Consider referring a patient with seborrhoeic keratosis for further evaluation or treatment if there is diagnostic uncertainty, failure to respond to routine treatment, or if the lesion shows features suspicious for malignancy such as rapid growth, ulceration, bleeding, or changes in colour or shape.
Seborrhoeic keratosis is generally a benign skin lesion and does not usually require referral. However, if the diagnosis is unclear or the lesion behaves atypically, referral to a dermatologist is appropriate to exclude malignancy or other skin conditions.
Referral is also indicated if the lesion causes significant symptoms or cosmetic concern that cannot be managed in primary care.
Urgent referral pathways are reserved for lesions suspicious of melanoma or other skin cancers, which should be assessed using criteria such as the 7-point checklist or ABCDE system, not typically seborrhoeic keratosis unless features overlap.