Skin cancer specialist referral criteria: a UK patient guide

Skin cancer specialist referral criteria are defined by specific clinical features and national guidelines to ensure rapid, appropriate care for potentially malignant lesions. In the UK, the NHS and NICE use structured pathways, including the weighted 7-point checklist and the urgent suspected cancer pathway referral, to prioritise suspected melanoma and squamous cell carcinoma (SCC) for specialist review. In England, the target after an urgent referral is a diagnosis or ruling out of cancer within 28 days; NHS England removed the old two-week-wait standard in October 2023. Basal cell carcinoma (BCC) usually follows a routine referral pathway, with urgency reserved for high-risk cases. Understanding these criteria helps you have informed conversations with your GP and act promptly when a lesion changes.

1. What clinical features trigger urgent referral for suspected melanoma?

Melanoma carries the highest mortality risk of the common skin cancers. The NHS uses the weighted 7-point checklist to decide whether a pigmented lesion warrants urgent specialist referral. Under NICE guideline NG12, a score of 3 or more triggers an urgent suspected cancer pathway referral, and so does a dermoscopy finding that suggests melanoma.

Major features (score 2 each):

• Change in size
• Irregular shape or border
• Irregular colour (multiple shades within one lesion)

Minor features (score 1 each):

• Diameter greater than 7mm
• Inflammation
• Oozing or bleeding
• Sensory change such as itch or altered sensation

GPs also use dermoscopy findings to inform referral urgency, assessing features such as atypical pigment networks, regression structures, and irregular vascular patterns that are not visible to the naked eye. A GP trained in dermoscopy can identify lesions that warrant referral even when the 7-point score alone is borderline.

Pro Tip: Document any changing lesion with dated photographs taken in consistent lighting. A clear visual record of progression over weeks or months gives your GP objective evidence and strengthens the case for urgent referral.

In England, the target after an urgent referral is the Faster Diagnosis Standard: a diagnosis or ruling out of cancer within 28 days of referral. NHS England removed the two-week-wait standard in October 2023. Scotland, Wales and Northern Ireland set their own cancer waiting time targets. If you have not heard anything after an urgent referral, contact your GP surgery.

2. When does suspected squamous cell carcinoma require urgent referral?

Squamous cell carcinoma is the second most common skin cancer in the UK and carries a meaningful risk of local invasion and, in some cases, spread to lymph nodes. The referral threshold for SCC is based on lesion behaviour and appearance rather than a scoring system.

NICE NG12 advises GPs to consider an urgent suspected cancer pathway referral for a lesion that raises the suspicion of SCC. Features that raise that suspicion include:

• A persistent, non-healing keratotic or crusted lesion lasting more than four weeks
• A rapidly growing nodule on sun-exposed skin
• Ulceration without a clear traumatic cause
• A lesion arising within a pre-existing scar or area of chronic inflammation
• Firm, indurated texture on palpation

SCC most commonly appears on the face, scalp, ears, back of the hands, and lower lip. These are all areas with cumulative sun exposure over decades. Patients with a history of organ transplantation or long-term immunosuppression face a substantially higher risk of aggressive SCC and should be referred with a lower threshold.

Safety netting applies to borderline cases. If a lesion does not yet meet the criteria for urgent referral, your GP should give you clear written or verbal instructions on what changes to watch for and when to return. Safety netting is a recognised clinical strategy that transfers some monitoring responsibility to the patient for lesions outside urgent referral thresholds.

Pro Tip: If your GP is uncertain about a lesion on sun-damaged skin that has not healed within four weeks, ask specifically whether an urgent suspected cancer referral is appropriate under NICE NG12 criteria. You are entitled to ask that question directly.

3. Which BCC cases require specialist referral, and when is urgency needed?

Basal cell carcinoma is the most common skin cancer in the UK. Most BCCs are referred routinely rather than urgently, because they grow slowly and rarely spread beyond the skin. Waiting times for a routine referral vary by NHS trust.

