Referral to a specialist

Your GP should arrange for you to see a specialist if you have skin changes that could be due to melanoma skin cancer. Depending on your symptoms and other factors, this might be an urgent referral.

Seeing your GP

Abnormal looking moles are quite common but melanoma is quite rare in comparison. So it can be difficult for GPs to decide who may have a melanoma and who may have a non cancerous change in a mole or area of skin.

For some symptoms, your doctor may ask you to wait to see if the symptoms change over time.

UK referral guidelines

There are guidelines for GPs to help them decide who needs a referral.

Some of the UK nations have targets around how quickly you’ll be seen. In England an urgent referral means that you should see a specialist within 2 weeks.

This 2 week time frame is not part of the waiting time targets for Scotland, Wales and (in general) Northern Ireland. But wherever you live, you are seen as quickly as possible.

Urgent referral

Your GP might refer you urgently to a skin specialist (dermatologist).

GPs use a 7 point scale for assessing changes in moles. The scale has 3 major features and 4 minor ones. The major features are:

  • change in size
  • change in colour, such as getting darker, becoming patchy or multi shaded
  • change in shape

Each of these scores 2 points.

The 4 minor features are:

  • 7mm or more across in any direction
  • inflammation
  • oozing or bleeding
  • change in sensation, such as itching or pain

Each of these features scores 1 point. 

You need an urgent referral if you score 3 points or more.

You'll also have an urgent referral if a test to closely examine the skin (dermatoscopy) suggests you could have melanoma.

Your GP will consider an urgent referral to a specialist if you have a new growth on your skin, with or without pigment (colour). This could be a type of melanoma called nodular melanoma.

Your GP will refer you if you have a new or changing pigmented (coloured) line in your nail. Or if you have an unexplained mark in your nail.

Specialist skin cancer teams

Everyone with suspected melanoma is seen by a member of a skin cancer multidisciplinary team. A multidisciplinary team (MDT) is a team of health professionals who work together to decide on the best way to manage your care. The MDT can include many different health professionals including:

  • skin specialists (dermatologists)
  • surgeons (medical or plastic surgeons)
  • cancer specialists (oncologists)
  • radiotherapy specialist (therapy radiographers) 
  • clinical nurse specialists
  • doctors who look at your scans and x-rays (radiologists)
  • doctors who specialise in diagnosing illness from tissue specimens (histopathologists)
  • GPs with a special interest in skin cancer

There are 2 levels of MDT for melanoma and other skin cancers:

  • the local hospital skin cancer multidisciplinary team (LSMDT)
  • specialist skin cancer multidisciplinary team (SSMDT).

LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer centres, or plastic surgery centres.

Your GP, or doctor from the local team will refer you to the specialist team if:

  • you live close to the SSMDT, in which case it will act as both your local and specialist centre
  • you are under the age of 19
  • you have more than one melanoma
  • you were born with a large mole (more than 20cm across) that looks as though it may be becoming a melanoma
  • your melanoma is at higher risk of coming back or has come back
  • the melanoma has spread to another part of your body
  • you need treatment that the LSMDT does not provide
  • you are taking part in a clinical trial

If you're still worried

Sometimes you might feel that your GP is not concerned enough about your symptoms. If you think they should be more concerned, print this page and the symptoms page. Ask your GP to talk it through with you. Then you might be able to decide together whether you should see a specialist.

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