NICE urgent referral guidance for suspected malignant melanoma

Last reviewed 07/2022

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.

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:

• NICE (June 2015). Suspected cancer: recognition and referral
• NICE (June 2005). Referral Guidelines for Suspected Cancer