2ww Dermatology
2ww Dermatology
Suspicious pigmented skin lesion with a weighted 7‑point checklist score of 3 or more [Malignant melanoma]
Dermoscopy suggests melanoma of the skin [Malignant melanoma]
Pigmented or non‑pigmented skin lesion that suggests nodular melanoma
Skin lesion that raises the suspicion of squamous cell carcinoma. [Squamous cell carcinoma]
Skin lesion suspicious for basal cell carcinoma AND concern that a delay in referral may have a significant impact, because of factors such as lesion site or size [Basal cell carcinoma]
Non-urgent/Routine Dermatology referral
Skin lesion that raises the suspicion of a basal cell carcinoma. [Basal cell carcinoma]
Use the Weighted 7-point checklist for assessment of pigmented skin lesions, and to determine referral
Major features of the lesion (2 points each):
Change in size
Irregular shape or border
Irregular colour
Minor features of the lesion (1 point each):
Largest diameter 7 mm or more
Inflammation
Oozing or crusting of the lesion
Change in sensation (including itch)
Suspicion is greater for lesions scoring 3 points or more (—> 2ww Dermatology referral).
If there are strong concerns about cancer, any one feature is adequate to prompt urgent referral under the 2-week rule.
The following risk factors increase the risk of melanoma and should be factored at the time of assessment:
family history of melanoma
personal history of melanoma
immunosuppression
excessive UV exposure including tanning beds.
ABCDE CHECKLIST
SIGN also recommends the ABCDE checklist to identify signs of melanoma that are useful for diagnosis:
• Asymmetry
• Border irregularity
• Colour: at least two different shades
• Diameter greater than 6 mm
• Evolutionary changes in colour, size, symmetry, surface characteristics, and symptoms
Any of these features is an indication for referral
Basal Cell Carcinoma
Typical features of basal cell carcinoma include: an ulcer with a raised rolled edge; prominent fine blood vessels around a lesion; or a nodule on the skin (particularly pearly or waxy nodules).