Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • nil

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • benign lesions can be managed in the primary care setting or referred to general surgery

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • skin lesion highly suspicious for melanoma or excision-biopsy proven melanoma
  • rapidly growing skin lesions especially on the face
  • complex non-melanoma skin malignancies and any of the following:
    • involving face and hands
    • ulceration and bleeding
    • rapidly enlarging
    • neurological involvement
    • lymphadenopathy
    • poorly differentiated or infiltrative tumour on biopsy
  • other subcutaneous and deep tissue malignancies e.g. Merkel cell carcinoma, sarcoma
  • skin lesion causing substantial obstruction to vision
  • suspicion of malignant sarcoma
  • poorly differentiated squamous cell carcinoma (SCC)
  • prior malignancy at the same site

Category 2 — appointment clinically indicated within 90 days

  • biopsy confirmed, uncomplicated non-melanoma skin malignancies including basal cell carcinoma (BCC)/squamous cell carcinoma (SCC)/intra-epidermal carcinoma (IEC)
  • skin lesions with any of the following:
    • causing functional problems or significant disfigurement
    • lesion/s involving head, neck or hand
    • diameter exceeds equal to or greater than 3cm in size or rapid growth over short period of time
    • significant persistent pain that is not solely pressure related
    • fixed to deep tissues, i.e. muscle or fascia
    • recurring after a previous excision
    • prone to recurrent infection

Category 3 — appointment clinically indicated within 365 days

  • non melanoma skin cancers, biopsy confirmed, that have failed topical treatments, and are equal to or less than 3cm in size; not involving face and hands

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical history
  • current medications and dosages
  • allergies and sensitivities
  • presenting symptoms
  • management history including:
    • onset and duration
    • severity
    • pain/discomfort
    • associated features, e.g. size, shape, colour, inflammation, oozing, change in sensation, bleeding
    • treatments trialled/implemented prior to referral e.g. topical first line treatment for basal cell carcinoma (BCC)/Bowen’s disease
  • biopsy results unless clinically contraindicated:
    • in larger lesions an incisional biopsy of the most variegated or unstable skin area is acceptable
    • refrain from conducting shave biopsies for suspected cases of melanoma since excision biopsy is the recommended approach

Additional information to assist triage categorisation

  • photograph including disposable measurement tool – with patient’s consent, where secure image transfer, identification and storage is possible

Clinical management advice

Melanoma/non-melanoma skin cancer referrals can be managed by the following specialist services:

  • dermatology
  • plastic and reconstructive surgery
  • surgical oncology.

Consider initial medical treatment with monitored cryotherapy, topical treatments with imiquimod (Aldara), or 5-flurouracil (Efudix) for Bowen’s disease and superficial basal cell carcinoma (BCC).

If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.