What are the referral criteria for patients with abnormal histopathology findings in primary care?

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].