bmj - Assessing and referring adult cancers infographic
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Patient Information
New Leaflet available for patients who are referred to exclude a diagnosis of cancer
Pathway Group
This guideline has been signed off by NHS Devon.
Publication date: November 2016
