Referral to a melanoma skin cancer 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 suspected cancer referral.

You will see a specialist as soon as possible. Ask your GP when this is likely to be.

Seeing your GP

Abnormal looking moles are quite common but melanoma is quite rare in comparison. It can be hard for GPs to decide who may have a melanoma skin cancer, and who may have a non cancerous (benign) change in a mole or area of skin.

Sometimes 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 to a skin specialist (dermatologist). They use these as well as their own experience and judgement.

Urgent referral

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

The major features each score 2 points. These are:

• change in size
• irregular colour – such as patchy colouring or different shades of brown, black or pink
• irregular shape – such as jagged or blurry edges or the two halves are different shapes or sizes (asymmetrical)

The 4 minor features score 1 point each. These are:

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

Your GP adds up the points. You need an urgent referral if you score 3 points or more.

Your GP will also refer you urgently if:

• a test to closely examine the skin (dermatoscopy) suggests you could have melanoma
• you have a new growth on your skin, with or without pigment (colour) – this could be a type of melanoma called nodular melanoma
• you have a new coloured line or mark in your nail that is unexplained, or an existing coloured line that has changed

Specialist skin cancer teams

Everyone with suspected melanoma is seen by a member of a skin cancer multidisciplinary team (MDT). An 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  
• plastic surgeons
• cancer specialists (oncologists)
• radiotherapy specialists (therapy radiographers) 
• clinical nurse specialists (CNS)
• doctors who look at your scans and x-rays (radiologists)
• doctors who specialise in diagnosing illness from tissue specimens (pathologists)
• 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 skin cancer MDT will refer you to the specialist team if:

• you live close to the SSMDT, in which case it will be your local and specialist centre
• you're 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
• you have melanoma and it 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're 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 and take them with you to your GP. Ask your GP to to explain why you don’t need a referral.

Contact your GP again if your symptoms don’t get better or you notice any new or unusual symptoms.

What should you do if you don't get an appointment?

If your GP has referred you, ask them when you should get your appointment. Contact them again if you don’t get one. Or some hospitals have a referral service you could try contacting if you know which hospital you are going to. Explain that you are waiting for an urgent suspected cancer referral.

Waiting times

Your hospital is working towards waiting time targets. For example, a target to find out whether you have cancer or not. And there are targets to start treatment if you are diagnosed with cancer. These are slightly different depending on where you live in the UK.