Download LUNG suspected Ca- urgent referral

SUSPECTED SKIN CANCER – REFERRAL FORM
SKIN
To make an URGENT REFERRAL, Fax / E-mail to:
Telephone Contact No.:
REFERRER’S DETAILS
Referring GP
Registered GP
GP Code:
GP Address &
postcode
GP Tel. No.
GP Fax. No.
Date seen by GP:
Decision to refer date:
PATIENT DETAILS
Forename(s)
Title & Surname
D.O.B.
AGE:
Gender: Male
Female
Address
Postcode
*Tel. No. (day)
Mobile Tel.
*Tel. No. (evening)
NHS No.
Hospital No.
* N.B. It is essential that you provide a current contact telephone number for the patient so that the Trust
can contact the patient within 24-hours to arrange a convenient appointment.
CULTURAL, MOBILITY, IMPAIRMENT ISSUES
What is the patient’s preferred first language?
………………………………………………..
Does the patient require Translation or Interpretation Services? YES
NO
………………………………………
Please list any hearing or visual impairments requiring specialist help (Sign language, Braille, Loop Induction systems)
………………………………………………………………………………………………………
Is Disabled Access Required? YES
NO
Is transport required? YES
NO
………………………
Ethnic Origin:
………………………………………..
Religion:
………………………………………………………
Is the patient from overseas? YES
NO
Is the patient a temporary visitor? YES
NO
REFERRAL INFORMATION (referral guidelines are provided below / attached to proforma)
Site:
Size:
Duration:
Melanoma
Squamous Cell Carcinoma


Lesions scoring 3+ points refer URGENTLY.
If you strongly suspect cancer any one feature is
adequate to prompt urgent referral.
Excision in primary care should be avoided
Major features of pigmented lesions (2 points)



Change in size
Irregular shape
Irregular color
YES
YES
NO
NO
YES
NO
Suspected SCC: Refer URGENTLY patients with:
 Non-healing keratinizing or crusted tumours larger
than 1cm with significant induration on palpation,
commonly found on the face, scalp or back of the
hand with a documented expansion over 8 weeks.
YES
NO

History of an organ transplant & a
new or growing cutaneous lesion
 Histological diagnosis of SCC
(attach histology report)
If basal cell carcinoma is
suspected, refer non-urgently.
Minor features of pigmented lesions (1 point)
 Largest diameter 7mm or more
YES
NO
 Inflammation
YES
NO
 Oozing
YES
NO
 Change in sensation
YES
NO
Any additional information
YES
NO
YES
NO
Is the patient aware of the reason & urgency for referral & aware that they will be seen within 2 weeks? Yes
Issued by Merseyside & Cheshire Cancer Network – January 2007
No
Referral Criteria: NICE – Clinical Guideline 27 (issued June, 2005)


Refer patients with persistent or slowly evolving unresponsive skin conditions with uncertain
diagnosis to a dermatologist
If you perform minor surgery you should have received appropriate accredited training in
relevant aspects of skin surgery including cryotherapy, curettage and incisional and excisional
biopsy techniques and should undertake appropriate continuing professional development.
Melanoma
 Change is a key element in diagnosing malignant melanoma. For low-suspicion lesions,
undertake careful monitoring for change using the 7-point checklist (see below) for 8 weeks.
Make measurements with photographs and a maker scale and/or ruler.
 Be aware of and use the 7-point weighted checklist for assessment of pigmented skin lesions.
Major features of lesions:
Minor features of lesions:
- change in size
- largest diameter 7mm or more
- irregular shape
- inflammation
- irregular colour
- oozing
- change in sensation
 Lesions scoring 3 points or more (based on major features scoring 2 points each and
minor features scoring 1 point each) in the 7-point checklist above are suspicious. (If you
strongly suspect cancer any one feature is adequate to prompt urgent referral.)
Urgent referral = the patient is seen within the national target for urgent referrals = currently 2 weeks
Melanoma
Refer urgently patients:
 With a lesion suspected to be melanoma. (Excision in primary care should be avoided.)
Squamous Cell Carcinomas
Refer urgently patients:
 With non-healing keratinizing or crusted tumours larger than 1 cm with significant induration on
palpation. They are commonly found on the face, scalp or back of the hand with a documented
expansion over 8 weeks
 Who have had an organ transplant and develop new or growing cutaneous lesions as squamous
cell carcinoma is common with immunosuppression but may be atypical and aggressive
 With histological diagnosis of a squamous cell carcinoma.
Basal Cell Carcinomas
Non-urgent referral
 Basal cell carcinomas are slow growing, usually without significant expansion over 2 months and
usually occur on the face. If a basal cell carcinoma is suspected, refer non-urgently.
Investigations
 All pigmented lesions that are not viewed as suspicious of melanoma but are excised should
have a lateral excision margin of 2mm of clinically normal skin and cut to include subcutaneous
fat in depth.
 Send all excised skin specimens for pathological examination
 When referring a patient in whom an excised lesion has been diagnosed as malignant, send a
copy of the pathology report with the referral correspondence.
Definitions
‘Urgent’: the patient is seen within the national target for urgent referrals (currently 2 weeks)
‘Persistent’ as used in the recommendations in this guideline refers to the continuation of specified
symptoms and/or signs beyond a period that would normally be associated with self-limiting problems.
The precise period will vary depending on the severity of symptoms and associated features, as
assessed by the healthcare professional. In many cases, the upper limit the professional will permit
symptoms and/or signs to persist before initiating referral will be 4–6 weeks.
Issued by Merseyside & Cheshire Cancer Network – January 2007
An algorithm1 summarising the principal recommendations on how to proceed when a
patient presents with symptoms suggestive of skin cancer.
1
National Institute for Health and Clinical Excellence: Referral guidelines for suspected cancer Clinical Guideline 27 (issued June, 2005)
Issued by Merseyside & Cheshire Cancer Network – January 2007