Criteria for referral to public hospital service

• Complex non-melanoma skin malignancies and any of the following:
  • lymphadenopathy
  • neurological involvement
  • poorly differentiated or infiltrative tumour identified on biopsy
  • rapidly enlarging
  • ulceration and bleeding
• Other subcutaneous and deep tissue malignancies e.g. Merkel cell carcinoma, sarcoma
• Skin lesions with any of the following:
  • causing functional problems (e.g. obstruction of vision)
  • causing significant disfigurement
  • diagnosis in doubt, or needs confirmation
  • diameter greater than or equal to 5cm in size
  • fixed to deep tissues
  • lesions are prone to recurrent infection
  • rapid growth over short period of time
  • recurring after a previous excision
  • significant persistent pain that is not solely pressure related

Information to be included in the referral

Information that must be provided

• Details of onset, duration, site, size and any recent changes in size of lesion(s)
• Symptoms such as ulceration, bleeding, pain
• Histology results
• History of smoking
• If the patient is taking and anticoagulant medicine
• If the patient is immunocompromised or has a history of immunosuppression
• Statement about the patient’s interest in having surgical treatment if that is a possible intervention.

Provide if available

• Photograph of lesion(s)
• Ultrasound of lesion(s)
• If the person identifies as an Aboriginal and/or Torres Strait Islander
• If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Most low-risk basal cell carcinomas and squamous cell carcinomas can be managed in primary care and do not require referral to a public hospital specialist clinic.

Vulnerable populations include:

• people from culturally and linguistically diverse backgrounds
• older Australians
• carers of people with chronic conditions
• people experiencing socio-economic disadvantage
• people living in remote, or rural and regional locations
• people with a disability
• people with mental illness
• people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

Benign skin lesions not causing functional problems (e.g. causing obstruction to vision), or significant disfigurement and not related to immunosuppression.