Managing suspected skin cancer in primary care

An overview of skin cancer types

There are two main types of skin cancer – melanoma and non-melanoma.

Melanoma

Melanoma is rarer than non-melanoma skin cancer, but it is more likely to metastasise quickly and has a higher mortality rate. Melanoma incidence rates have increased by around 25% over the past decade in the UK¹. Fortunately, earlier diagnosis can increase the chance of survival. Almost all people diagnosed with stage 1 melanoma will survival five years, whereas around 7 in 10 people will survival 5 years when diagnosed at stage 3².

Non-melanoma skin cancer

Non-melanoma skin cancer is much more common with around 204,000 new cases in England each year³. There are two main types of non-melanoma skin cancer: basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). In almost all cases, BCC is treatable and rarely metastasises. cSCC can metastasise but survival outcomes are good when it's diagnosed early⁴.

Who is most at risk of skin cancer?

The following groups of people are at greater risk of developing skin cancer:

• People aged 85 to 89 (for melanoma skin cancer in the UK) and people aged 90 or above (for non-melanoma skin cancer in England) as incidence rates are highest in these age groups¹⁵.

• People who are immunosuppressed (such as transplant patients) or those with certain chronic conditions like HIV⁶⁷.

• People with lighter skin tones as they have less melanin to protect them against sun damage. In the UK, almost 9 in 10 melanoma skin cancer cases are caused by too much exposure to UV⁸.

Be aware that people with darker skin tones have a greater risk of developing a type of melanoma which more commonly presents on areas of the skin not normally exposed to the sun (e.g. palms, feet, nail beds)⁹¹⁰. GPs can investigate these lesions using the key tips and resources below.

Your GP practice can use our free Sun Smart resources to help the public learn about sun safety and take steps to reduce their risk of skin cancer.

Tools to help GPs recognise and refer suspected melanoma cases

It can be challenging to distinguish skin cancer from other skin lesions. National guidelines provide tools that can help GPs across the UK to recognise and refer suspected melanoma cases.

The weighted 7-point checklist

The weighted 7-point checklist¹¹ features in NICE NG12 guidelines. It advises GPs to refer people on an urgent suspected skin cancer pathway if they have a suspicious pigmented skin lesion that scores 3 or more.

The ABCDE mnemonic

The ABCDE mnemonic in the Scottish Referral Guidelines (SRG) helps clinicians identify characteristics of concerning lesions.

Moles with the following should be referred to the local skin cancer pathway as a USC (urgent suspicion of cancer):

• Asymmetry

• Border irregularity

• Colour irregularity

• Diameter increasing or >6mm

• Evolution in shape, size or colour

You can find images of melanoma and non-melanoma skin cancers in our key tips and resources section below. These can help you assess your patient and decide whether to refer.

Teledermatology pathways

GPs can use teledermatology pathways to support timelier diagnosis. This may involve taking macro and dermatoscopic images of skin lesions that are then sent for remote assessment by secondary care specialists. Remote clinical assessment may be used before or as part of an urgent suspected cancer referral.

Consider the following if you’ve been trained to take the macro and dermatoscopic images and have access to teledermatology pathways:

• Take images using this method instead of using images provided by patients, which won’t be as high-quality and are inadequate for clinical assessment¹².

• Be aware that secondary care professionals will not examine patients physically and are unable to palpate lesions¹³.

• Teledermatology pathways are not suitable for multiple lesions or lesions in intimate or difficult to photograph areas¹⁴.

• If your patient doesn’t need further investigation, ask them to get back in touch if they notice any changes to the size, shape or colour of a skin lesion.

• Pathways will vary by region and nation.

Northern Ireland has implemented the Dermatology Photo Triage pathway, which is an enhanced triage pathway.

If available, GPs should use their iPhone with the SmartDerm app and dermatoscope attachment to take and upload images for referral. Visit GPNI for pathway training resources.

The emerging role of AI in teledermatology pathways

There are ongoing evaluations exploring if AI technologies can be incorporated into teledermatology pathways to support the assessment and triage of skin lesions. In May 2025, NICE recommended using the AI technology DERM in NHS teledermatology services under specific conditions while further evidence is generated.

We will update this section to reflect developments in AI and teledermatology.

Key tips and resources

We have provided a list of handy tips and resources to support the recognition, referral and management of patients with suspected skin cancer.

Patient information

You can also direct your patients to our public-facing materials to help them reduce their risk of skin cancer and learn more about the disease:

• Skin cancer (Non melanoma skin cancer)

• Melanoma skin cancer

• Let's stay safe in the sun leaflet (mobile-friendly)