Typical BCC features that prompt a routine referral include:

• A pearly or translucent nodule with rolled edges
• A flat, scar-like lesion with an ill-defined border
• A lesion that bleeds easily or fails to heal fully
• Superficial red, scaly patches on the trunk

Urgent referral for BCC is appropriate when the lesion is large, located in a functionally or cosmetically sensitive area, or when delay risks significant harm. High-risk sites include the nose, inner canthus of the eye, eyelids, ears, and lips. BCC on the face near these structures can infiltrate deeply before the surface appearance suggests severity. BCC near functional structures on the face warrants prompt specialist review to preserve both function and appearance.

Pro Tip: When speaking to your GP about a facial lesion, mention its exact location in relation to the eye, nose, or ear. Location is a key factor in deciding between routine and urgent referral, and your GP may not have examined the lesion under magnification.

Not all suspicious lesions require urgent referral. The NHS prioritises melanoma and SCC for urgent referral, with BCC triaged according to lesion-specific risk factors. Understanding this distinction prevents unnecessary anxiety and helps you ask the right questions at your GP appointment.

4. How does the national suspected cancer referral process work?

The national skin cancer referral process follows a structured pathway from GP assessment to specialist confirmation. Knowing each stage helps you track your own care and identify if something has stalled.

1. GP assessment. Your GP examines the lesion, applies the 7-point checklist or clinical judgement for SCC and BCC, and decides on urgent or routine referral.
2. Urgent referral. For suspected melanoma or SCC, the GP makes a suspected cancer pathway referral to the local skin cancer team.
3. Routine referral. For most BCCs and lower-risk lesions, a routine outpatient referral is made. Waiting times vary by NHS trust.
4. Teledermatology triage. Many NHS trusts now use teledermatology, where a GP submits clinical photographs for remote specialist review. This can accelerate triage without requiring an in-person appointment.
5. Specialist consultation. A dermatologist, Mohs surgeon, or plastic surgeon reviews the lesion, may perform a biopsy, and confirms the diagnosis.
6. NHS Faster Diagnosis Standard. In England, the 28-day diagnosis target aims for cancer to be diagnosed or ruled out within 28 days of an urgent referral. NHS England removed the separate two-week-wait standard in October 2023.
7. Safety netting for non-referred lesions. If your lesion does not meet referral criteria, your GP should document a safety net plan. Safety netting transfers monitoring responsibility to you, with clear guidance on what changes should prompt an urgent return.
8. Follow-up if timelines slip. If you have not received an appointment within the expected window, contact your GP surgery to confirm the referral was submitted and ask them to chase the appointment.

You can also raise the question yourself. Under NICE NG12 criteria, you can ask your GP whether your lesion history and changes make you eligible for an urgent suspected cancer referral. GPs are not obliged to agree, but the conversation is appropriate and encouraged.

If you would rather be assessed privately, you can send an enquiry to Miss Rakhee Nayar, Consultant Plastic Surgeon and Mohs surgeon.

5. Referral criteria at a glance: melanoma, SCC, and BCC compared

The table below summarises the key differences in referral criteria, urgency, and clinical features across the three main skin cancer types.

This table reflects NICE NG12 guidance and NHS referral standards. Individual GP decisions may vary based on clinical context, patient history, and local trust protocols.

Key takeaways

Skin cancer specialist referral criteria in the UK are determined by cancer type, lesion features, and site risk, with melanoma and SCC prioritised for urgent referral and most BCCs managed through routine referral.

Can I see a skin cancer specialist privately?

Yes. Miss Rakhee Nayar, Consultant Plastic Surgeon and Mohs surgeon, sees adult patients privately at Circle Cheshire Clinic in Northwich and Fairfield Independent Hospital in St Helens. She is dual-trained in plastic surgery and Mohs micrographic surgery, and assesses suspicious lesions as well as treating confirmed skin cancers, from Mohs surgery to facial reconstruction.

If you have been referred and would like a second opinion, or you are worried about a lesion, you can send an enquiry or call her secretary, Lisa, on 07740 306144. There is no charge for an enquiry and no obligation to book. For the signs that warrant a specialist review, see the guide on how to spot skin cancer symptoms on the face.

This article is for general information only and does not constitute medical advice. Consult a GMC-registered specialist for assessment of any suspicious lesion.

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• How to spot skin cancer symptoms on the face
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Filed under Choosing Your Care