Skin cancer

Borders Ref Help Toolkit (in development)
NHS Borders

This page sets out the current referral guidelines and pathways for the management of patients referred with a suspicion of Skin cancer, including highlighting which elements of the pathway will be provided locally by NHS Borders, and which will require to be undertaken in NHS Lothian (Tertiary services).

Patients referred as Urgent with Suspicion of Cancer will be tracked against the Skin Cancer (Melanoma) pathway. Currently only skin cancer patients with Melanoma are reportable under the 62-day standard.  In addition to the pathway used for tracking patients to their first treatment, this document will also show the pathways for ongoing treatment and surveillance beyond this point, describing the patient’s entire treatment journey.

Skin Cancer: Symptoms & Clinical Indications

Approximately 12,000 people are diagnosed every year with non-melanoma skin cancer in Scotland, of which around 3,000 are squamous cell carcinomas (SCC). In addition, around 1,200 malignant melanoma are registered per annum. The incidence of both melanoma and non melanoma skin cancer is rising.

Risk factors for all skin cancer types include excessive sunlight exposure, sun bed use, fair skin and susceptibility to sunburn. For melanoma, a large number of benign melanocytic naevi and family history are risk factors. For SCC, multiple small actinic keratoses, high levels of previous UV-A photochemotherapy and immuno-suppression are also risk factors. People with multiple atypical naevi and a strong family history may have an increased risk of developing skin cancer. Skin cancers are very infrequent in people with dark skin and in children under 15 years.

Guides for assessment include the 7-point checklist and the ABCD (Asymmetry, Border irregular, Colour irregular, Diameter increasing) checklist. Some melanomas will have no major features. The dermatoscope is a useful tool for trained clinicians screening pigmented lesions as it can increase diagnostic accuracy. People presenting with a skin lesion suggestive of cancer should be referred to a Dermatologist with an image of the lesion.

Skin Cancer: Urgency Suspicion of Cancer Referral Criteria

 

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 high risk BCC diagnosed from biopsy
  • Any unexplained skin lesion in an immuno-suppressed patient

Good Practice Guidelines

  • 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 attached photo(s) to permit appropriate triage.

 

Skin Cancer: Known Issues & Opportunities

  • The service is under extreme pressure due to Consultant vacancies and relying on insourcing Consultants.
  • The majority of urgent referrals are currently being seen through the Tele-dermatology pathway
  • There is currently no Cancer Nurse Specialist support for patients with Melanoma.

Please include images in your referral – by accessing Pando App. Please see  Teledermatology SOP for further details

 

Scottish Cancer Referral Guidelines

Turas Learn Digital Dermatology Education and Training Links to all the latest guidance for including how to use pass-through-app, how to take a good quality image, and make an informative referral.

Dermatology resource: Derm net

Editorial Information

Last reviewed: 01/02/2024

Next review date: 01/02/2025

Author(s): Pauline Burns.

Author email(s): paulineburns@borders.scot.nhs.uk.