Referral criteria for patients with abnormal histopathology findings in primary care depend on the specific suspected cancer type and associated clinical features. When histopathology suggests malignancy or premalignant conditions, a suspected cancer pathway referral should be considered urgently.
For example, abnormal histopathology indicating melanoma (e.g., pigmented suspicious lesions with a weighted 7-point checklist score of 3 or more, or nodular melanoma) warrants referral via the suspected cancer pathway [1.7.1, 1.7.3].
Histopathological findings suggestive of squamous cell carcinoma require a suspected cancer pathway referral [1.7.4], whereas basal cell carcinoma findings generally lead to routine referral unless there is concern about lesion site or size, in which case urgent referral may be considered [1.7.5, 1.7.6].
Abnormal histopathology consistent with erythroplakia or erythroleukoplakia in the oral cavity should prompt urgent referral for specialist assessment, typically by a dentist [1.8.3, 1.8.4].
Histopathology indicating possible lymphoma (Hodgkin’s or non-Hodgkin’s) in the context of unexplained lymphadenopathy or pruritus should lead to a suspected cancer pathway referral, considering associated symptoms [1.10.7, 1.10.9].
For abnormal blood test histopathology such as serum protein electrophoresis or free light chain results suggesting myeloma, especially with persistent bone pain or unexplained fractures, urgent referral is recommended [1.10.6].
In all cases, the primary care clinician should review investigation results promptly and act accordingly, ensuring safety netting and communication with specialists as needed [1.15.1, 1.16.2].