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

Northern Adelaide Local Health Network 

  • Lyell McEwin Hospital (08) 8182 9000, during business hours. After 5:00 pm contact either of the CALHN services. 

Southern Adelaide Local Health Network

Inclusions

  • biopsy confirmed non-melanoma skin cancer (NMSC)/keratinocyte carcinoma, melanoma and other skin malignancies including lymphoma

Exclusions

  • benign skin lesions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • rapidly enlarging skin nodule/s
  • severely hyperkeratotic nodules
  • biopsy confirmed malignant skin cancers, which includes but is not limited to squamous cell carcinoma (SCC), melanomas, Merkel Cell Carcinoma, angiosarcoma

Category 2 (appointment clinically indicated within 90 days)

  • biopsy confirmed NMSC/keratinocyte carcinoma e.g. basal cell carcinoma (BCC) and SCC in situ, lymphoma

Category 3 (appointment clinically indicated within 365 days)

  • nil

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.

  • reason for referral
  • description of lesion including specific site and measured size, suspected clinical diagnosis i.e. melanocytic or keratinocyte derived
  • duration of lesion
  • relevant investigations, including pathology and imaging reports
  • past medical history including skin cancer history, family history of melanoma
  • ethnicity and skin type, in particular if skin type 4, 5 or 6
  • current medications
  • provisional diagnosis
  • treatment to date
  • any skin biopsy/excision reports
  • any radiological reports relevant to the skin with films to be sent with patient
  • all skin cancers referrals must be biopsy proven where possible

Additional information to assist triage categorisation

  • colour photograph/s of lesion/s

Clinical management advice

  • refer urgently if rapidly growing nodule
  • examine rest of skin for presence of lymphadenopathy
  • ensure lesion biopsy before referral to confirm diagnosis. Any suspicious naevi should be fully excised (excisional biopsy) rather than partial excision for confirmation of diagnosis
  • please note, Dermatology conduct skin cancer surgery using local anaesthetic only - if patient requires sedation or general anaesthetic, please refer to Plastics and Reconstructive Surgery and state the requirement for sedation or general anaesthetic

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.