Skin cancer

Red flags

Mark referral urgent for patients with the following

Histologically proven melanoma
Histologically proven BCC with nerve/blood vessel involvement
Histologically proven SCC with nerve/blood vessel involvement
Any skin cancer with lymph node spread or distant organ spread refer urgently to General Surgery

All patients with red flags will usually be categorised Cat 1.

Conditions covered in this category are:

Melanoma
- Melanoma-in-situ
Basal cell cancer (BCC)
Squamous cell cancer (SCC)
Merkel cell tumours

Other important information for referring practitioners

Lifestyle changes

Advise re sun avoidance and sun block use
Advise patients on care of the skin and encourage yearly skin checks
Advise on early signs of skin cancer

Medical management

Arrange yearly skin checks for at risk groups
Maintain regular examinations for patients previously diagnosed with melanoma
Provide advice regarding appearance of suspicious lesions
Biopsy suspicious lesions before referral unless obviously melanoma

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Presence of any Red Flags
Reason for referral
Relevant clinical history
- Description of lesion
- Site
- Speed of growth
- Evidence of any spread including nerve or blood vessel involvement
Detailed medication history including any allergy
Any relevant histology (do not perform punch biopsy if melanoma is suspected)

Additional referral information (useful for processing the referral)

Diagram or photograph of lesion
Any relevant blood tests relevant to co-morbidities
- Important if Level 3/4 melanoma
CXR if level 3/4 melanoma

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use