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.

The Skin Analytics AI pilot at UHBW has now ended. Both UHBW and NBT may invite patients to an appointment with a medical illustrator to enable virtual assessment of their skin lesions, this will be explained by the secondary care booking teams if offered.

Skin Telederm Pilot for Urgent Suspected Cancer

As of February 2024 several practices and PCNs have been taking part in a funded pilot through which macro and dermoscopic photos are being taken in primary care to enable virtual assessment in secondary care. Patients are contacted by secondary care to advise whether their skin lesion is benign or whether it needs further assessment. Please check with your practice whether you are taking part in the pilot if you are unsure.

The USC Telederm Referral Pilot referrals are to be sent to:

• RESTRICTED Skin Telederm PILOT 2WW Suspected Cancer - Bristol Royal Infirmary - RA7 or
• RESTRICTED Urgent Skin Telederm PILOT Triage Service - Southmead - RVJ
• For UHBW referrals secretaries will need to book dummy appt slots as per other USC referrals. For NBT secretaries should select 'send for Triage'

The following are available on the ICB website:

• Patient leaflet: https://bnssg.icb.nhs.uk/library/bnssg-teledermatology-patient-leaflet/
• Patient questionnaire: https://bnssg.icb.nhs.uk/library/bnssg-teledermatology-patient-questionnaire/

Please note: This clinic is only open for participating practices and only for adults (aged 16 years and older).

Referral

Suspected Skin Cancer Referral Form - this form is embedded in EMIS and details the criteria for Urgent Suspected Cancer skin referrals, including which head and neck BCCs should be referred via USC.

Referral process:

• Please ensure the USC skin referral is completed in full including details about the duration, size, symptoms and reasons for concern. If possible include macro and dermoscopic photos with your referral.
• Complete USC skin proforma in EMIS and send via eRS to the Skin urgent suspected cancer clinic at  NBT or UHBW (or RUH Bath)* attaching any photos.
• If possible please include a patient email address and obtain consent for the patient to be contacted by secure email regarding their appointment if necessary.
• Give the patient the appropriate patient information leaflet** (see below) explaining the process.

Referrals to NBT 

Please note: This service has moved to a Triage Service / RAS at NBT. Therefore, you need to select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.

 *Referrals of lesions near the eye

For referrals of lesions that might be malignant and are within 5mm of the ocular margins, these need to be referred to the Skin USC clinic at UHBW so that they can triage into the eye service (no other provider can triage directly into the eye service).

**Patient Leaflet

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

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.

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.