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  Two-Week Wait Rule - Suspected Cancer  
Referral Guidelines for Suspected Cancer (Two week wait rule) based on NICE Guidance 2005
Last Updated October 2012.

Skin Cancer - Melanoma

Urgent Referral

Refer urgently patients

  • with a lesion suspected to be melanoma (excision in primary care should be avoided) - see melanoma checklists below


Skin Cancer - Squamous Cell Carcinoma

Urgent Referral

Refer urgently patients

  • with non-healing crusted tumours >1cm with significant induration on palpation (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


Skin Cancer - Basal Cell Carcinoma

Non-urgent referral

Basal cell carcinomas are slow growing, usually without significant expansion over 2 months, and usually occur on the face. If basal cell carcinoma is suspected, refer non-urgently


Skin Cancer - Pigmented Lesions - Checklists

Melanoma should be considered if any of the characteristics in either the Glasgow 7-point checklist or the ABCDE checklist is found.

Glasgow 7-point Checklist for Melanoma

Refer people using a suspected cancer pathway referral (2 week wait) for melanoma if they have a suspicious pigmented skin lesion with a (weighted) Glasgow 7-point checklist score of 3 or more.

  • Major (each one scores 2 points)
    • Change in size of lesion
    • Irregular pigmentation
    • Irregular border
  • Minor (each one scores one point)
    • Inflammation
    • Itch / Altered sensation
    • Lesion larger than others
    • Oozing / Crusting of lesion


The ABCDE of Melanoma

  • A - Asymmetry
  • B - Border irregularity
  • C - Colour variation
  • D - Diameter > 6mm
  • E - Evolving (enlarging / changing)





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Last Update: 31 January 2008