Rapid referral guidelines for skin cancer

Read our referral guidelines for skin cancer, which includes malignant melanoma, basal cell carcinoma and squamous cell carcinoma.

About these guidelines

We have developed Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:


Non urgent

Non urgent

Requires routine referral or tests.


Urgent

Urgent

Required within two weeks.


Very urgent

Very urgent

Required within 48 hours.


Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Basal cell carcinoma referral guidelines

Very urgent

Urgent referral


Only consider urgent referral (appointment within two weeks) if a person has a skin lesion that raises the suspicion of a basal cell carcinoma and there’s concern a delay may have an unfavourable impact, because of the location or size of the lesion.

Non urgent

Non urgent


Consider routine referral for people with a skin lesion that raises the suspicion of a basal cell carcinoma.

Accompanying notes

Features suggestive of a basal cell carcinoma include:

  • an ulcer with raised, rolled edge
  • prominent fine blood vessels around the lesion
  • nodules, often waxy or pearly in appearance.

Suspected basal cell carcinomas should only be excised in primary care in accordance with NICE’s guidance on Improving outcomes for people with skin tumours including melanoma (May 2010).

Specific sites of concern are sun-exposed areas such as the scalp, face, hands and arms, particularly with fair-haired people.

Malignant melanoma referral guidelines

Non urgent

Urgent referral


Urgently refer (appointment within two weeks) if:

  • a person presents with a suspicious pigmented skin lesion that has a weighted seven-point checklist score of three or more
  • OR a dermoscopy suggests malignant melanoma of the skin.

Consider urgent referral (appointment within two weeks) for melanoma in people with a pigmented or non-pigmented skin lesion that suggests nodular melanoma.

Accompanying notes

The seven-point weighted checklist:

Major features (scoring two points each)

  • change in size
  • irregular shape
  • irregular colour.

Minor features (scoring one point each)

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

Squamous cell carcinoma referral guidelines

Very urgent

Urgent referral


Consider urgently referring (appointment within two weeks) if a person has a skin lesion that raises the suspicion of squamous cell carcinoma.

Accompanying notes

Squamous cell carcinomas are usually raised lesions. They’re often described as being ulcerated, keratinised or crusting lesions that typically grow on the head and neck, or the back of the hand. They occur commonly, and people who are immunocompromised or have had an organ transplant are more likely to develop them. If a person like this does develop a new skin lesion, urgently refer them.

Glossary

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years
  • Young people – people aged 16–24
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks).