Should I see a melanoma specialist?
This page tells you about the guidelines that GPs in the UK have to help them decide who needs to see a specialist for suspected melanoma. There is information about
Should I see a melanoma specialist?
Abnormal looking moles are common but melanoma is quite rare. So it can be very difficult for GP's to decide who may have a melanoma and who may have something more minor. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines to help GP’s in the UK decide which patients need to be seen urgently by a specialist.
What your GP should do
If you have a mole or other skin change that does not look likely to be a melanoma, it is acceptable for your GP to monitor it in the surgery for 8 weeks. The mole should be measured with a ruler or marker scale, and assessed on the 7 point scale described below.
If there is any possibility that the mole could be a melanoma, your GP should send you to a hospital skin specialist. You should not have any skin change that could be a melanoma removed in the GP surgery.
Guidelines for urgent referral
The NICE guidelines say that all GPs should use the 7 point scale for assessing changes in moles. This scale has 3 major features and 4 minor ones. The major features are a change in size, colour or shape. The minor features are measuring 7mm or more across in any direction, inflammation, oozing or bleeding, and a change in sensation, such as itching or pain.
The doctor counts 2 points for any of the major features and 1 point for any of the minor features. If your mole scores 3 points you need an urgent referral to a specialist. Strong concerns about any one feature also mean that urgent referral is reasonable.
You can view and print the quick guides for all the pages in the About melanoma section
Abnormal looking moles are quite common but melanoma is quite rare. So it can be very difficult for GPs to decide who may have a melanoma and who may have a non cancerous change in a mole or area of skin. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs in the UK to help them decide which patients need to be seen urgently by a specialist. There are particular symptoms that mean your GP should refer you to a specialist straight away.
While reading these guidelines, it is important to remember that
- The number of people in the UK being diagnosed with melanoma is going up
- It can affect adults of all ages
- Some people are at higher risk than others of melanoma
- The most common place for a melanoma to develop is on the lower leg for women and on the back for men
The NICE guidelines and British Association of Dermatology guidelines recommend that anyone who may have a melanoma should not have a biopsy done by a GP. You should be referred to a skin specialist (dermatologist) in your local area for further examination and tests.
If you have a mole or other area of skin that looks abnormal but your GP thinks it is not a melanoma, it is acceptable for your GP to monitor it for 8 weeks. They should measure the mole with a ruler or against a marker scale. It is best if the GP takes photos so that any changes are recorded. The guidelines say that GPs should use the 7 point scale (see below) to judge changes in your mole. Your GP will look for these changes over the 8 weeks.
Remember that if there is any possibility that the mole could be a melanoma, your GP should refer you to see a hospital skin specialist within 2 weeks. You should not have a suspected melanoma removed in the GP surgery.
The NICE guidelines say that all GPs should use the 7 point scale for assessing changes in moles. The scale has 3 major features and 4 minor ones. The major features are
- Change in size
- Change in colour, such as getting darker, becoming patchy or multi shaded
- Change in shape
The 4 minor features are
- 7mm or more across in any direction
- Oozing or bleeding
- Change in sensation, such as itching or pain
The doctor counts 2 points for any of the major features. Any of the minor features scores 1 point. If your mole scores 3 points you need urgent referral to a specialist. But the guidelines say that if there are strong concerns about any one feature, urgent referral is also reasonable.
You can use this link to pictures of some abnormal moles to give you some idea of what you should be looking out for. There is also more information about the symptoms of melanoma in the about melanoma section.
NICE has issued guidance called Improving Outcomes For People With Skin Tumours Including Melanoma. This guidance recommends that all cancer networks set up two levels of multidisciplinary teams.
The multidisciplinary team (MDT) is a team of health professionals who work together to decide on the best way to manage your care. The MDT can include many different health professionals including skin specialists (dermatologists), plastic surgeons, cancer specialists, doctors who specialise in reading X-rays and scans (radiologists), specialist nurses, GPs with a special interest in skin cancer, physiotherapists, occupational therapists, cosmetic camouflage advisers, and doctors who specialise in diagnosing illness from tissue specimens (histopathologists).
There are 2 levels of MDT for melanoma and other skin cancers. They are the Local Hospital Skin Cancer Multidisciplinary Team (LSMDT) and a Specialist Skin Cancer Multidisciplinary team (SSMDT). LSMDTs are usually in cancer units in district general hospitals. SSMDTs are more likely to be in larger hospitals that have cancer centres, or plastic surgery centres. Everyone with suspected melanoma is seen by a member of one of these teams.
Your GP, or doctor from the local team will refer you to the specialist team if
- Your melanoma is at higher risk of coming back or has come back
- The melanoma has spread to another part of your body
- You need treatment that the LSMDT does not provide
- You are taking part in a clinical trial
- You live close to the SSMDT, in which case it will act as both your local and specialist centre
- You are under the age of 19
- You have more than one melanoma
- You were born with a large mole (more than 20cm across) that looks as though it may be becoming a melanoma
If you are worried that you have a skin change that could be melanoma and your GP does not want to refer you urgently to a specialist, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. Then you may be able to decide together whether you need to see a specialist and if so, how soon.
There is information about preventing skin cancer in this section.
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