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skin cancer (NICE guidance for urgent referral guidance for suspected cancer)

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Skin cancers

Malignant melanoma of the skin

  • refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma if they have a suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more.

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 7 mm or more
  • inflammation
  • oozing
  • change in sensation.

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if dermoscopy suggests melanoma of the skin

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma in people with a pigmented or non-pigmented skin lesion that suggests nodular melanoma

Squamous cell carcinoma

  • consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with a skin lesion that raises the suspicion of squamous cell carcinoma

Basal cell carcinoma

  • consider routine referral for people if they have a skin lesion that raises the suspicion of a basal cell carcinoma
  • NICE have now suggested that a possible basal cell carcinoma may warrant a two week referral but
    • "..only consider a suspected cancer pathway referral (for an appointment within 2 weeks) 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. .."

Notes:

  • in a previous version of the guidance there was a description of what was a suspected squamous cell carcinoma (2):
    • with non-healing keratinizing or crusted tumours larger than 1 cm with significant induration on palpation. They are commonly found on the face, scalp or back of the hand with a documented expansion over 8 weeks
    • who have had an organ transplant and develop new or growing cutaneous lesions as squamous cell carcinoma is common with immunosuppression but may be atypical and aggressive
    • with histological diagnosis of a squamous cell carcinoma

Reference:

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