Skin Cancer

What to consider in Primary Care before referring:

General Comments

Basal Cell Carcinoma (BCC)

• These are common slow growing and locally invasive tumours.

• Most are easily recognised with a pearly rolled edge and later central ulceration.

• Pigmented and morphoeic (scar like, poorly defined) BCC’s are less common variants.

Squamous Cell Carcinoma (SCC)

• These malignancies are much less common.

• They may be slow growing, well differentiated, keratinising or rapidly enlarging, poorly differentiated tumours.

• 5% may metastasise to regional lymph nodes.

Malignant Melanoma (MM)

• This is the most dangerous skin malignancy. Early detection and excision is vital for good prognosis.

• Melanoma subtypes
  Superficial spreading
  Nodular
  Amelanotic
  LentigoMaligna
  Acrallentiginous and subungual

Criteria for diagnosis

The following six point checklist may be useful in deciding whether to refer a changing pigmented lesion:

• Major features:
  Change in size
  Change in colour (variation of pigmentation)
  Change in shape (irregularity of edge)

• Minor features:
  Size ≥ 7mm diameter
  Inflammation
  Bleeding/crusting

Itch is not a good indicator of malignancy or otherwise, but may draw attention to a mole.

Treatment in primary care

Basal Cell Carcinoma (BCC)

• They are best managed by complete excision by the dermatology surgeons within the department and should be referred in the usual manner.

• In some cases radio-therapy may be a preferred option but a tissue diagnosis (i.e. biopsy) is still required prior to referral for radiotherapy and will be carried out in the Dermatology clinic.

• BCC’s can only be removed in primary care by PCT accredited GPs.

Squamous Cell Carcinoma (SCC)

• Lesions with a high index of suspicion, especially if rapidly growing should be referred by fax within 24 hours.

• USE 2WW SKIN CANCER REFERRAL PROFORMA

Malignant Melanoma (MM)

• All referrals for suspicious moles should be faxed to the dermatology service to be seen within the 2 week rule.

• Any lesion felt to be highly suspicious of melanoma will be excised on the day of clinic or as soon as possible afterwards.

• USE 2WW SKIN CANCER REFERRAL PROFORMA

Referral Threshold

• All skin cancer should be referred to Dermatologists for confirmation of diagnosis and treatment plan.

• Suspicious lesions, SCC and MM refer under 2/52 rule via faxed proforma