Guidance for referring patients for suspected skin cancer

In summary:

• If appropriate, use a routine pathway or utilise services such as Consultant Connect for advice & guidance. This will release key capacity allowing patients who need to be seen for a potential cancer more quickly.
• Local trusts are offering patients, referred via the urgent suspected skin cancer pathway, a teledermatology appointment, allowing for a remote dermatology review more quickly. Patients who may be suitable are identified post referral. To aid trusts in selecting the appropriate patients, please ensure the referral includes:
  • clearly indicated location and number of lesions
  • risk factors or history of skin cancer
  • performance status.
• If a GP feels that a patient may be suitable for teledermatology they can include this within the narrative of the urgent suspected cancer forms and it will be picked up in triage.
• Patients need to be available for appointments in the next 2-weeks to give time for trusts to be able to complete the diagnostics in time to reach the faster diagnosis standard (28 days).

Considerations based on NG-12 guidelines

For suspected basal cell carcinoma: 
Only consider a suspected cancer pathway referral for people with a skin lesion that raises the suspicion of a basal cell carcinoma if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size.

For squamous cell carcinoma: 
Consider a suspected cancer pathway referral for people with a skin lesion that raises the suspicion of squamous cell carcinoma.

Eligibility Criteria

Inclusions

• resident of NCL

• weighted 7‑point checklist

Major features of the lesions (scoring 2 points each):

• change in size
• irregular shape
• irregular colour

Minor features of the lesions (scoring 1 point each):

• largest diameter 7mm or more
• inflammation
• oozing
• change in sensation 

How to Refer