Skin - USC (2WW)

Overview

The suspected skin cancer service is provided by UHBW at the Bristol Royal Infirmary and NBT at Southmead Hospital. The services are for patients who meet the NICE Skin Cancer criteria.

Please note that skin cancer is exceptionally rare in children. Any skin lesions suspicious of cancer in patients aged under 16 should be referred using the Children & Young People USC (2WW) referral form.

Referral Pathways for Urgent Suspected Cancer

Following on from the successful pilot of a Teledermatology Service for Suspected Skin Cancer Referrals in 2024/25 this service has now been rolled out across BNSSG.

Remote assessment of suspected skin cancer offers a timely and effective route to diagnosis and treatment while enabling patients to be cared for closer to home. This referral route should be the default option for patients with a suspected skin cancer.

Information about this service including the inclusion/exclusion critiera is detailed in the following document: 

Urgent Suspected Cancer (USC) skin teledermatology referral (June 2025)

Suspected Skin Cancer Referral Form - this form is embedded in EMIS and details the criteria for Urgent Suspected Cancer skin referrals

The following are available on the ICB website; Accurx messages containing these links are available to share with patients

• Patient leaflet: BNSSG Teledermatology Suspected Skin Cancer Patient Leaflet
• Patient questionnaire: https://bnssg.icb.nhs.uk/library/bnssg-teledermatology-patient-questionnaire/ (this link is currently not working - 17.6.25 - we will endeavour to update asap)

Referral Pathway Outline

Referral Pathway Outline

• Patient assessed by primary care clinician and decision made to refer
• Process explained and PIL provided (please note guidance re lesions with scale)
• Patient is booked for a photography appointment within 5 calendar days
• Patient is seen by member of primary care team and images captured as per SOP
• Referral is sent to secondary care for remote assessment
• Patient and GP are informed of the outcome of remote assessment which may include benign diagnosis (discharge), booked for OPA, booked for surgical procedure.

 Referral of lesions near the eye

• Lesions that might be malignant and are within 5mm of the ocular margins need to be referred to the Skin USC clinic at UHBW who will triage into the eye service (no other provider can triage directly into the eye service).

ERS Referral Options

For UHBW referrals secretaries will need to book dummy appt slots as per other USC referrals. For NBT secretaries should select 'send for Triage'

If referring with images attached referrals should be sent to:

• DO NOT ATTEND Teledermatology SKIN urgent cancer – Bristol Royal Infirmary RA7

or

• DO NOT ATTEND Teledermatology SKIN urgent cancer referral – Southmead RVJ

If the patient meets the exclusion criteria or declines referral on this pathway then patients can be referred to OPA using

• Skin 2ww Suspected Cancer - BRI UHBW RA7

Or

• Urgent Suspected Cancer Skin Malignancies Triage Service – Southmead RVJ

MDT Referrals

If advised to refer into Multidisciplinary Team (MDT), then please submit a USC referral to the relevant secondary care team as above, who will ensure that all the required information is available to enable an effective MDT discussion.

Advice and Guidance

Advice and guidance is not suitable for patients with a lesion that meets USC criteria, but if you would like advice on a skin lesion that you suspect is NOT high risk (ie. NOT a melanoma or invasive squamous cell carcinoma) please consider using the Dermatology Advice & Guidance service (e-RS).

Clinical Guidance

For further guidance including weighted 7 point check list please see NICE Cancer Guidelines 2015 - Skin Cancers

There are useful resources and pictures on the PCDS website at the links below:

Malignant Melanoma

Further information on Acral-lentiginous melanoma (pcds.org.uk) assessment is also available

Squamous Cell Carcinoma

Basal Cell Carcinoma (usually not USC unless there is particular concern that a delay in treatment may have a significant impact, because of factors such as lesion site or size. Please see the Suspected Skin Cancer Referral Form for details of which head and neck BCCs should be referred via this route)

Benign Skin Lesions

Please see the Benign Skin Lesions Remedy page. 

Actinic Keratosis

Please note that patients with Actinic Keratosis should not be referred via a USC pathway unless malignancy is suspected. Please see the Actinic Keratosis page for further information.

Nail changes and suspicion of cancer

PCDS guidance Acral-lentiginous melanoma

Dr DeBerker (UHBW Dermatologist) also advises as follows;

Consider subungual melanoma in the following scenarios:

1. Someone presenting in adulthood with a single nail that has a longitudinal pigmented streak that persists for more than 3 months and is not growing out. 
2. If someone has darker skin and multiple pigmented streaks, then normally that is part of normal genetic skin colour. However, if one of the nail streaks looks darker, broader or altered in some way that makes it appear markedly different from the others, consider referring for this. 
3. The third scenario is for people with non-pigmented melanoma, which can present in the same way as squamous cell carcinoma of the nail unit. This may be a non-pigmented lesion altering the base of the nail, or pushing through the nail, giving rise to damage to the nail. It can be mistaken for a chronic wound, granulating tissue or a pyogenic granuloma. 
4. Finally, if someone presents with a single nail which is split without being clearly due to a traumatic or benign cause, consider referral for evaluation. 

Fast track (USC/2WW) office

Contact details ADULT USC/2WW office:

NBT - Tel on 0117 414 0522 / 0536 / 0537 / 0538 or email to  fasttrackoffice2ww@nbt.nhs.uk

UHBW - Tel on 0117 342 3277 or email to FastTrackOffice@uhbw.nhs.uk

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.