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).

Prof Rajesh Varma