Urgent suspected cancer (USC) referral of skin lesions

Melanoma, Squamous Cell carcinoma and keratocanthoma should be referred as USC’s. Also included are certain Basal Cell Carcinoma’s positioned in significant anatomical sites where delayed removal would cause a significant poor cosmetic outcome, or even become inoperable.

Malignant melanoma of the skin  

NICE recommend the following criteria when referring a suspected melanoma.

  • If dermoscopy suggests melanoma of the skin.
  • A pigmented or non‑pigmented skin lesion that is suggestive of a nodular melanoma.
  • A score of 3 or more using the 7-point checklist a USC referral is advised.
Weighted 7-point checklist
Major features of the lesion (scoring 2 points each)
  • change in size
  • irregular shape
  • irregular colour
Minor features of the lesions (scoring 1 point each)
  • largest diameter 7mm of more
  • inflammation
  • oozing
  • change in sensation













1. Squamous cell carcinoma  

All lesions suspected to be a SCC should be referred as an USC.

2. Basal cell carcinoma

If there are particular concerns over the impact of the waiting list, where a delay may have a significant impact for example lesion site or size then consider a USC. (8)

3. Keratoacanthoma

All keratoacanthomas are presumed to be an SCC until proven otherwise.


The British Association of Dermatologists (BAD) advise the following list of melanomaconcerns to be referred as a USC; 
  • A new mole which is growing quickly over the age of puberty
  • A long-standing mole which is changing progressively in shape or colour regardless of age any mole which has three or more colours or has lost its symmetry
  • Any new nodule which is growing and is pigmented or vascular in appearance
  • A new pigmented line in a nail
  • Something growing under a nail
  • A mole which has changed in appearance and which is also itching or bleeding (9)



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