When should I consider referring a patient for a skin biopsy to a specialist?

Consider referring a patient for a skin biopsy to a specialist when the skin lesion raises suspicion of malignancy, particularly if it meets any of the following criteria:

• Skin lesion (pigmented and suspicious) with a weighted 7-point checklist score of 3 or more, suggestive of melanoma. Refer using a suspected cancer pathway referral.
• Skin lesion (pigmented or non-pigmented) that suggests nodular melanoma. Consider a suspected cancer pathway referral.
• Skin lesion that raises suspicion of squamous cell carcinoma. Consider a suspected cancer pathway referral.
• Skin lesion that raises suspicion of basal cell carcinoma. Consider routine referral, but only consider a suspected cancer pathway referral if delay may significantly impact due to lesion site or size.

Typical features prompting referral include ulcers with raised rolled edges, prominent fine blood vessels around a lesion, or pearly/waxy nodules.