Scottish referral guidelines for suspected cancer: quick reference guide

Skin Cancers

Urgent suspicion of cancer referral

Lesions on any part of the body which have one or more of the following features:

• Change in colour, size or shape in an existing mole
• Moles with Asymmetry, Border irregularity, Colour irregularity, Diameter increasing or >6mm
• New growing nodule with or without pigment
• Persistent (more than four weeks) ulceration, bleeding or oozing
• Persistent (more than four weeks) surrounding inflammation or altered sensation
• New or changing pigmented line in a nail or unexplained lesion in a nail
• Slow growing, non-healing or keratinising lesions with induration (thickened base)
• Any melanoma or invasive SCC or a high risk BCC diagnosed from biopsy
• Any unexplained skin lesion in an immuno-suppressed patient
• BCC invading potentially dangerous areas, for example peri-ocular, auditory meatus or any major vessel or nerve

Good practice points

• Lesions which are suspicious for melanoma should not be removed in primary care. All excised skin specimens should be sent for pathological examination
• Lesions suspicious of basal cell carcinomas (BCC) may not require urgent referral, except those invading potentially dangerous areas
• Referrals should be accompanied by an accurate description of the lesion (including size, pain and tenderness) and photos if possible, subject to clinical governance arrangements, to permit appropriate triage