Skin lesions (head, face, trunk, hands, genitals) Referral Access Criteria

• Nil

• Nil

• Skin cancer/lesion
• Technically difficult non-melanoma lesions – consider referral to Plastic and Reconstructive Surgery for specialist assessment of lesions located on:
  
  • face, especially if greater than 5mm diameter, where scarring may be problematic
  • scalp, especially if greater than 10mm diameter unless direct closure is possible
  • trunk or extremity lesion greater than 15mm diameter (e.g. potentially requiring a graft)
  • periocular region, ears, lips, nose
  • nipple, genitalia
  • wrist, hand
• Recurrence, or near a previously treated area
• Rapidly growing
• Extending beyond subcutaneous tissue
• Persisting cosmesis concern after risk discussion (including scar revision of any region not related to cancer treatment)

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reasons). This information is required to inform accurate and timely triage.

If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset and duration of symptoms including detailed location and any change over time
• Current medication list
• Any known allergies
• Previous history of malignant melanoma (MM) or non-melanoma skin cancer (NMSC)

• Features of pigmented lesions: size, shape, colour, inflammation, oozing, change in sensation

• Biopsy results unless clinically contraindicated or technically not feasible
  Note, below information for referrer only
  
  • for suspected melanoma:
    
    • the optimal biopsy approach is an excisional biopsy with 2mm margins. If this is not feasible, an incisional biopsy may be considered.
    • where an excisional or incisional biopsy is not feasible, a large punch biopsy (>5mm) may be considered. A shave biopsy is not recommended by WA Kirkbride Melanoma Advisory Service (WAKMAS) guidelines.
  • for basal cell carcinoma and squamous cell carcinoma:
    
    • punch or excisional biopsy to allow for surgical planning (punch biopsy preferred if lesion is large and not amenable to excisional biopsy with 2mm margin)

• Family history of skin cancer
• Details of smoking and/or vaping (containing nicotine) status
• Advise whether or not your patient is taking any anti-platelets or anti-coagulants
  
  • if so, please state the indication

• Photograph or diagram of the area/biopsied site
• BMI

• Ultrasound (US) lesion (for atypical lipoma)

Category 1

Appointment within 30 days

• Skin lesion highly suspicious for melanoma or excision biopsy proven melanoma or SCC (over 10mm diameter in a cosmetically sensitive area)
• Uncomplicated non-melanoma skin malignancies (BCC/SCC)
• Rapidly growing skin lesions especially on the face
• Suspicion of malignant liposarcoma
• 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
• Skin lesions with any of the following:
  
  • causing substantial obstruction to vision
  • causing functional problems or significant disfigurement
  • diameter exceeds ≥ 5cm in size or rapid growth over short period of time
  • severe persistent pain that is not solely pressure related
  • fixed to deep tissues i.e. muscle or fascia

Category 2

Appointment within 90 days

• Skin lesions with any of the following:
  
  • recurring after a previous excision
  • prone to recurrent infection
  • diagnosis in doubt or needs confirmation

Category 3

Appointment within 365 days

• Symptomatic benign soft tissue lesions e.g. lipoma, ganglion
• Non-suspicious moles which are regularly traumatised

• Mucosal lesions of female genitalia
  
  • refer to Western Australian Gynaecologic Cancer Service (WAGCS): King Edward Memorial Hospital
• Removal of benign moles

• Skin lesions can be referred to the following specialties:
  
  • Plastic and Reconstructive Surgery
  • General Surgery
  • Oral Maxillofacial Surgery (oral and facial lesions)
• For information on skin biopsies:
  
  • see WA Kirkbride Melanoma Advisory Service (WAKMAS): Information for referring doctors
    
    • WAKMAS information for Medical Practitioners booklet
  • see RACGP: Improving diagnostic accuracy of skin biopsies (2018)
  • see Clinician Assist WA: Skin biopsy
• see MBS item: 30071 or MBS item: 30072 for information on the Medicare Benefits Schedule on the mandatory investigations (diagnostic biopsy)
• see Cancer Council: Skin cancer guidelines