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Skin cancer/skin lesion

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Airway compromise
  • Uncontrolled bleeding
  • Acute burns
  • Uncontrolled sepsis including hand infections
  • Complex facial fractures
  • Compound fractures
  • Threat to limb viability
  • Hand fractures (open or closed)
  • Acute fingertip injuries
  • Tendon injuries
  • Acute development of peripheral nerve compression symptoms following trauma or acute event
  • Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects.

Paediatric

  • Amniotic band compromising circulation

 

 

  • Refer to Healthpathways or local guidelines
  • Advise patient regarding sun avoidance and appropriate use of sun screens
  • Educate patient on skin cancer surveillance and arrange annual skin checks

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Skin lesion highly suspicious for melanoma or excision biopsy proven melanoma
    • Rapidly growing skin lesions especially on the face
    • Complex non-melanoma skin malignancies and any of the following:
      • ulceration and bleeding
      • rapidly enlarging
      • neurological involvement
      • lymphadenopathy
      • poorly differentiated or infiltrative tumour on biopsy
    • Other subcutaneous and deep tissue malignancies e.g. Merkel cell carcinoma, sarcoma
    • Skin lesion causing substantial obstruction to vision
    • Suspicion of malignant liposarcoma
    • Poorly differentiated SCC
    • Prior malignancy at the same site
  • Category 2
    (appointment within 90 calendar days)
    • Uncomplicated non-melanoma skin malignancies (BCC/SCC/IEC)
    • Skin lesions with any of the following:
      • causing functional problems or significant disfigurement 
      • diameter exceeds ≥ 5cm in size or rapid growth over short period of time
      • Significant persistent pain that is not solely pressure related 
      • fixed to deep tissues, i.e. muscle or fascia 
      • recurring after a previous excision 
      • prone to recurrent infection 
      • diagnosis in doubt or needs confirmation
  • Category 3
    (appointment within 365 calendar days)
    • Benign soft tissue lesions e.g. lipoma, ganglion not suitable for primary health management
    • Clinically significant benign lesions

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Features of pigmented lesions: size, shape, colour, inflammation, oozing, change in sensation.
  • Biopsy results unless clinically contraindicated - excision biopsy is the preferred method for suspected melanoma
  • Smoking status
  • History of anticoagulant therapy

3. Additional referral information Useful for processing the referral

  • Photograph – with patient’s consent, where secure image transfer, identification and storage is possible
  • USS lesion result (for a suspicious lipoma)

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • 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

Reason for request

  • 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 modifiers

  • 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

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and available, the referral may be streamed to an associated public allied health and/or nursing service. This may include initial assessment and management by associated public allied health and/or nursing, which may either expedite or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.