HNY Policy and Pathway Repository - Humber

Skin cancer — the abnormal growth of skin cells - most often develops on skin exposed to the sun but can occur on any areas of skin.

There are three major types of skin cancer - basal cell carcinoma, squamous cell carcinoma and melanoma.

Basal and squamous cell skin cancers - these cancers are most often found in areas exposed to the sun, such as the head, neck, and arms, but they also can occur elsewhere. Overexposure to ultraviolet (UV) light is the main cause of non-melanoma skin cancer, this includes UV from sunbeds and sunlamps.

Other risk factors that can increase the chances of developing non-melanoma skin cancer include:

• a previous non-melanoma skin cancer
• a family history of skin cancer
• pale skin that burns easily
• a large number of moles or freckles
• taking medicine that suppresses the immune system
• a co-existing medical condition that suppresses the immune system

Melanoma is less common than some other types of skin cancer, but it is more likely to grow and spread.

No Red Flags Listed

No Guidelines on Management Listed

Referrals should be made via eRS and will be triaged prior to appointments being offered.

The eRS system will accept the attachment of images alongside the referral form.

If no images are available, the referral will still be accepted and processed in line with existing pathway

The referral form is available on Ardens and can be accesed on the resources section of this page.

Referral checks

Could you bear in mind the following when sending in a 2 week wait referral:

1. The individual needs to know that this referral is for suspected cancer
2. The referral will be triaged and if photographs have been provided these may enable the Consultant to exclude skin cancer
3. If no photographs have been provided or there is ongoing clinical concern an appointment will be offered usually within the following 2 weeks
4. The individual needs to be able to attend an appointment, at relatively short notice, if offered
5. Are there any information sources the individual can access? (see resources section) 
6. Up to date contact details are needed

Role of Images

Nationally, supported by Cancer Alliances, there is a move towards the use of imagery to accompanying 2 Week Wait referrals into secondary care to:

• Support more effective triage of referrals
• Provide clinicians with more information, at the point of referral, on which to make decisions
• Maximise the advantages of changes to consultation modalities introduced during the pandemic
• Deal with increasing numbers of referrals and the recovery process 

Associated benefits include:

• Improvement in risk management
• Reduced waits for treatment for those who need it
• Increased diagnostic confidence

Images

It is recommended that 3 images are taken:

1. Wider shot to provide the location on the body
2. A simple close-up providing detail of the lesion being referred
3. An image utilising a dermatascope

Equipment

To support the use of images each Practice will need:

• A dedicated iPhone
• A dermatascope
• A dermatascope mount

Teaching Aids

Dr Simon Carruthers GpwSI ERYCCG has produced a teaching video on using of the equipment being offered (see below)