Scottish Government

Scottish Referral Guidelines for Suspected Cancer

8 SKIN CANCERS

8.1 Key Points

Melanoma

• Risk factors:

• • excessive U.V. exposure

  • fair skin, poor ability to tan

  • large number of benign melanocytic naevi

  • family history

• Commonest locations:

• • women :50% on lower leg

  • men:33% on back

• Biopsy: It is recommended that GPs refer urgently all patients in whom melanoma is a strong possibility, rather than carry out a biopsy in primary care. In cases where melanoma is unlikely but a pigmented lesion is to be excised in general practice, an excision biopsy should be performed with a surrounding cuff of 2mm of normal skin. All such specimens should be submitted for pathological examination.

Squamous Cell Carcinoma

• Risk factors :

• • lifetime excessive sun exposure

  • multiple small actinic keratoses

  • fair skin

  • poor tanning ability

  • transplant recipients

• Commonest locations:

• Cancers tend to be larger (> 1 cm) than actinic keratoses and have a palpable component deep to the skin surface.

• Lesions which grow rapidly, arising in apparently normal skin, particularly on the ear, columella and lip over a six week period are potentially sinister and should be referred urgently

Basal Cell Carcinoma

• In general, patients with suspected basal cell carcinoma should be seen by a specialist within 3 months.

• The slow growth and low metastatic potential of these lesions mean that they do not need to be seen urgently unless they have an exceedingly long history (in excess of 10 years) or large size invading potentially dangerous areas such as the auditory meatus, eye or base of nose.

• Appearance: Slowly growing red pearly nodule on skin surface. Later may break down with crusting to give the classic 'rodent' ulcer

• Location : majority are on the face, particularly around the inner canthus and nose.

8.2 Skin Cancers: Guidelines for Urgent Referral

1 Melanoma

• Pigmented lesions on any part of the body which have one or more of the following features:

• • growing in size

  • changing shape

  • irregular outline

  • changing colour

  • mixed colour

  • ulceration

  • inflammation

NB. Melanomas are usually 5mm or greater at the time of diagnosis, but a small number of patients with very early melanoma may have lesions of a smaller diameter than this.

2 Squamous Cell Carcinoma

• Lesions which grow rapidly, arising in apparently normal skin, particularly on the ear, columella and lip over a six week period are potentially sinister and should be referred urgently

• Slowly growing, non-healing lesions with a significant induration on palpation (commonly on face, scalp, back of hand) - with documented expansion over a period of 1 - 2 months.

• Patients in whom squamous cell carcinoma has been diagnosed from a biopsy undertaken in general practice.

• Patients who are therapeutically immuno-suppressed after an organ transplant have a high incidence of skin cancers mainly squamous cell carcinoma. These tumours can be unusually aggressive and metastasize. It is therefore strongly recommended that transplant patients who develop new or growing cutaneous lesions should be referred urgently.

3 Basal Cell Carcinoma

• Lesions with an exceedingly long history (in excess of 10 years) or large size or recurrent basal cell carcinoma invading potentially dangerous areas such as the auditory meatus, eye or base of nose.