When should I consider referring a patient with suspected melanoma to a dermatologist for further evaluation?

Refer a patient with suspected melanoma urgently using a suspected cancer pathway (for an appointment within 2 weeks) if:

• They have a suspicious pigmented lesion with a weighted 7-point checklist score of 3 or more ¹.
• Dermoscopy suggests melanoma ¹.
• There are nail changes, such as a new pigmented line in the nail (especially if there is associated damage to the nail), or a lesion growing under the nail ¹.
• They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear ¹.
• There is any doubt about the lesion, or there is a history of recent change ¹.
• A biopsy has confirmed the diagnosis of malignant melanoma ¹.

Consider referring using a suspected cancer pathway (within 2 weeks) if they have:

• A pigmented or non-pigmented skin lesion that suggests nodular melanoma ¹.
• Any major feature in the 7-point checklist, or any features of the ABCDE system ¹.

Most regions will have a local referral form for pigmented lesions; if not, include detailed history, examination, and risk factors ¹.